Organization of local healthcare systems in remote rural Brazilian municipalities to combat the COVID-19 pandemic

Author(s)

Nereide Lucia Martinelli ^[1] ; Simone Schenkman ^[2] ; Elisete Duarte ^[3] ; Cleide Lavieri Martins ^[4] ; Renata Elisie Barbalho ^[5] ; Márcia Cristina Rodrigues Fausto ^[6] ; Aylene Emilia Moraes Bousquat ^[7]

Affiliation

^[1] Universidade Federal de Mato Grosso. Instituto de Saúde Coletiva - Brasil

^[2] Universidade de São Paulo. Faculdade de Saúde Pública - Brasil

^[3] Universidade Federal de Mato Grosso. Instituto de Saúde Coletiva - Brasil

^[4] Universidade de São Paulo. Faculdade de Saúde Pública - Brasil

^[5] Universidade de São Paulo. Faculdade de Saúde Pública - Brasil

^[6] Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca - Brasil

^[7] Universidade de São Paulo. Faculdade de Saúde Pública - Brasil

• Document type: Journal article
• Source: Cadernos de Saúde Pública; v. 40, n. 6 2024-07-29.

Abstract

Abstract: During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC’s difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health. (AU)

• FAPESP's process: 22/05461-5 - Urban-rural intersectional equity, permeability to globalization and organizational models in Primary Health care: efficiency analysis and health effectiveness in rural remote areas
• Grantee: Simone Schenkman
• Support Opportunities: Scholarships in Brazil - Post-Doctoral