Martinelli Nereide Lucia, Schenkman Simone, Ribeiro Lorena Araújo, Mota Paulo Henrique Dos Santos, Magnago Carinne, Bousquat Aylene Emilia Moraes
Instituto de Saude Coletiva, Universidade Federal de Mato Grosso, Cuiabá, Brasil.
Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.
Cad Saude Publica. 2025 Aug 8;41(7):e00194324. doi: 10.1590/0102-311XPT194324. eCollection 2025.
The health crisis resulting from community transmission of COVID-19 called for the health surveillance to play a central role in facing the pandemic. This study analyzes the contributions and difficulties faced by health surveillance in the development of actions to combat the COVID-19 pandemic in Brazilian remote rural municipalities from the perspective of managers, professionals and users. This was a qualitative study of multiple cases that involved a thematic and deductive analysis of 51 interviews conducted with managers and health professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas, and 29 interviews with users, community health agents and social movements in eight remote rural municipalities. During the COVID-19 pandemic, they faced difficulties in operationalizing health surveillance and ensuring the access of patients with compromised respiratory status to health services. They needed to reorganize the health care network, establish technical cooperation, conduct inter-agency governance and seek alternatives to operationalize the local health system. The main obstacles faced in care were related to articulation between states, which were insufficient to strengthen the care and laboratory network and the logistical system. The political, structural and organizational constraints confirmed that local managers contributed to contain the risks and made an effort to establish local intersectoral arrangements and relations, integrate health surveillance with primary health care, reorganize work processes and communication with the population. Effectively and sustainably overcoming the difficulties faced by remote rural municipalities requires cooperation between states guided by the principles of comprehensiveness, intersectoriality, and social participation.
由新冠病毒社区传播引发的健康危机，要求卫生监测在应对这场大流行中发挥核心作用。本研究从管理人员、专业人员和用户的角度，分析了巴西偏远农村市镇在开展抗击新冠疫情行动过程中，卫生监测所做出的贡献以及面临的困难。这是一项多案例定性研究，涉及对朗多尼亚州、马托格罗索州、托坎廷斯州、皮奥伊州、米纳斯吉拉斯州和亚马逊州16个偏远农村市镇的管理人员和卫生专业人员进行的51次访谈，以及对8个偏远农村市镇的用户、社区卫生工作者和社会运动组织进行的29次访谈的主题和演绎分析。在新冠疫情期间，他们在实施卫生监测以及确保呼吸功能受损患者获得医疗服务方面面临困难。他们需要重组医疗保健网络、建立技术合作、进行跨部门治理，并寻求使当地卫生系统运转起来的替代方案。在医疗护理方面面临的主要障碍与各州之间的协调有关，这些协调不足以加强医疗护理和实验室网络以及后勤系统。政治、结构和组织方面的制约因素表明，地方管理人员为控制风险做出了贡献，并努力建立地方部门间的安排和关系，将卫生监测与初级卫生保健相结合，重组工作流程并与民众进行沟通。要有效且可持续地克服偏远农村市镇面临的困难，需要各州之间以全面性、跨部门性和社会参与原则为指导进行合作。
