Table 4 Summary of “expressive statements” about the challenges for access to health transport, Remote Rural Municipalities, Brazil, 2019

Central-West

Ambulance purchased with parliamentary amendment resources

People, there is no such thing as refusing resources from the parliamentary amendment! Who wouldn't want the resources? We bought two ambulances with parliamentary amendment resources; therefore, the difference is to seek resources somehow. (1/RM/MT)

Matopiba

Intermunicipal bus

Users go on their own to Teresina (capital). Sometimes, we give them tickets. I spend ten thousand reais per month on transport. Many come to ask me because the price of the ticket is high, and they cannot afford it. We help many of them, more serious cases; for example, we have many cases of cancer. (1/MM1/PI)

Municipal ambulances

We also have an ambulance that is here in the village, depending on the case of people who cannot move; in these specific cases, we will pick them up. (1/NUR/RA/MA)

North Waters

Voadeiras (small boats)

For Boa Vista do Cuçari, we have a voadeira that does not belong to the health services but is rented and contracted by the health services to transport patients to Monte Alegre. Santa Maria also has the voadeira that sends patients here, all offered for health services. (1/MM2/PA)

Water ambulances

The riverside communities have difficulties of access because access is only by river, and not everyone has a canoe or boat available to get around… (…) So, sometimes, when the place has a telephone signal, they call, and we’ll go and pick them up. We have nine water ambulances in the rural area of the municipality and one water ambulance, equipped as if it were a bed, in the urban area; then there is the equipment that we take, a medicine box, and an oxygen box. (1/MM2/PA)

Municipal and state ambulances

I do not know if there is a way to criticize that the ambulance here should be 4 × 4 traction. Most times, we send patients there, but the ambulance does not go because it does not move through the mud. Sometimes they come, but there are no conditions; they get halfway there, but they do not go beyond there if it is an urgent case. There are no conditions. (1/DOC/RA/PA)

North Roads

4 × 4 traction car

They called: “there’s a patient in a local area to go for an appointment or an emergency”. I asked, “does the ambulance get there?” “It does,” and off goes the ambulance. “No, the ambulance doesn’t get here,” off goes the pickup truck because there are places that even the pickup truck can’t reach; so, imagine a little ambulance… (2/MM2/PA)

Car

The driver arrives earlier, he is experienced, but it usually takes four hours. Now imagine a patient with only an hour to live… there are some villages that are three days from here, and communities that take four to five hours by car; it can be some 200 km because the roads are bad. (3/MM2/PA)

Airplane

Our biggest problem is the people involved in accidents, motorcycle, and car accidents. And each patient costs the municipality a range of R$15.000 to travel to Santarém, as it is by airplane. (1/MM1/PA)

The airplane is private, and the city hall pays; they are small planes that are called “teco-teco”; when it is necessary and the patient is in serious condition, for example, we already had two mobile ICU transfers in this period now, the plane came fully equipped and with an intensivist, who performed the intubation and took the patient. (3/MM2/PA)

Users carried in hammocks

When it rains, there are no conditions to reach the branches due to the amount of mud. Patients sometimes arrive carried in hammocks, as we have to have traction pickup trucks to be able to arrive and, many times, we cannot. The situation is very bad. (1/MM1/AC)

North Minas

Municipal ambulances

There are a lot of homes far away. I even suggested to a son, with a 90-year-old elderly woman, living in a place so far away; what if she gets sick? Don’t use the phone until he gets in touch with someone to arrange an ambulance… And the ambulance can’t get there, it’s a downhill, you go down and there’s only rock. No car can pass. (1/NUR/RA/MG)

School bus

But most of the population uses transport linked to the city hall, like the school bus. They take the school bus that brings their daughters and goes to the primary care unit (located in the RRM headquarters). (1/MM2/MG)

No [there is no public transport in this area]; there is only school transport that ends up giving people a ride. (2/NUR/RA/MG)

Semiarid

Cars from other areas—education and social assistance

And today, we don’t have money for transport; the transport that we have in health services can be counted on our fingers. We have a car that takes the doctor every day and another car that travels (for patients). And we end up using the education and social assistance car for health services. There are days when the three cars are on the road to take patients, go to appointments with specialists, or have an exam… (1/MM2/BA)

Private cars paid by users

On average, the dentist sees from 5 to 7 people, but because of the rural area, we schedule to see at least 10 in the morning. And those 10 people come because if I schedule 5, they can’t come because of transport. There is a location here where the private car charges R$ 40,00 per person. So, if he manages to put 10 people in the service schedule, this price decreases. (2/MM2/BA)