Table 2 Access barriers related to Policy and Macro-Environment and Geographic accessibility. Baseline (2010) and results 7 years after implementation (2017)
From: Building an innovative Chagas disease program for primary care units, in an urban non- endemic city
Dimensions | Criteria | Baseline(2010) | 2017 |
|---|---|---|---|
Policy and Macro-Environment | |||
Legislation | • Health guaranteed by the Constitution • Existence of specific law for ChD • Other supportive laws | • Although constitutionally guaranteed, partially implemented • Law for ChD voted in 2007, partially implemented • Without monitoring actions | • Although constitutionally guaranteed, partially implemented • Implemented as a Municipal Program • Permanent monitoring process |
Health Management | • National guidelines for ChD diagnosis and treatment | • Published but not implemented | • Implemented as a core part in the Program • A guide for patients with ChD attending to the MPCF was elaborated |
• Existence of a national and/or provincial Network of health services | • None | • A local network with the hospitals from La Plata was created-although informal | |
Social involvement in ChD | • Presence in the local media • Presence in local activities • Visited schools • Surveys in schools (children 6 and 12 years) | • Absent and unknown • Absent • None • None | • Activities in all the public schools of La Plata • Participation in local fairs with stands and basic information • 46 • 3750 children |
Geographic Accessibility | |||
User’s location | • Roads | • Few good roads, many households with difficult access during rainy days | • Health assistants prepared to go to distant places if necessary |
• Communication and public transport | • Scarce public transport to hospitals | • Patient centered model, bringing services to MPCF with no need to travel | |
Service location | • Nearness to patient’s households | • Near but with inconvenient opening hours and long waiting times | • Some MPCF could change opening hours |
Availability | |||
Health workers Training and outcomes | • Trained in diagnosis and treatment • Patients tested • Patients positive • Number of patients treated • Number and specialties | • No experience in treatment • None • None • None • Enough general practitioners. Only 2 cardiologists | • Highly qualified in diagnosis and treatment • 17894 • 1394 • 1035 • Enough general practitioners with central service of cardiology operated by tele-medicine |
Drugs Equipment | • Drug stocks • Needed for biochemical diagnosis • Clinical management | • None • Present but with scarce supplies • No ECG for all MPCF. Patients were send to far away hospitals | • Complete free of charge treatment of ChD • Present with enough supplies • ECG for all MPCF by tele medicine |
Financial Accessibility | |||
Direct costs and prices of services Indirect costs | • User fees • Source of financing of the MPCF • Opportunity costs of time • Transportation costs • Food and lodging | • None • Mainly Municipal. Insufficient to fulfill all the needs • Initially high • Initially present • Not considered | • None • Mainly Municipal. Some supplies financed by MS • Reduced • Excluded • Not considered |
Acceptability | |||
Characteristics of health services | • In line with prevailing cultural norms | • Not explored | • Pilot tests to investigate this item. Need of specialized teams to explore this aspect more deeply |
User’s attitudes and expectations | • Satisfaction with the health service | • Not explored | • Pleased to receive complete diagnosis and treatment free of charge in the first level • More studies needed to assure this item |