RESUMO
OBJECTIVE: To characterize remote rural Brazilian municipalities according to their logic of insertion into socio-spatial dynamics, discussing the implications of these characteristics for health policies. METHODS: Starting from the category of analysis - the use of the territory - a typology was elaborated, with the delimitation of six clusters. The clusters were compared using socioeconomic data and the distance in minutes to the metropolis, regional capital, and sub-regional center. Mean, standard error and standard deviation of the quantitative variables were calculated, and tests on mean differences were performed. RESULTS: The six clusters identified bring together 97.2% of remote rural municipalities and were called: "Matopiba," "Norte de Minas," "Vetor Centro-Oeste," "Semiárido," "Norte Águas," and "Norte Estradas." Differences are observed between the clusters in the analyzed variables, indicating the existence of different realities. Remote rural municipalities of "Norte Águas" and "Norte Estradas" clusters are the most populous, the most extensive and are thousands of kilometers away from urban centers, while those in "Norte de Minas" and "Semiárido" clusters have smaller areas with a distance of about 200 km away from urban centers. The remote rural municipalities of the "Vetor Centro-Oeste" cluster, in turn, are distinguished by a dynamic economy, inserted into the world economic circuit due to the agribusiness. The Family Health Strategy is the predominant model in the organization of primary health care. CONCLUSION: Remote rural municipalities are distinguished by their socio-spatial characteristics and insertion into the economic logic, demanding customized health policies. The strategy of building health regions, offering specialized regional services, tends to be more effective in remote rural municipalities closer to urban centers, as long as it is articulated with the health transportation policy. The use of information technology and expansion of the scope of telehealth activities is mandatory to face distances in such scenarios. Comprehensive primary health care with a strong cultural component is key to guaranteeing the right to health for citizens residing in such regions.
Assuntos
População Rural , Telemedicina , Brasil , Cidades , Política de Saúde , HumanosRESUMO
ABSTRACT OBJECTIVE To characterize remote rural Brazilian municipalities according to their logic of insertion into socio-spatial dynamics, discussing the implications of these characteristics for health policies. METHODS Starting from the category of analysis - the use of the territory - a typology was elaborated, with the delimitation of six clusters. The clusters were compared using socioeconomic data and the distance in minutes to the metropolis, regional capital, and sub-regional center. Mean, standard error and standard deviation of the quantitative variables were calculated, and tests on mean differences were performed. RESULTS The six clusters identified bring together 97.2% of remote rural municipalities and were called: "Matopiba," "Norte de Minas," "Vetor Centro-Oeste," "Semiárido," "Norte Águas," and "Norte Estradas." Differences are observed between the clusters in the analyzed variables, indicating the existence of different realities. Remote rural municipalities of "Norte Águas" and "Norte Estradas" clusters are the most populous, the most extensive and are thousands of kilometers away from urban centers, while those in "Norte de Minas" and "Semiárido" clusters have smaller areas with a distance of about 200 km away from urban centers. The remote rural municipalities of the "Vetor Centro-Oeste" cluster, in turn, are distinguished by a dynamic economy, inserted into the world economic circuit due to the agribusiness. The Family Health Strategy is the predominant model in the organization of primary health care. CONCLUSION Remote rural municipalities are distinguished by their socio-spatial characteristics and insertion into the economic logic, demanding customized health policies. The strategy of building health regions, offering specialized regional services, tends to be more effective in remote rural municipalities closer to urban centers, as long as it is articulated with the health transportation policy. The use of information technology and expansion of the scope of telehealth activities is mandatory to face distances in such scenarios. Comprehensive primary health care with a strong cultural component is key to guaranteeing the right to health for citizens residing in such regions.
RESUMO OBJETIVO Caracterizar os municípios rurais remotos brasileiros segundo suas lógicas de inserção na dinâmica socioespacial, discutindo as implicações dessas características para as políticas de saúde. MÉTODOS Partindo da categoria de análise - o uso do território - elaborou-se uma tipologia, com delimitação de seis clusters . Os clusters foram comparados a partir de dados socioeconômicos e da distância em minutos para a metrópole, capital regional e centro sub-regional. Foram calculados a média, o erro padrão e o desvio padrão das variáveis quantitativas e realizados testes de diferenças de média. RESULTADOS Os seis clusters identificados aglutinam 97,2% dos municípios rurais remotos e foram denominados de: Matopiba; Norte de Minas; vetor Centro-Oeste; Semiárido; Norte Águas; e Norte Estradas. Observam-se diferenças entre os clusters nas variáveis analisadas, indicando a existência de distintas realidades. Os municípios rurais remotos dos clusters Norte Água e Norte Estrada são os mais populosos, mais extensos e distam milhares de quilômetros de centros urbanos, enquanto os do Norte de Minas e do Semiárido tem áreas menores com distância de cerca de 200 km. Por outro lado, os municípios rurais remotos do vetor Centro-Oeste se diferem por uma economia dinâmica, inserida no circuito econômico mundial devido à presença do agronegócio. A Estratégia de Saúde da Família é o modelo predominante na organização da atenção primária à saúde. CONCLUSÃO Os municípios rurais remotos distinguem-se em suas características socioespaciais e de inserção na lógica econômica, demandando políticas de saúde customizadas. A estratégia de construção das regiões de saúde, com oferta de serviços regionais especializados, tende a ser mais efetiva nos municípios rurais remotos mais próximos de centros urbanos, desde que articulada à política de transporte sanitário. O uso de tecnologia de informação e ampliação do escopo das atividades de telessaúde é mandatório para enfrentamento das distâncias em cenários como esse. A atenção primária à saúde integral com forte componente cultural é peça-chave para garantir o direito à saúde para os cidadãos que aí residem.
Assuntos
Saúde da População Rural , Cidades , Território Sociocultural , Modelos de Assistência à Saúde , Política de SaúdeRESUMO
O artigo analisa a posição da Estratégia Saúde da Família na rede de atenção à saúde sob a perspectiva das 16.566 equipes de Saúde da Família e dos 62.505 usuários participantes do Programa Nacional para Melhoria do Acesso e da Qualidade da Atenção Básica em 2012. Os resultados indicam que as equipes atuam cada vez mais como porta de entrada preferencial, atendendo a demandas diversas e exercendo a função de filtro para a atenção especializada. Contudo, persistem importantes barreiras organizacionais para acesso, os fluxos estão pouco ordenados, a integração da APS à rede ainda é incipiente e inexiste coordenação entre APS e atenção especializada.
The article analyses the position of the Family Health Strategy teams in the health care network of the Unified Health System in Brazil from the perspective of 16,566 family health teams and 62,505 users who participated in the 2012 Evaluation PMAQ-AB. The results show that Family Health teams act as first contact services and gatekeepers for specialized care. However, there are important organizational barriers to care access, the integration of Primary Health Care (PHC) in health care network is limited, and there is no coordination among PHC and specialized care providers.
