Challenges to the provision of specialized care in remote rural municipalities in Brazil

Abstract

This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.

Toward Iran's health system regionalization: a qualitative approach.

“…IHNs, as micro levels in regionalized health systems, have been promoted in health systems to overcome the fragmentation due to decentralization and promote population health and coordination capacity of regionalized networks (32)(33)(34). The fundamental principles behind regionalized systems of care at the operational level, as proposed by Walton and Mohr (2021), are standard selection, infrastructure design and development, data collection and surveillance, and performance veri cation (10).…”