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

• Published in: BMC health services research Vol. 22; no. 1; p. 1386
• Main Authors: Nunes, Fabiely Gomes da Silva, Santos, Adriano Maia Dos, Carneiro, Ângela Oliveira, Fausto, Márcia Cristina Rodrigues, Cabral, Lucas Manoel da Silva, Almeida, Patty Fidelis de
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22-11-2022; BioMed Central; BMC
• Subjects: Access to health services; Brazil; Budgets; Cities; Commerce; Comprehensive Health Care; Economic development; Finance; GDP; Gross Domestic Product; Health care; Health care access; Health care management; Health services; Humans; Municipalities; Population density; Primary care; Regions; Rural areas; Rural health services; Secondary health care; Brazil; Brazil; Rural health services; Secondary health care; Comprehensive health care; Access to health services
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08805-6

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.