The persistence of healthcare access inequality in quilombos in the interior of Maranhão

challenges and reflections from a local experience

Abstract

This is a descriptive study, a type of experience report, conducted within an extension project focused on quilombola health in a municipality of the Baixada Maranhense region, from March 2024 to March 2025. The project integrates teaching, research, and extension activities of a medicine course at a university in Maranhão, aiming to analyze the difficulties faced by quilombola communities in accessing healthcare services. The methodology applied was Problematization and Problem-Based Learning, using the Maguerez Arc. Field visits, interviews with residents, community leaders, and healthcare professionals were conducted, along with training sessions for Community Health Agents and health education actions, including pamphlet distribution. The results highlighted structural barriers such as the distance to healthcare units, inadequate infrastructure, and a shortage of qualified professionals. A culturally sensitive population with distrust towards healthcare services was also identified, making treatment adherence challenging. Training CHAs and promoting intersectoral actions emerged as essential strategies to reduce these inequalities. It is concluded that equitable healthcare access for quilombola communities requires investments in research, professional training, and the effective implementation of the National Policy for Comprehensive Health of the Black Population, ensuring that SUS guidelines are met efficiently and in a culturally appropriate manner.