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How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis

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  • Cucunubá, Zulma M.
  • Manne-Goehler, Jennifer M.
  • Díaz, Diana
  • Nouvellet, Pierre
  • Bernal, Oscar
  • Marchiol, Andrea
  • Basáñez, María-Gloria
  • Conteh, Lesong

Abstract

Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3–0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating. We identify opportunities for improvement that can inform additional planned health reforms.

Suggested Citation

  • Cucunubá, Zulma M. & Manne-Goehler, Jennifer M. & Díaz, Diana & Nouvellet, Pierre & Bernal, Oscar & Marchiol, Andrea & Basáñez, María-Gloria & Conteh, Lesong, 2017. "How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 187-198.
    • Handle: RePEc:eee:socmed:v:175:y:2017:i:c:p:187-198
    DOI: 10.1016/j.socscimed.2017.01.002
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    References listed on IDEAS

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    1. Forsyth, Colin, 2015. "Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia," Social Science & Medicine, Elsevier, vol. 145(C), pages 7-16.
    2. Londono, Juan-Luis & Frenk, Julio, 1997. "Structured pluralism: towards an innovative model for health system reform in Latin America," Health Policy, Elsevier, vol. 41(1), pages 1-36, July.
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    1. Colin Forsyth & Sheba Meymandi & Ilan Moss & Jason Cone & Rachel Cohen & Carolina Batista, 2019. "Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 13(9), pages 1-23, September.
    2. Sandra Parisi & Miriam Navarro & Jeremy Douglas Du Plessis & Jonathan Phillip Shock & Boris Apodaca Michel & Minerva Lucuy Espinoza & Carolina Terán & Nino Antonio Calizaya Tapia & Katharina Oltmanns , 2020. "“We have already heard that the treatment doesn't do anything, so why should we take it?”: A mixed method perspective on Chagas disease knowledge, attitudes, prevention, and treatment behaviour in the," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(10), pages 1-20, October.
    3. Martínez-Parra, Adriana Gisela & Pinilla-Alfonso, Maria Yaneth & Abadía-Barrero, César Ernesto, 2018. "Sociocultural dynamics that influence Chagas disease health care in Colombia," Social Science & Medicine, Elsevier, vol. 215(C), pages 142-150.

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