Shortage of health professionals in the Legal Amazon – 07/18/2023 – Saúde em Público

Inequalities in access to health services resulting from the shortage of professionals in remote areas have been observed as a persistent and critical problem in several countries. According to a report by the United Nations (UN), almost half of the world’s population lives in remote rural areas, where more than 80% of people live in extreme poverty. A report by the World Health Organization (WHO) estimates that around 67% of rural populations do not have adequate access to essential health services.

In Brazil, regional inequalities mark the health system. In the Legal Amazon, specifically in the state of Pará, this issue deepens and impacts, mainly, social groups and segments, such as quilombola, indigenous and riverside populations.

The Institutional Study n. 4 from the Institute for Health Policy Studies (IEPS), points out that access to health professionals in the Legal Amazon, especially for specialists such as cardiologists and oncologists, is three times lower compared to the rest of the country. Dentists, nurses, nutritionists and psychologists are also considered scarce, according to a survey of local actors carried out in the field, in March 2023, by the Projeto Saúde na Amazônia, a partnership between IEPS and Instituto Clima e Sociedade (iCS).

The shortage of health professionals in this territory is related to different causes, such as working conditions, infrastructure, financing and availability of access to the region. There is also the difficulty of professionals in managing the typical health demands of the Amazon region.

Santarém, in western Pará, is an example for thinking about health inequalities in that territory. The municipality has urban areas, plateaus and rivers, which impact the access of health teams to the region. The distances to access services are very significant, especially for urgent and emergency services, dialysis and chemotherapy. Many health units have difficulties with the storage of medicines and only 49% of them have an internet connection.

Data available on the IEPS Data platform show that, in 2021, the number of doctors per thousand inhabitants in Santarém was 1.2, well below the national average (2.1). Despite this, the number is still higher than most municipalities in the west of the state, which reached 0.2 in cities such as Placas, Porto de Moz and Rurópolis.

Given this complexity, there is a need to reflect on health care models that are able to dialogue horizontally with the Amazonian territories. Actions that allow incorporating knowledge of indigenous and traditional peoples, local innovations in lines of care, practices aimed at climate finance and integration of health technologies that can overcome socioeconomic, cultural and geographic barriers in the expansion and improvement of the health services network are fundamental. .

Initiatives aimed at building state and municipal co-financing models in partnership with non-governmental organizations can lead to an adequate supply of vacancies and better management of professionals. Complementary programs to Mais Médicos should provide the management and regulation of work and health workers with the necessary structure for their operation. This will not be possible if other actions are not combined, such as common paths of permanent education for health professionals, implementation of a job, career and salary plan, as well as the necessary infrastructure for the development of the work.

The accumulated experience in Brazil and in several countries points to the understanding that there is no definitive, simple, isolated solution to the problem, the issue is complex, and of intersectoral, continuous and coordinated management. It requires the definition and implementation of technopolitical interventions at the national, state and municipal levels.

Isabela Ramos is a psychologist, from Pará, consultant at the Institute of Studies for Health Policies (IEPS) and advisor to Doctors Without Borders (MSF) Brazil.

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