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Going to the hospital in Popayán, in Colombia, can turn into an odyssey costing up to 100,000 pesos (€35), a luxury most people can't afford.
A European citizen takes an average of 15 minutes to reach a doctor, but in Colombia territorial dispersion represents a barrier to ensuring access to healthcare services. The city of Tambo, the country’s second largest in surface area, is one such example. There, in an area of 3,280 km2 with some 60,0000 inhabitants (94% in remote rural areas), there is one doctor for every 7,500 inhabitants, well below the national average (15 per 10,000 inhabitants). And from one community, it can take several hours, on horseback or in a car, to reach the closest medical centre. Under these conditions, reaching the hospital in Popayán, the capital of the department, can turn into an odyssey costing up to 100,000 pesos (€35), according to Eduardo Villa, physician and manager of the hospital of Tambo. A luxury beyond the reach of most of the inhabitants of one of the poorest departments of the country, in which the average per-capita income is 250,000 pesos[ii] (€100).
These factors explain, in part, the city’s dramatic perinatal mortality rates in recent years: 34 per 1,000, double the national average and nearly 10 times greater than in Spain. When he arrived at the hospital in 2012, Dr Villa decided to address this problem by seeking the support of key stakeholders in this mainly indigenous and rural territory: traditional doctors and midwives. This meant adding the experience of Western medicine to the experience and ancestral knowledge of midwives. Dr Villa created groups for exchanges and training with the aim of improving monitoring of pregnant women, and prevention and detection of high-risk pregnancies. Luis Amaro, midwife and traditional doctor, was a member of one of these groups. He’s been attending births in isolated indigenous communities, day and night, all his life. Since he’s started participating in the midwife group, he now quickly identifies high-risk pregnancies and sends the patients to the hospital.
Another initiative launched by the hospital was the opening of a “hotel for pregnant women”, to facilitate early admission of women with high-risk pregnancies at no charge. The result of these two measures combined is noteworthy: in less than three years the perinatal mortality rate in the city fell decisively, approaching zero.
This module represents a new paradigm for Colombian health policies and aims to achieve “quality access to healthcare services”, in the words of Fernando Ruiz, the Deputy Minister of Health, “so that problems are mainly resolved at the primary healthcare level”. The model is focused on family and community medicine, for care that is closer to patients, understands their social context, and puts the accent on pro-health and preventive healthcare. To do this, 5,000 family doctors will be trained over the next 10 years. The model also aims to reduce territorial gaps in healthcare through the opening of clinics closer to the population, the creation of “mobile health brigades”, and a system of incentives for family doctors in remote areas. Implementation of the new model is already underway in the department of Guainía after a three-way negotiation with the local authorities and indigenous representatives. In 2015 it will be implemented in other departments to achieve full coverage in the territory by 2016. The opening of another 15 university programmes in Family Medicine is also anticipated.
EUROsociAL, the cooperation programme of the European Commission with Latin America for social cohesion, supported the Colombian Ministry of Health in designing the model, sharing the experiences of France and Brazil in the area of healthcare in remote areas, and that of the United Kingdom, Spain and Mexico in the area of family medicine. The aim is to ensure the right of all citizens to healthcare so that in within a few years the success of El Tambo is not the exception in Colombia.
Peggy Martinello, Senior FIIAPP Expert in the EUROsociAL Programme
[ii] Source: Colombian National Administrative Department of Statistics, 2013Principio del formularioFinal del formulario
