Decentralization of snakebite antivenom treatment to indigenous community health centers in the Brazilian Amazon: From demand to the first treatment (the SAVING Program).

Brazilian antivenoms have excellent efficacy in recovering venom-induced coagulopathy, in addition to having a good safety profile with only 10% of patients experiencing a mild reaction such as urticaria or pruritus. More than 3.5 hundred thousand snakebite antivenom vials are produced per year, and all the batches are acquired by the Ministry of Health and distributed free of charge to 2,200 hospitals across the national territory. However, these health facilities are unevenly distributed across the territory, so that the distance a patient needs to travel to receive care is much greater in the Amazon region in comparison to the extra-Amazonia region, leading to a huge access barrier in this region. The lack of access to healthcare facilities for snakebite patients may be greater than 30% in some regions of the Amazonia. The decentralization of SBE treatment with antivenoms to the scope of indigenous community health centers requires the discussion of proper organizational designs and arrangements of practices based on the user needs, singularities of the territory, and the clinical reality of the indigenous populations. In this report, we describe a successful experience of decentralization of antivenom treatment for an indigenous health unit in the Brazilian Amazon, which provides a platform to improve the lives of SBE patients at risk of this life-threatening condition. In this work, we report the experience in the development and implementation of a program to decentralize antivenom treatment for indigenous communities, which represents a significant change in the national policy for snakebite control, with a potential impact on reducing morbidity and mortality from this health problem. In the next steps, SAVING Program will be evaluated through mixed-method studies in regards team and community's experience within the program, aiming to identify barriers, perceptions about the implementation process, and facilitators for the maintenance/sustainability.