O acesso aos serviços de saúde na várzea amazônica

Abstract

In the Amazon region, ways of life are structured in close relationship with nature, shaped by rivers, forests, and climate dynamics, which configure and reconfigure specific territorialities that directly influence the mobility and work of Amazonian populations, as well as their access to health services. Although there have been advances in the Brazilian Unified Health System (SUS), particularly in the Amazon region, territorial inequalities still hinder effective access to the services provided, especially in floodplain areas, where the organization of the healthcare network does not fully correspond to the territorial dimension of nature, shaped by the seasonal dynamics of water levels and climatic conditions. In this context, the present study aims to understand the mobility of peasants in the Amazonian floodplain in accessing health services, considering (im)material territorial dimensions and the routes undertaken across the islands of Paciência, Muratu, Jacurutu, and Paz, in the municipality of Iranduba, Amazonas (AM). The research is grounded in the framework of Health Geography and adopts methodological procedures that combine territorial analysis, the collection of empirical data, and the investigation of socio-environmental and infrastructural conditions that influence access to health services, taking territory as its analytical basis. The results demonstrate that the health territory in the floodplain is dynamic and strongly influenced by the hydroclimatic regime, producing differentiated routes between periods of river flooding and drought, which directly impact the time, cost, and conditions of population mobility. It was observed that, during the flooding season, fluvial access facilitates mobility, whereas during the dry season, travel becomes longer, more fragmented, and more costly, thereby exacerbating situations of vulnerability and health inequities. It was further found that the concentration of services in urban centers, combined with the limited territorial adaptation of public policies, contributes to the fragmentation of access to Primary Health Care (PHC) in the study area. As a contribution, this study proposes territorial health arrangements that are sensitive to the seasonality of the floodplain, grounded in the territorial reorganization of service provision, the expansion of healthcare coverage, and the development of planning strategies adapted to climate change and to the socio-spatial specificities of the Amazon. It is concluded that the planning of health territories in the Amazon requires the incorporation of (im)material dimensions as structuring elements of health territories in floodplain areas, in order to promote greater equity in access to health services and to strengthen the territorialization of the Brazilian Unified Health System (SUS) in contexts of high socio-environmental vulnerability.