Internalisation of the SDGs in the Western Brazilian Amazon: a qualitative study on continuing education processes and health vulnerability.

backgroundNoncommunicable diseases are closely linked to health inequalities and disproportionately affect socially vulnerable populations, leading to higher morbidity and mortality rates as well as poorer health outcomes. In alignment with the Sustainable Development Goals (SDGs) on health and well-being, the health situation in the Brazilian Amazon stands out due to the region's numerous vulnerabilities. In this context, educating primary healthcare professionals has emerged as a key strategy for promoting a more integrated approach that includes addressing social determinants of health and tackling health inequities. This study explores training processes for the dissemination of the SDGs among primary healthcare professionals. METHODOLOGY: This qualitative study is guided by the social theory of situated learning. Individual online interviews were conducted with 25 out of 116 health professionals working in primary healthcare settings in four states in the Brazilian Amazon region. They were part of a public initiative to internalise the SDGs in the Amazon (TED no. 57/2021 between the Ministry of Health and UFAC). In addition, technical reports written by participants regarding their professionals' interventions were explored. The data were analysed via thematic analysis.

resultsA total of 25 interviews were conducted, and four themes emerged from the thematic analysis: (1) Convergence of Agendas, (2) Situated Learning in Coparticipation, (3) Faces of Vulnerability, and (4) Dynamics of Political Influence. The course participants developed intervention projects, focusing mainly on targets 3.8 and 3.4 of SDG 3 and on synergies with SDGs 2, 5, 8, and 16. The professionals demonstrated a multidimensional view of vulnerability, described as complex and related to the lack of access to resources and services, manifesting in health services as work overload. The municipal political context was critical, cited both as an obstacle and as a success factor in the actions.

conclusionThe results highlight the importance of permanent health training in the implementation of the SDGs in contexts of great vulnerability and inequality, such as the Brazilian Amazon, showing that the permeability of these actions faces obstacles such as a lack of infrastructure and political influence. STUDY REGISTRATION: This study was registered with OSF on April 18, 2024. https://doi.org/10.17605/OSF.IO/NHJ7Q .