Municípios rurais remotos e acesso a rede de apoio diagnóstico no contexto da pandemia da covid-­19 em Mato Grosso

Abstract

Introduction: Rural and remote municipalities located far from urban centers, with low demographic density and small population size, generally have only the Primary Health Care (PHC) network installed to serve their citizens. The Covid­-19 pandemic has highlighted several gaps in the functioning of the Unified Health System in Brazil, including the difficulty in accessing the population to Intensive Care Unit beds and Diagnostic and Treatment Support Services, such as RT­PCR exams, X­rays, Computed Tomography and Ultrasound for early diagnosis and follow­up. The rapid evolution, and the evolutionary clinical worsening of Covid-19, requires support from highly complex hospital clinical care, so these municipalities need to have an orderly patient referral flow to ensure adequate care in a timely manner. Objective: To analyze the organization of the health care network and the intermanager arrangements used to access the network of diagnostic support services in the health regions and in the State of Mato Grosso, with a focus on guaranteeing full access to health in the context of the pandemic from Covid­-19. Methodology: This is an exploratory­descriptive, mixed­method study, originating from the multicentric national research entitled “Challenges and strategies in coping with the Covid­-19 pandemic in rural and remote Brazilian municipalities”, based on secondary and primary data from based on interviews with representatives of the MRR selected in the health regions of the State of Mato Grosso. Descriptive analysis was used for the treatment of quantitative data and content analysis for qualitative data. Result: The study revealed that municipal management, through the local care network, sought to reorganize the service and defined strategies for coping with Covid­-19, strongly supported by the PHC units. It reinforced the existence of empty assistance in the health regions of the State of MT, in relation to Therapeutic Diagnostic Support Services in imaging and laboratory methods. There is a need for greater support from the State to fill the existing service gaps. With regard to the organizational arrangements to face the Covid­-19 pandemic, the MRR used the access strategies already agreed by the PPI, Health Consortia, Contractualizations, partnerships between city halls to transport samples and support from educational institutions. The main contribution of this study is to demonstrate the insufficiency and inequality of the care network in the regions studied, which during the pandemic led municipalities to adapt their means of access to existing services, to cope with the unexpected demand of suspected and confirmed cases of Covid-19, as well as joining efforts with municipalities in the region to overcome common challenges. The political arrangements instituted in these places are relevant strategies to overcome barriers or difficulties imposed by the conditions of the network or location of the MRR, however the limits imposed by the local supply capacity and support services, restrict the expansion or continuity of the established agreements.