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- In the Inter-American Development Bank’s new article, we examine how hospital services and health infrastructure are distributed and used across urban and non-urban areas of Amazonia.
By Sofia Castro Vargas, Sebastian Peter Alexander Bauhoff, Laura Goyeneche
Highlights
- A new study examines how hospital services are distributed and used across the Amazon region, drawing on data from six countries.
- Hospitalisation rates in Amazonia are higher than national averages, including avoidable admissions and hospitalisations related to maternal and neonatal conditions.
- Strengthening primary care, referral systems, and culturally appropriate service models will be essential to improving health system performance across the region.
WASHINGTON, USA – Urban health systems in Amazonia face unique and persistent challenges. Spread across vast distances and primarily shaped by river-based access, the Amazon region still struggles with availability and continuity of care, despite growing urbanisation. Today, more than 40 million people live in nearly 900 urban settlements across Amazonia.
In the Inter-American Development Bank’s new article, we examine how hospital services and health infrastructure are distributed and used across urban and non-urban areas of Amazonia. This type of analysis reveals opportunities to strengthen service networks and better adapt health systems to the realities of the region.
What we measured and what the data tell us
Using publicly available data from Bolivia, Brazil, Colombia, Ecuador, Guyana, and Peru, the analysis focuses on descriptive differences in facility availability across public and private providers, hospital discharge patterns from public hospitals, and the types of conditions for which people are hospitalised. These indicators help identify how hospital capacity is being used and where gaps may exist in meeting population health needs. Here is what we have learned:
- Health Facility Availability: Gaps that persist
Within the Amazon region, overall facility density is broadly comparable to national averages, but services are unevenly distributed. Urban areas tend to concentrate specialized hospitals and higher-complexity services, while non-urban areas remain predominantly served by basic or primary-level facilities. This uneven distribution reflects persistent structural inequalities despite urbanization and population growth and suggests that the main gap is not simply the number of facilities, but the limited availability of higher-level care, referral capacity, and operational readiness in remote areas. The issue is not only the number of facilities, but their distribution, complexity, and operational capacity. Expanding higher-level services in underserved areas and strengthening referral and primary care networks may be as important as building new infrastructure.
- Hospital use is higher in Amazonia
Although the number of health facilities is slightly lower in the Amazon region, hospitalisation rates are higher than the national averages. In several countries, urban Amazonia areas show hospitalisation rates that exceed both national and non-Amazonia levels. Conditions related to maternal and neonatal health and chronic illnesses account for a large share of hospitalisations in the Amazon region. This might point to differences in how and when people seek care or are able to access it. These findings highlight the need to better understand how urbanisation, geography, and service organisations interact in shaping health systems use in the region.
- In-hospital maternal and neonatal mortality remains high
In-hospital mortality for maternal and neonatal causes remains higher in Amazonia territories. This pattern suggests that proximity to health services alone is not enough to guarantee timely or effective care. Geographic barriers, delayed care-seeking, gaps in referral systems, weaknesses in the quality of care delivered, and the lack of culturally appropriate services may all play a role.
- Avoidable hospitalisations are more frequent in the Amazon region
Hospitalisations for conditions that could be addressed with timely and effective primary care (so-called ambulatory care-sensitive conditions, or ACSCs) —such as complications from diabetes or hypertension, urinary tract infections, or gastroenteritis — account for a similar share of admissions in the region and at the national level. But when adjusted for population size, the rate of ACSC-related hospitalisations is higher in Amazonia areas, including urban areas. This pattern may reflect challenges in primary care, delayed care-seeking, limited continuity of care, or barriers to timely diagnosis and treatment.
What does this mean for health systems in Amazonia?
Our findings point to the importance of focusing on how services are used and by whom. Improving health systems in the region will require adapting service models to local realities, including strengthening primary care, referral systems, expanding community outreach, and investing in culturally appropriate care strategies.
This could include building on successful experiences in the region, such as maternal care models that incorporate traditional practices or transport systems tailored to river-based access. Some of the most promising approaches in Amazonia combine community-based care, culturally adapted services, and better links between primary care and hospitals, rather than relying solely on hospitals.
It is also clear that we need more evidence and insights into populations and health systems in this unique region. As Amazonian cities continue to grow, better understanding how people navigate health services, from initial contact to hospital care, will be critical for designing effective and responsive health systems.
Read the full analysis: Cross-country analysis of health systems and hospital utilization across the Amazon. And, as a complement, explore the IDB’s Amazon Cities report, published within the Amazonia Forever regional coordination program, which highlights the complexity of urban areas in Amazonia: Cities in Amazonia: People and Nature in Harmony.
Cross-country analysis of health systems and hospital utilization across the Amazon – Análisis comparativo entre países sobre el sistema de salud y la utilización de los hospitales en toda la Amazonía.
