Health care to women with cancer precursor lesions in the cervix: Qualitative evidence of the health system fragmentation in Colombia

Abstract

This study aims to analyze the health care road that women with cervix cancer precursor lesions have gone through, the barriers they found to access to health services, and the screening they underwent under a prevention program in the Province of Cauca, Colombia. A qualitative descriptive-interpretative study was carried out with 16 women chosen after a sampling with typical cases; the selection criterion was the time taken to go from the living place to the closest health care provider with medium complexity service level. A content analysis was conducted together with a descriptive quantitative analysis in order to identify the time gaps between the screening and the health care provision. All the women interviewed herein, irrespective of their living place, faced a fragmented health care process with some indicators of non-articulation between the actors. The health services depend strongly on the legal agreements between insurance companies and health care providers, thus negatively affecting the patients and their access and continuity in the sequence of screening, diagnosis, treatment health care reprocessing, increase in the health costs and specific needs going under-/unserved. The findings bring into question the implementation of screening programs and whether they make sense in relation to the subsequent health care process. An effective prevention with a reduction in the morbidity-mortality rates for cervix cancer will be attain only by bridging the gap in the real availability and access to health services.