Specialized care in health regions: challenges to ensure comprehensive health care in Brazil

Abstract

To analyze aspects of specialized health care provision in the context of incipient regional integration, as well as barriers to offering comprehensive health care. Case studies in tree municipal seats of health regions in the state of Bahia, Brazil. 31 semi-structured interviews were conducted with health managers and surveys were applied to 201 physicians and nurses of family health care teams and 1 590 users. The participants agreed on the lack of the specialized health care, considering limitations in regional planning due to low public funding and difficulties to attract specialized physicians. A significant percentage of users seek specialized health care directly in private services. The provision of comprehensive health care faces not only the challenge of strengthening the essential characteristics of primary health care (PHC), but also the lack of specialists, the fragmentation between different points of the network and communicational disarticulation between levels of the health system.