Structural barriers to accessibility in primary health care: An observational study

Primary health care is widely recognized as the foundation of effective and equitable public health systems. However, even well-established primary care models may fail to adequately address the needs of populations with disabilities. This study examines structural barriers to accessibility within primary health care settings, with particular attention to communication challenges faced by deaf patients. The analysis is based on 35 hours of authorized observational fieldwork conducted within Brazil’s public health system, including 30 hours in a primary health clinic (Unidade Básica de Saúde) and 5 hours in a hospital setting. The observations were non- interventional, involved no direct contact with patients, and were conducted with institutional authorization. Systematic observation revealed recurring patterns of communicational inaccessibility, including the absence of standardized protocols, insufficient professional training, and limited institutional preparedness to meet the needs of patients with hearing disabilities. These structural gaps undermine patient autonomy, compromise diagnostic accuracy, and weaken continuity of care, even within systems designed to promote universality and equity. Importantly, the findings suggest that effective communication in primary care does not depend on ideal conditions or advanced technologies, but rather on the consistent integration of accessibility considerations into routine care practices. Although grounded in the Brazilian context, this study highlights a broader global challenge faced by primary health systems worldwide. Addressing accessibility for populations with disabilities at the primary care level is essential to advancing health equity and ensuring that strong care models function inclusively in practice.