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

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 population sparseness 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.

Automated summary

Despite socio-spatial diversity, remote rural areas in Brazil face similar challenges such as scattered small villages, isolated populations, and lengthy distances from urban centers. This study aimed to analyze the unique characteristics of organizing and accessing primary health care (PHC) in the Brazilian National Health System (SUS) within remote rural municipalities (MRR). Through qualitative research methods, including multiple case studies and thematic content analysis of interviews with managers and health professionals, the study identified the impact of remote rural contexts on PHC provision, differences in health service delivery, challenges in areas with sparse populations and long distances, funding contradictions, and workforce shortages. The findings underscore the need for public policies that consider the territorial, social, and access characteristics to address the healthcare needs of MRR.