Provision of specialized care in remote rural municipalities in Brazil: challenges for local managers

This case study analyses the challenges to the provision of Specialized Care (SC) in remote rural municipalities (RRM) in Brazil. Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). The distance between municipalities is a limiting factor for access; in addition, the significant care gaps contribute to different organizational arrangements for the provision and access to SC. In all the RRMs, periodically, physicians offer SC by direct disbursement to users or sale of procedures to managers, compromising municipal and family budgets. Health regions do not meet the demand for SC, accentuating the need for extensive travel. The managers of RRM have additional challenges for the provision of SC regarding the financing, the implementation of cooperative arrangements, the provision of care articulated in networks with a view to comprehensive care in search of solutions to the locoregional specificities.