Acesso aos serviços públicos de saúde na fronteira de Ponta Porã-estado de Mato Grosso do Sul/Brasil e Pedro Juan Caballero-Departamento de Amambay/Paraguay

Abstract

This thesis addresses access to public health on the border, focusing on the spatial delimitation of the twin cities of Ponta Porã (Mato Grosso do Sul-Brazil) and Pedro Juan Caballero (Amambay-Paraguay), territories characterized by intense and dynamic interactions, life experiences, exchanges, and encounters. It argues that poor, undocumented border residents have a right to access public health services, given that Brazilian public health is a fundamental right, constitutionally guaranteed as universal and free of charge. In Paraguay, the legislation addresses health strictly regarding its own nationals; however, it is observed that public health does not even cover the totality of the country's population. Thus, the general objective of this study is to analyze access to public health services by poor, undocumented border residents in this spatial delimitation from 2019 to 2024. The specific objectives are: to compare the legal frameworks of Brazil and Paraguay regarding the guarantee, sharing, and enforcement of the right to health access, particularly concerning the provision and financing of the system. The methodology encompasses qualitative and quantitative exploratory research, involving the study of theses, dissertations, published articles, and official documents from both municipalities, focusing on border and public health issues, as well as questionnaires and interviews with users and public managers from both sides of the border. Mercosur presents legislation tailored to border residents; in this regard, this study analyzes the phenomenon of municipality and bilateral power, and how national policies for shared health management in international border cities effectively contribute (or not) to regional integration. Consequently, it reveals the central role of networks of relationships among border residents, including the bonds of friendship within this space. Furthermore, comparisons are made among federal/national, state/departmental, and municipal legislations to identify legal records addressing the rights of binational populations to access health services. It demonstrates how different border subjects access (or fail to access) care on both sides, highlighting opportunities for cross-border governance with examples from various fields. The COVID-19 pandemic is also presented alongside the unfolding of its effects on border residents, which impacted inhabitants' lives due to the border closure by Paraguay. This closure hindered access to health services and prevented residents from receiving the government emergency aid provided to low-income and economically vulnerable individuals at that time. The research allows to state that powers at the federal, state, and municipal levels of both twin cities must be articulated to ensure effective access to public health services. The conflicting yet hopeful sentiments of border residents suggest that healthcare access issues must be addressed and resolved in an integrated manner across both cities. These challenges should be viewed collectively, which will ultimately benefit all local inhabitants.