ABSTRACT
Background: Extremely poor people have more problems to have access to social networks and health care. Aim: To evaluate the access to health services and the perception about these services of adults living in conditions of extreme poverty. Material and methods: A survey was applied to 361 people living in slums aged 15 to 77 years (83 percent females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty. Results: Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32 percent were not registered in primary health clinics. Among children of less than 6 years of age, 22 percent were delayed in their vaccination schedule and 32 percent were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems. Conclusions: People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system.