Improving healthcare in the Tres Fronteras region
Researchers from Nottingham University Business School are working with international partners to improve healthcare delivery in one of the most remote regions of the Amazon.
Colleagues in the Work, Organisation and Management (WOM) department and the Centre for Health Innovation, Leadership and Learning (CHILL) are collaborating with researchers from the Federal University of Amazonas and the University of São Paulo to address healthcare challenges in the Tres Fronteras region, where Brazil, Colombia and Peru meet.
Stephen Timmons, is a Professor of Health Services Management at Nottingham University Business School and the Director of Centre for Health Innovation, Leadership and Learning (CHILL). In this blog Stephen talks about this important work and his visit to the region as part of the research.
Delivering healthcare across borders, languages and systems
Stephen said: “Tres Fronteras is a unique place in the Amazon forest, on the rivers that eventually become the Amazon. Because it is so remote and inaccessible, there is no land frontier between Brazil, Colombia and Peru. It is only possible to get to the three neighbouring cities of Tabatinga (Brazil), Leticia (Colombia) and Santa Rosa (Peru) by boat or aeroplane. The only way you know you have crossed from Colombia to Brazil is that the shop signs change from Spanish to Portuguese.
"I would have enjoyed the six-day boat trip from Manaus (the capital of Brazilian Amazonas) but felt I could not justify the time.
“While this fluidity is part of everyday life locally, it presents significant challenges for coordinating public services, particularly healthcare, across national systems.”
Population mobility and health needs
"The cities of Tres Fronteras have a large indigenous population who have always moved around the region. Many people who have arrived more recently (and the cities are growing fast) work in agriculture, forestry or tourism, all of which are seasonal and again involve moving around. There is also a substantial informal economy.
“Healthcare in the region is almost entirely publicly provided as it’s not a wealthy region. My impression was that services are variable. Another challenge is insect-borne infectious disease, including a newly discovered virus that even my Sao Paulo colleagues had not heard of.“
Research focus: Improving post‑surgery care
“As part of this research we are working on improving post-surgery care, particularly diagnosing and treating surgical site infections. These are largely avoidable and treatable – but a system that works well, in this context, is hard to design and build.”
We aim to better understand both people and services, and work with them to improve across three countries, two main languages and substantial infrastructure issues.
Further information
For more information about the Work, Organisaion and Management (WOM) deprartment and the Centre for Health Innovation, Leadership and Learning (CHILL), please visit their web pages using the links below.
Posted February 5 2026
