Universality under tension and production of the common in primary care access in Amazonian territories

Abstract

This study aimed to analyze how territorial and organizational conditions, pathways for obtaining medicines, and plural care practices shape access to Primary Health Care in Óbidos and Terra Santa, western Pará, and how they relate to processes of producing the common and tensions surrounding the institutional recognition of such knowledge and practices. This qualitative and interpretive study was based on 21 semi-structured interviews with 17 health service users and 4 health workers, as well as a conversation circle with 15 workers. The material was subjected to thematic content analysis. Location, transportation, costs, and team organization produced inequalities in the effort required to use services, including within the same service area. The lack of medicines at a health facility did not necessarily mean that they were unavailable throughout the network; effective access depended on supply, information, guidance, circulation among public dispensing points, and financial capacity. Care repertoires were plural and heterogeneous. The production of the common became visible in family and intergenerational practices that remained only marginally incorporated into clinical interactions and care pathways. The findings indicate the need for territorially sensitive policies and regulated forms of articulation between local knowledge and health system institutions, without replacing state responsibility.