Barriers to access to health services in Colombia
Since the World Health Assembly in 1975, there was evidence of the need for countries to have advice on the “selection and acquisition, at affordable prices, of approved quality drugs” (1), although this need referred to drugs essential to treat diseases of interest in public health, at present and taking into account that the right to health must be guaranteed to the entire population, this need is more latent and widespread than ever.
However, what does guaranteeing the right to health consist of? in the articulation of different factors such as universal health coverage and timely and quality effective access to health facilities, services and technologies.
The World Health Organization has proposed that, specifically to contribute to access to medicines, countries should formulate pharmaceutical policies that include five dimensions (see figure 1):
Following these WHO recommendations and in line with the evident needs in the country to guarantee timely access to quality medicines, in Colombia, during 2012 and through CONPES 155 “National Pharmaceutical Policy”, the National Government stated that “ The central problem of the national pharmaceutical situation was unequal access to medicines and poor quality of care ”and established a series of strategies and actions to address this situation, however, almost a decade later this problem is still evident (2 ).
Analyzes carried out have shown that, once the drug price control measures were implemented (one of the strategies proposed in the pharmaceutical policy), drug prices decreased by 43%, but pharmaceutical spending on health almost fell. It doubled, which contrasts with the access problems that Colombians present, both in the contributory and subsidized regimes, which is reflected in the number of guardianships in health in Colombia, which represent the largest participation in the total of guardianships based in the country since 2008 (2). For example, in 2018 every 2.5 minutes a guardianship was filed for violation of the right to health in Colombia (3).
What are the causes of access barriers in Colombia?
Access barriers are caused by multiple factors, some authors affirm that among these causes, which also promote inequity, are the privatized model of pharmaceutical innovation and the monopoly condition that has been established with the granting of intellectual property rights, that have allowed the establishment of high prices in medicines (1).
Particularly in Colombia, the causes oscillate between the structural, the intersectoral and the specific of the health system. Among the first causes (structural and intersectoral) we have health inequalities, evidenced in populations with great financial limitations, low health education and high vulnerability, conditions that exacerbate some of the access barriers, especially economic barriers such as transportation and travel or copayments for medications and exams (4).
Reviewing the Index of Access to Health Services in Colombia, the more specific causes of access barriers can be observed, which can be addressed more immediately by the health system, for example, the lack of beds and professionals health of various specialties, the number of medical and nursing professionals per 10,000 inhabitants, insufficient installed capacity and infrastructure and, in many regions, low use of available services (3).
A clear example is access to sexual and reproductive health services, where out-of-pocket spending is an important barrier, including care for low-income pregnant women and remote areas (3).
Another cause of barriers to effective access to medicines is shortages, in this sense, according to the INVIMA Medicine Shortage Management Report until 2018, the insufficient number of suppliers, the discontinuation of products and manufacturing problems ( quality) have been the main causes of shortages in the country (5).
What can be done to lower these barriers?
There are many challenges to guarantee access to medicines, and responsibility is distributed among the different actors of the Health System, some actions implemented, not only in Colombia but in several countries, to favor access to medicines are:
The successful implementation of most of these actions requires greater communication and articulation between the Government, civil society, academia and the private sector, which allows to promote the efficiency of the health system and reduce the difficulties that patients currently suffer in the country and which are reflected in a large number of guardianships, evidence of the violation of their right to health.
Prioritizing the use of scarce resources to generate the greatest gain in health, improve quality of life and reduce the numbers of mortality from all causes in the population are the purposes of health systems.