Access barriers to Primary Health Care in remote rural municipalities of Western Pará state, Brazil

• Autor(a) principal: Lima, Juliana Gagno
• Data de Publicação: 2022
• Outros Autores: Giovanella, Ligia, Bousquat, Aylene, Fausto, Márcia Cristina Rodrigues, Medina, Maria Guadalupe
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Trabalho, Educação e Saúde (Online)
• Texto Completo: https://www.tes.epsjv.fiocruz.br/index.php/tes/article/view/616
• topic: Acesso aos serviços de saúde; Saúde rural; Atenção Primária à saúde; health service access; rural health; primary health care; Acceso a servicios de salud; Salud rural; Atención Primaria de Salud

This article analyzes the access to Primary Health Care in remote rural municipalities in Western Pará state, Brazil, discussing barriers and challenges before the specificities of Amazonian territories. This was a qualitative study in five municipalities with distinct spatial logics, based on rivers or roads. There were 58 interviews with managers, health professionals, and users, as well as visits to basic health units, in 2019. The analysis matrix contemplated: geographical accessibility, organizational accessibility, primary health care unit as first contact, and Primary Health Care in the health care network. It was identified that the geographical access barriers involve great distances, times, costs, poor road conditions, and transportation, with differentiated seasonal variation, according to fluvial or terrestrial flows. Organizational accessibility is hindered by the insufficient offer of  consultations, exams, medications, restrictions on the days of operation, and itinerant actions, accentuated by the high professional turnover. The basic health units are the first contact service, but the demand is conditioned to the perceived resoluteness and satisfaction, where the performance of the community health agent stands out. The support for specialized care is precarious, with difficulties in supply, regulation, transportation, and communication. The Amazon socio- environmental scenario requires unique strategies for the supply and organization of services, reflected in specific funding.