This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.

This case study analyses the challenges to the provision of Specialized Care (SC) in remote rural municipalities (RRM) in Brazil. Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). The distance between municipalities is a limiting factor for access; in addition, the significant care gaps contribute to different organizational arrangements for the provision and access to SC. In all the RRMs, periodically, physicians offer SC by direct disbursement to users or sale of procedures to managers, compromising municipal and family budgets. Health regions do not meet the demand for SC, accentuating the need for extensive travel. The managers of RRM have additional challenges for the provision of SC regarding the financing, the implementation of cooperative arrangements, the provision of care articulated in networks with a view to comprehensive care in search of solutions to the locoregional specificities.