The challenge presented was selected as a practice of excellence in Primary Health Care (PHC) by the Uruguayan Health Intelligence Node (NISU), Ministry of Public Health (MSP), Uruguay Presidency, Uruguayan Agency for International Cooperation (AUCI), Pan American Health Organization (PAHO) with the support of the United Nations Uruguay.
The proposed practice consists of the development of an interdisciplinary work based on the PHC strategy, with the SDG objectives, bringing health and social services closer to the rural population living in areas far from the city of Durazno. The department is located in the center of Uruguay and has a population of 57,084 with a total of 3,896 rural inhabitants.
The Cooperativa de Asistencia Médica de Durazno (CAMEDUR-IAMPP) has worked since its inception, more than 10 years ago, in the fairs that group rural schools and surrounding areas in order to ensure universal access to health and social services achieving health coverage, family planning, provides information, health education with emphasis on healthy habits, sexual and reproductive health, and safe, effective, affordable, quality vaccines.
The objective is to contribute to improve the quality of life, promote health, prevent diseases in schoolchildren, adolescents and their families, local inhabitants, promoting self-care and providing comprehensive assistance, with emphasis on the rural population living in vulnerable conditions, with a family, community, epidemiological, productive and social approach. Aiming to reduce premature morbidity and mortality due to non-communicable diseases through prevention, timely approach, health protection, and empowerment of the population.
In accordance with PHC principles and SDG objectives, the aim is to provide quality health services, with a comprehensive approach and full participation of all people involved in the process and the generation of spaces for interinstitutional and intersectoral articulation, as well as the reduction of inequalities by strengthening and promoting the social, economic and political inclusion of all people, regardless of their age, sex, disability, race, ethnicity, origin, religion or economic situation or other condition, and to adopt policies, especially wage and social protection policies.
The root causes of this practice are the difficulty of reaching social policies in the deep interior of the department, the dispersion of the rural population, organizational difficulties and the scarcity of trained human resources, and the low accessibility to health and social services.
The fairs are planned on an annual basis with inter-institutional coordination. Health care providers, primary education referents, rural society and public and private institutions of the department participate. In order to obtain global coverage, monthly fairs are planned, which are free of charge, promote participation, with a comprehensive, people-centered approach and an assessment of the population's needs.
In order to achieve the objectives set, health and social services are provided, such as:
Screening for risk factors of non-communicable diseases: blood pressure control, capillary glycemia, weight, height and body mass index (BMI).
Visual acuity screening.
Nutritional food education.
Vaccines included in the national immunization program, special vaccines and flu and covid vaccination campaigns.
Oral health education and assistance.
Physical activity counselin
Incidental and planned health education on different topics: prevention of sexually transmitted infections, healthy habits, disease prevention and infant feeding.
Health check-ups, including gynecological and obstetrical.
Placement and removal of intrauterine device (IUD) and subdermal implant.
Ultrasound scans.
Sensitization and prevention on issues related to gender violence.
Advice on social benefits and services, such as retirement, pension, social cards for economic and technological support (wheelchairs, hearing aids, glasses, canes, etc.), in situations of vulnerability, employment and vocational training.
Advice in areas related to livestock, agriculture, fishing and other crisis situations.
Workshops and advice in the approach to disability.
Consulting and addressing specific needs and problems of various kinds, according to local demands (internet access, rural roads).
With these activities we will contribute to the achievement of the SDGs, joining efforts to achieve a healthy, empowered and sustainable future society.

This practice has been maintained over the years, being replicated in different localities of Durazno, with the support of all the city's referent institutions, both health and social, so it is transferable to rural areas in other departments of Uruguay and neighboring countries such as Argentina and Brazil.

People committed to the welfare of the community, with vocation, dedication and love.
Rural communities that facilitate the inclusion and empowerment of the rural population.
Rural children, adolescents and adults.
Hospitals in other departments.

The theme of the Expo is “Designing future society for our lives” and the sub-theme is “Saving lives”. The practice presented brings health and social services closer to rural schoolchildren, with a family, community, epidemiological and productive approach, reducing inequalities in relation to the city population.
It would not be possible to cover the entire rural area of Durazno without teamwork and optimization of resources in interinstitutional and interdisciplinary work with the common objective of achieving a healthy community, with decentralization of services, PHC and health promotion, and the principles of equity, solidarity and community participation.
The rural population is very receptive, welcoming, grateful and actively participates in all activities, contributing with its characteristic mark of the area. It is a population willing to commit to change, to adopt healthy behaviors that protect health and prevent disease, promoting empowerment of care and reducing morbidity and mortality. These practices have had a great impact on the health of the rural population, improving continuity of care and early detection of pathologies. Coordination and assistance at the different levels of care was facilitated, carrying out primary, secondary and tertiary prevention. For this reason, this practice empowers the population in their care and, consequently, saves lives.

dfernandez@camedur.com.uy

The National Integrated Health System (SNIS) approved by law at the end of 2007 and the National Rural Health Plan of 2011 provided the initial framework for the practice. The Departmental Health Directorate of Durazno, the governing body of health policy at the departmental level, began the organization of health fairs which, throughout their history, have changed names and coordination, but always with the same objective. Social services were added to the health services in order to bring the city's services closer and provide them in the interior of the department of Durazno.
The initiative's implementation process was based on achieving universal access for the rural population to quality health and social services, guaranteeing equity from a rights-based perspective.
Short-term plans involve the fulfillment of planned activities in a timely manner. In the long term, it is expected to expand the supply of services in the rural community to contribute to the improvement of the quality of life of this population.
The practice has been sustained over the years, has transcended changes in government and CAMEDUR-IAMPP has always been committed to the practice, providing support and including it in its strategic planning. The commitment of the institutions is key to the achievement of long-term plans.