Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2021 Jul 7;37(7):e00310520. doi: 10.1590/0102-311X00310520. eCollection 2021.
Primary healthcare is essential for dealing with the iniquities marking rural and remote territories. The concept of rurality is somewhat imprecise, and rural health policies in Brazil are insufficient. A review of the international literature can foster better understanding of the strategies developed in central rural health issues. The article's objective was to identify and analyze the challenges in access, organization of healthcare, and health workforce in primary care in rural areas. An integrative literature review was performed to search for scientific articles published from 2000 to 2019 in the Cochrane and MEDLINE databases and specific rural health journals. The search yielded 69 articles, categorized as addressing access, organization of healthcare, or health workforce. The findings' main themes were analyzed. Articles classified as access presented the following central themes: geographic aspects, patients' needs to travel for care, and access to hospital and specialized services. Articles on organization of healthcare dealt with structure and inputs, functioning of health services, and community-based management. Health workforce featured healthcare workers' profiles and roles and factors for their attraction/retention. Crosscutting issues in strengthening access, organization of healthcare, and health workforce in rural areas were community action, outreach/visiting models, communication/information technologies, access to care, and professional training/development. The review provides a comprehensive understanding of primary care in rural health to promote equity for rural populations.
初级卫生保健对于解决农村和偏远地区的不平等问题至关重要。农村的概念有些不精确,巴西的农村卫生政策也不足。对国际文献的审查可以促进更好地理解在农村卫生核心问题方面制定的战略。本文的目的是确定和分析农村地区初级卫生保健中获取服务、卫生保健组织和卫生人力方面的挑战。进行了综合文献回顾,以搜索 2000 年至 2019 年在 Cochrane 和 MEDLINE 数据库以及特定农村卫生期刊上发表的科学文章。检索到 69 篇文章,分为解决获取服务、卫生保健组织和卫生人力问题。对研究结果的主要主题进行了分析。被归类为获取服务的文章提出了以下核心主题:地理方面、患者需要旅行就医以及获取医院和专科服务。关于卫生保健组织的文章涉及结构和投入、卫生服务的运作以及以社区为基础的管理。卫生人力以卫生工作者的特征和角色以及吸引/留住他们的因素为特色。加强农村地区获取服务、卫生保健组织和卫生人力的交叉问题是社区行动、上门/巡回服务模式、通信/信息技术、获得护理以及专业培训/发展。该综述全面了解农村卫生中的初级卫生保健,以促进农村人口的公平。