Acesso geográfico à saúde na Região Metropolitana de Manaus (RMM)

Abstract

The Metropolitan Region of Manaus (Região Metropolitana de Manaus - RMM) is located in the Legal Amazon and includes natural aspects and singular occupation, whose population is fixed in its extensive hydrographic network and dense forest. The natural aspects of the RMM determine ways of access different from the other Metropolitan Regions (Regiões metropolitanas - MR) of Brazil, especially for those who seek health in the state capital. Considering the context of population mobility in search of health at different levels of hierarchy in the study area, the present study aimed to perform a comparative analysis of the conditions of geographical access to health in the municipalities of the RMM. As a methodology, secondary data surveys, fieldwork and the use of geoprocessing techniques were carried out. The results showed that low population density, natural aspects and the organization of healthcare levels, subject the RMM population to travel long distances in search of health care, especially for the specialized care established in the city of Manaus. However, this situation also occurs in Primary Health Care (PHC) establishments, located closer to the population, especially during periods of drought in the Amazonian rivers. The seasonality of the Amazonian rivers influences the "go" and "come" of the metropolitan population of Amazonas, inducing the use of different modalities of transportation and forms of geographical access to health, and consequently, temporality, distances, costs, and direction of the itineraries vary at different times of the year. Geographic access to health becomes more unfavorable due to the low supply of physical and human health resources, especially of doctors and beds. In this sense, the low supply of these resources combined with the seasonality of the Amazonian rivers, produce health regionalizations, which differ from the Regional Health drawings that intersect the RMM. This variation of geographical access to health can induce death cases that could be avoided or reduced by effective actions of accessible and localized health services closer to the population (avoidable death), considering that this death variable represented about 70% of the deaths between the years 2010 to 2015 in the study area, to highlight: deaths due to diseases of the circulatory system, ill-defined cause, external causes, and neoplasias, whose deaths occur in residences and on public roads. Therefore, considering the results achieved in this study, it is concluded that it is necessary to plan health with a focus on Physical and Human Geography specific to the Amazon, in order to serve populations located far from urban centers, aspiring to health as the right of all, regardless of socio-spatial characteristics of disparate territories, such as the Amazon.