Accessibility to primary health care by black families in a poor neighborhood of Salvador, Northeastern Brazil

Abstract

OBJECTIVE: To analyse the accessibility of primary health care for black families from a poor neighbourhood. METHODS: Ethnographic study with an interpretative anthropological approach, carried out with 18 families selected from a poor neighbourhood of Salvador, Northeastern Brazil, over a period of two years. Criteria for inclusion included being resident in the neighbourhood and classifying themselves as black. The analysis was based on interpretative anthropology and encompassed the following categories: ethnic and racial self-reference; experience of discrimination from public services; perception of accessibility to primary health care and barriers to accessibility. RESULTS AND DISCUSSION: We identified the following aspects: a) ethnic and racial identity and health: the users' perception that organizational barriers and barriers to access are due to the wider social context which produces "first class" and "second class" citizens, rather than due to institutional racism; b) the accessibility of the Brazilian National Health System (Sistema Único de Saúde, SUS): difficult access, delays in being seen, lack of commitment on the part of health professionals, no management action taken to manage or improve these situations; c) accessibility of primary health care; overall vision of the context of the SUS and support in the interviewees descriptions of access to primary health care. CONCLUSIONS: There are economic, organizational and cultural barriers to access which come between the service provided and effective care for the needs of the population of this study.