Barreras y facilitadores para el uso de los servicios de primer nivel de atención de la Caja Costarricense de Seguro Social (CCSS) por parte de la población de uno a menos de 6 años en los sitios centinela de Costa Rica
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Fecha
2014
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Población y Salud en Mesoamérica, Volumen 11, número 2 (enero-junio 2014)
Páginas
1-29
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Objetivos: Determinar las barreras y facilitadores para el uso de los servicios de primer nivel de atención de la Caja Costarricense de Seguro Social (CCSS) por parte de la población de uno a menos de 6 años en las comunidades de Damas de Desamparados, San Antonio de Nicoya y territorio indígena de La Casona de Coto Brus. Métodos: Metodología cualitativa. La información se obtuvo de tres fuentes de datos: entrevistas semi-estructuradas, tanto con las madres o encargadas de los niños, como con los funcionarios a cargo de las consultas en los Equipos Básicos de Atención en Salud (EBAIS), y observaciones de las consultas en los EBAIS. Resultados: Las razones de uso están relacionadas, en los tres sitios, con los beneficios que les trae a las usuarias la consulta, el buen trato del personal y la comodidad de las instalaciones de los EBAIS. Mientras que las razones de no uso comunes están asociadas al concepto de salud ligado a ausencia de enfermedad, la falta de información y problemas económicos de las usuarias, la no asignación de citas después del año de edad y la calidad de la atención recibida. Las razones relacionadas con el contexto, como las largas distancias, las limitaciones en cuanto a medios de transporte, cobran gran relevancia principalmente en la zona rural y en el territorio indígena. Conclusiones: El colocar la asistencia a cita control de esta población dentro de los compromisos de gestión de la CCSS, asignar la cita previamente y designar el equipo de atención en los EBAIS tomando en cuenta no una norma general, sino las condiciones particulares de cada sitio, son medidas que garantizarían el aumento de la cobertura de la atención integral a esta población.
Objectives: to determine the barriers and facilitators why the population is using or not the services at the primary care level for the children 1 - 6 years of age in the communities of Damas de Desamparados, San Antonio de Nicoya and indigenous community of the Casona. Methods: A qualitative methodology was applied to fulfil the objectives. Three sources of information were used: semi-structured interviews to mothers or legal guardians, and local health care teams workers of the EBAIS, as well as direct observations (to triangulate information) in health care settings of three communities: one urban, one rural and one indigenous. Results: Reasons for using the services in the three communities are related to the benefits of the medical consultation, good attention from the health care team and the infrastructure of the health care facility. However, the reasons for not using the services are mainly a concept of health as “absence of disease”, lack of information regarding the services provided, family poverty, the no offer of a pre-scheduled appointment after one year of age which is very important and relates to an institutional norm that prioritize on children younger than one year of age.Reasons related to the context are very important such as: long distances to the health care setting, lack or limitations for transportation, weather constraints, roads in bad condition. These reasons are particularly important in the indigenous community and rural. Conclusion: The process of assigning an appointment for growth control to children older than one year of age and younger than five years of age may be the strategy to improve coverage on those communities. A review of the capabilities and infrastructure of the EBAIS is also recommended in order to reach the needs and geographical differences of the communities, children and families with particular attention to the indigenous communities.
Objectives: to determine the barriers and facilitators why the population is using or not the services at the primary care level for the children 1 - 6 years of age in the communities of Damas de Desamparados, San Antonio de Nicoya and indigenous community of the Casona. Methods: A qualitative methodology was applied to fulfil the objectives. Three sources of information were used: semi-structured interviews to mothers or legal guardians, and local health care teams workers of the EBAIS, as well as direct observations (to triangulate information) in health care settings of three communities: one urban, one rural and one indigenous. Results: Reasons for using the services in the three communities are related to the benefits of the medical consultation, good attention from the health care team and the infrastructure of the health care facility. However, the reasons for not using the services are mainly a concept of health as “absence of disease”, lack of information regarding the services provided, family poverty, the no offer of a pre-scheduled appointment after one year of age which is very important and relates to an institutional norm that prioritize on children younger than one year of age.Reasons related to the context are very important such as: long distances to the health care setting, lack or limitations for transportation, weather constraints, roads in bad condition. These reasons are particularly important in the indigenous community and rural. Conclusion: The process of assigning an appointment for growth control to children older than one year of age and younger than five years of age may be the strategy to improve coverage on those communities. A review of the capabilities and infrastructure of the EBAIS is also recommended in order to reach the needs and geographical differences of the communities, children and families with particular attention to the indigenous communities.
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ATENCION PRIMARIA DE LA SALUD, SALUD, SERVICIOS DE SALUD, NIÑEZ, COSTA RICA