ABSTRACT
BACKGROUND: The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS: Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS: Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS: The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.
Subject(s)
Health Services Accessibility/organization & administration , Mobile Health Units/organization & administration , Primary Health Care/organization & administration , Rural Health Services/organization & administration , Brazil , Community Health Workers/organization & administration , Female , Humans , Interviews as Topic , Pregnancy , Prenatal Care/organization & administration , Qualitative Research , Workforce/organization & administrationABSTRACT
O presente artigo aborda uma experiência em educação em saúde realizada por duas psicólogas em uma escola municipal da cidade de Manaus, como estágio para conclusão do curso de especialização em Psicologia da Saúde. Foram realizados sete encontros com crianças de onze a quatorze anos participantes do programa Acelera Brasil. Estas tiveram como objetivo inicial discutir a morte e o morrer. Ao longo dos encontros, com surgimento de demanda espontânea passou-se a abordar também temas como relacionamentos interpessoais, autocuidado e respeito. Os encontros aconteceram dentro de sala de aula e contemplaram temas relacionados às problemáticas e desejos dos participantes, utilizando rodas de conversa, dinâmicas e jogos lúdicos como potencializadores da discussão. Ao final, foi possível notar que as crianças puderam experimentar diversos papéis durante o projeto, denotando a possibilidade de cuidado e respeito para consigo e para com o outro. (AU)
This article discusses an experience in health education conducted by two psychologists in a municipal school in the city of Manaus, as a stage to complete the specialization course in Health Psychology. Seven meetings were held with children aged 11 to 14 years participating in the program Accelerates Brazil. These had as their initial objective to discuss death and dying. Throughout the meetings, with the emergence of spontaneous demand, topics such as interpersonal relationships, self-care and respect were also addressed. The meetings took place within the classroom and included topics related to the problems and desires of the participants, using conversation wheels, dynamics and play games as a potentiator of the discussion. In the end, it was possible to notice that the children could experience several roles during the project, denoting the possibility of care and respect for themselves and with the other. (AU)
