Primary Health Care in remote rural municipalities: context, organization, and access to integral care in the Brazilian National Health System

Abstract

Despite the socio-spatial diversity, remote rural locations have in common small villages dispersed over a vast territory, isolated populations, and long distances from urban centers. The objective of the study is to analyze the specificities of the organization and access to primary health care (PHC) in the Brazilian National Health System (SUS) in remote rural municipalities (MRR). To that end a study with a qualitative approach, based on a multiple case study in 27 MRR was carried out. Thematic content analysis of 211 semi-structured interviews with managers and health professionals and a triangulation of information to explore and recognize the forms of organization, strategies, and challenges for the access to health were performed. The results indicate that: the characteristics of remote rural contexts condition the provision of PHC; there are differences in the ways of offering health actions and greater gaps in care coverage in the most rarefied and remote areas of the municipalities; there are contradictions between national PHC funding and the characteristics of territories marked by sparcely populated areas and long distances; and the shortage of the workforce is a common challenge among the cities studied. It is, thus, necessary to consider the territorial, social, and access characteristics to health services to propose public policies that meet the needs of the MRR.

Temporal and spatial distribution of polio vaccine coverage in Brazil between 1997 and 2021

“…It is important to mention that difficulties in accessing the internet, especially in more remote regions, such as the North and Northeast of Brazil, may have an influence on vaccination data. Adequate feeding of information systems on vaccination depends on an efficient system for recording and updating information, which can be compromised by lack of connectivity 28 .…”

“…É importante mencionar que as dificuldades de acesso à internet, especialmente em regiões mais remotas, como o Norte e o Nordeste do Brasil, podem ter influência nos dados de vacinação. A alimentação adequada dos sistemas de informação sobre vacinação depende de um sistema eficiente de registro e atualização das informações, o que pode ser comprometido pela falta de conectividade 28 .…”