Abstract
Background: Access to health in rural and dispersed areas is a major challenge in Colombia. Two municipalities in Tolima, affected by the armed conflict, face barriers to equitable access to health services due to geographic isolation and limited institutional capacity. This study aimed to explore factors related to the responsiveness and problem-solving capacity of health care providers in these rural areas, focusing on the availability, accessibility, acceptability and use of services as perceived by health care providers and users.
Approach: This descriptive qualitative study was conducted in the first half of 2024 based on semi-structured interviews with health and administrative staff, as well as focus group discussions with community leaders and service users. A total of 25 interviews were conducted with health professionals, administrators and staff of local health institutions. In addition, eight focus groups were conducted to gather the perspectives of patients and community leaders. The data were transcribed and analysed using thematic analysis techniques supported by artificial intelligence (AI) tools. Interviews focused on four key areas: availability, accessibility, acceptability, and contact and use of health services.
Results: Findings revealed significant barriers in the availability of primary health care services, particularly for chronic disease management, mental health and maternal and child care. The limited availability of skilled health personnel, as well as the intermittent supply of drugs and medical supplies, are a recurrent problem. The geographical remoteness of communities from service providers, as well as transport costs and travel times, are barriers to accessing health care services. Acceptability of services is affected by loss of credibility and trust in health personnel and cultural factors, with many patients opting for traditional healers due to dissatisfaction with formal health care services. In addition, insufficient health personnel, low supply of services and limited resources for diagnosis, treatment and rehabilitation are factors affecting demand and care in rural areas; people often have to be referred to institutions of higher level of complexity; however, the care process is truncated by difficulties in scheduling and the costs of travel and stay outside the municipality.
Implications: The study shows the need for decision-making for the adequacy of the supply of health services in rural areas and the improvement of inter-institutional coordination, based on knowledge of organisational factors, health personnel and the community context that affect effective access to health services in each territory. Community participation in the design and implementation of innovative care initiatives will be key to improving access to health care in these underserved regions.