Review Article

Primary health care in the Amazon and its potential impact on health inequities: a scoping review


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Amandia Sousa1
PhD Candidate, Research Associate *

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Fernando J Herkrath2
PhD, Public Health Researcher

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Carolyn Wallace3
PhD, General Manager

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Jane Farmer4
PhD, Director

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Aylene Bousquat5
PhD, Professor


1 Institute Leônidas e Maria Deane, Oswaldo Cruz Foundation (Fiocruz), Rua Terezina, 476 - Adrianópolis, Manaus, Amazonas 69058278, Brazil; and Politics, Management and Health, University of São Paulo, São Paulo 01246904, Brazil

2 Institute Leônidas e Maria Deane, Oswaldo Cruz Foundation (Fiocruz), Rua Terezina, 476 - Adrianópolis, Manaus, Amazonas 69058278, Brazil

3 Merri Health, Pentridge Boulevard, Coburg, Vic. 3058, Australia

4 Social Innovation Research Institute, Swinburne University, Hawthorn, Vic. 3122, Australia

5 Politics, Management and Health, University of São Paulo, São Paulo 01246904, Brazil

ACCEPTED: 16 September 2021

early abstract:

Introduction: Amazon’s health studies often focus on diseases and infections prevalent in the region, with few studies addressing health organisations and services. In this sense, this study fills a gap by reviewing the studies aimed at Primary Health Care (PHC) implementation in the nine Amazonian countries. This review addresses a need to explore the forms in which Primary Health Care (PHC) is implemented in the Amazon areas outside the urban centres and their potential to reduce health inequities. This study contributes to improvements in managers and health professionals’ practices and research on the topic.
Method: Scoping review methodology was applied to peer-reviewed articles. The databases searched were PUBMED, SCOPUS, LILACS, EMBASE and WEB OF SCIENCE. Selected studies included peer-reviewed publications, published between January 2000 and November 2019, focused on PHC or one of its components in the Amazon, and were printed in English, Spanish and Portuguese. The study used Arksey and O’Malley’s scoping review guidelines, supported by Levac that included five steps: i) identification phase, where search queries were applied to the databases followed by the removal of duplicates; ii) screening phase, where titles and abstracts of articles were screened to exclude irrelevant articles; (iii) eligibility phase, where the full texts of articles were read to assess their relevancy to this study. The second and third phases were conducted independently by two reviewers. If a disagreement arose between the reviewers, a third reviewer was consulted to assist in the decision-making of inclusion or exclusion of the study; (iv) the data were extracted using an MS Excel spreadsheet designed for this review to capture relevant information required in the review using an iterative process; (v)The next steps were to summarise and classify each article according to content.  
Results: This review included 25 studies. Of these, 11 presented promising results regarding PHC functioning in the Amazon region, a further 14 presented challenges and difficulties in its functioning.  Some PHC strategies implemented in the Amazon showed the potential to reduce inequities, mostly when they involved actions that increased the access to PHC in the region when they developed a culturally adapted role and engaged community members in the decision making and collective construction health services. Actions that exposed challenges and difficulties, were related to ill-prepared health care professionals, inadequate service approach and the inability to adapt to cultural issues.
Conclusions: The findings reveal knowledge about PHC implementations that have introduced promising results in the Amazon region and, at the same time, show the challenges and difficulties of the PHC actions. It also highlights and synthesises the potential that the PHC actions implemented have to impact the inequities existing in the Amazon region and gaps in the studies that have been undertaken or at least published - including a lack of studies of PHC implementation and examination of strategies aimed at health determinants.