Social and territorial barriers to healthcare access and care resolutiveness in quilombola communities of the Brazilian Amazon

Background Healthcare access among quilombola communities in the Brazilian Amazon is shaped by socioeconomic and territorial conditions. This study examined factors related to healthcare access and service resolutiveness among quilombola residents. Methods This cross-sectional study included 574 participants from eight quilombola communities in Santarém, Pará, Brazil. Healthcare use, healthcare obtained outside the community, and problem resolution were examined using crude and adjusted logistic regression models. Socioeconomic inequality was assessed using Gini, Theil, and concentration indices. Transportation cost burden was explored as an economic dimension of accessibility. Health-unit availability was analyzed descriptively because only one community had a local health unit. Results Women reported higher healthcare use than men (73.9% vs. 59.6%; p<0.001). Educational attainment was not associated with the outcomes. Household income was associated with problem resolution in crude analysis (global p=0.035), but the association was attenuated after adjustment (p=0.106), with evidence of non-linearity. Income inequality was observed (Gini=0.399; Theil=0.287), without clear socioeconomic concentration of healthcare outcomes. Transportation cost burden decreased with increasing income (ρ=−0.509; p<0.001), whereas absolute transportation cost did not (ρ=0.039; p=0.421). In Tiningu, the only community with a local health unit, 23.1% obtained healthcare outside the community versus 63.9% in the other communities; this comparison was descriptive. Conclusions Healthcare access did not follow a consistent socioeconomic gradient. However, transportation imposed a greater potential economic burden on lower-income households. The findings highlight the importance of considering service availability, territorial mobility, and the economic conditions required to reach healthcare in remote quilombola communities.