Access to primary health care in rural and peri-urban areas of latin america: barriers and facilitators

Abstract

Access to primary health care (PHC) services is a fundamental component for ensuring the right to health; however, significant inequalities persist in Latin America, particularly among rural and peri-urban populations, driven by geographical, economic, and organizational factors. The objective of this systematic review was to analyze the available scientific evidence on the barriers and facilitators influencing access to primary health care in these populations. A systematic search was conducted following the PRISMA 2020 guidelines, and the search and selection strategy was structured using the SPIDER methodological framework. The search was performed in the SciELO, Scopus, and ScienceDirect databases during the period 2016–2025, using descriptors related to primary health care, accessibility, barriers, facilitators, and rural populations. Studies published in Spanish, English, and Portuguese with qualitative, quantitative, and mixed-method designs were included, resulting in 13 articles that met the inclusion criteria. The results showed that access to primary health care was influenced by multiple barriers, including long distances, territorial isolation, high out-of-pocket expenses, fragmentation of the health system, and limited availability of human resources and services. However, key facilitators were identified, such as the role of community health workers, community participation, home visits, and the implementation of context-adapted care models, including river-based health units. It is concluded that access to primary health care in rural and peri-urban populations is a multifactorial phenomenon that requires comprehensive, territorial, and culturally appropriate strategies aimed at reducing inequalities and strengthening the primary level of care in Latin America.