Organization of Primary Health Care in Remote Rural Municipalities in West Pará

Abstract

The article aims to identify specificities and strategies for the organization of Primary Health Care (PHC) in remote rural municipalities (MRR) in western Pará in the face of singularities in the Amazonian. Multiple case study in five municipalities, with interviews: municipal managers, nurses and physicians from the family health teams. The analysis dimensions were: territorialization, scope of practices and agenda organization, interprofessional collaboration, professional attraction and retention initiatives and use of information and communication technologies. The work of the PHC in the MRR, mainly in the countryside, is organized primarily around care, individual procedures and immunization. Nurses, nursing technicians and CHA from the countryside have an expanded scope of action, often due to the absence of physicians. In addition to the positive impact of the Mais Médicos Program, local strategies for itinerant care and on-call for emergencies stand out. Territorialization, central to the discussion of sustainable and healthy territories, must be dynamic and require different arrangements, adjusting the number of families per CHA/teams. Specific strategies to organize a comprehensive PHC integrated into the Health Care Network, sufficient and differentiated federal funding and professional training aimed at rural areas, are necessary to guarantee access and quality of services to all citizens.