Health in the Middle Solimões region, state of Amazonas: the centrality of Tefé

Abstract

In a rural setting of the Amazon floodplain, the study investigates the articulation of primary care with specialized care. For this, a combination of strategies was adopted, including interviews, survey of morbidity and sociodemographic indicators, tracking of the intermunicipal routes, and survey of expenses on Public Health Actions and Services. Tefé city concentrates financial and banking services, equipment of the judiciary branch, education, control and security agencies that give it a centrality of roles. However, health does not consider the existing flows in the territory to define which municipalities have the Tefé as a health reference. In addition, the outdated data in the Health Information Systems, combined with the absence of the state entity in regional health planning, support for the provision of specialized professionals, payment of inputs and organization of the referral-counter-referral flow in the network have been challenges to plan comprehensive care in the region, overloading the hub municipality. Tefé's expenses on hospital care were higher than those in Primary Care in the past five years. Despite the progressive increase in health expenditures in the analyzed municipalities, the offer of services beyond primary care remains a major challenge for the SUS in the Amazon floodplain rurality.