Many discussion participants talked about difficult access to health services for families in areas further from facilities and with no outreach.
Living in rural/remote areas presents additional challenges for dying persons and their families, such as reduced and difficult access to needed services [ 15- 18].
A further explanation is the dispersion of the population in this mountainous area: the more difficult access to health services motivates the family doctor not to discharge patients from the HaH programme before they are fully cured.
People with no income or low income, and/or with low level of education, and/or homeless, and/or with difficult access to health services, are statistically significantly correlated (p<0.0001) with the presence of TB co-infection.
Particularly, the snake Bothrops leucurus is present in the Northeastern region of Brazil [ 3], being related to accidents with rural workers who often have difficult access to health services to receive the antiophidic treatment proposed by the Health Ministry, that is, the antibothropic antivenom.
When questioned about perceived barriers for attending health check-ups, 57% stated that difficult access to health service would be a hindering factor.
"You're facing economic problems, challenges achieving professional qualifications, unemployment and difficult access to basic social services … so I'm asking you to be conscious of your civil and civic responsibilities".
These areas were chosen because they had the required target population for the available OCV doses, poor water and sanitation infrastructure, difficult access to health care services, and historically high cholera attack rates (10.1%37%%) (21 ).
Problems include long waiting lists; restricted availability of psychotherapy and psychological treatments; a shortage of social workers in hospitals; a lack of mental health components in primary care services, aftercare and coordination; no provision of day care; and no or difficult access to information on mental health services.
