[Surveillance and primary health care: the integration of actions in Brazilian remote rural municipalities during the COVID-19 pandemic].

The health crisis resulting from community transmission of COVID-19 called for the health surveillance to play a central role in facing the pandemic. This study analyzes the contributions and difficulties faced by health surveillance in the development of actions to combat the COVID-19 pandemic in Brazilian remote rural municipalities from the perspective of managers, professionals and users. This was a qualitative study of multiple cases that involved a thematic and deductive analysis of 51 interviews conducted with managers and health professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas, and 29 interviews with users, community health agents and social movements in eight remote rural municipalities. During the COVID-19 pandemic, they faced difficulties in operationalizing health surveillance and ensuring the access of patients with compromised respiratory status to health services. They needed to reorganize the health care network, establish technical cooperation, conduct inter-agency governance and seek alternatives to operationalize the local health system. The main obstacles faced in care were related to articulation between states, which were insufficient to strengthen the care and laboratory network and the logistical system. The political, structural and organizational constraints confirmed that local managers contributed to contain the risks and made an effort to establish local intersectoral arrangements and relations, integrate health surveillance with primary health care, reorganize work processes and communication with the population. Effectively and sustainably overcoming the difficulties faced by remote rural municipalities requires cooperation between states guided by the principles of comprehensiveness, intersectoriality, and social participation.