The Igarau fluvial mobile clinic: Lessons learned while implementing an innovative primary care approach in Rural Amazonia, Brazil

In Amazonia, which includes regions in eight South American countries (and an enormous area in Northern Brazil) many of the inhabitants live in small communities scattered across a vast territory? Since too often they cannot be accessed by road, health services must be brought to them on specially constructed river barges, which are floating comprehensive primary care clinics. To effectively deliver health services to vulnerable populations living deep in the Amazon Rain Forest, the Municipal Health Authority of Borba, Brazil piloted the innovative technology of the Igaracu Fluvial Mobile Clinic, a boat with full primary care services. The aim of this investigation is to do a case study of the pilot implementation of an innovative technology, Igaracu the fluvial mobile clinic, which delivers primary care services in rural, Amazonas, Brazil. In Borba, the implementation of the Igaracu has increased the number of people receiving primary care by over 10% and improved the quality of primary care provided, in particular, health promotion, maternal and child care, and treatment of chronic disease. Before the Igaracu fewer people used services for the following reasons: (1) Insufficient professional healthcare staff (e. g. medical doctor and advanced practice nurses); (2) Lack of privacy during consultations; (3) Loss of exam samples; and (4) No continuity of care. Implications of this successful healthcare delivery innovation for the importance of coordination between national health authorities and local policy makers are discussed.   Key words: Amazonia, inhabitants, mobile clinic, primary care clinics.