Healthcare project in rural, remote, isolated, post-conflict, non-cohesive and/or vulnerable regions. Colombia: health, peace and social inclusion.

Background information.

Today, now that the Peace Accords have been signed, Colombia faces a commitment to the healthcare, integration and development of areas that have been identified as the “Isolated Zones” of post-conflict. It seeks to work intensely towards establishing regional strategies for an inclusive endogenous development that breaks away from the historical roots of what has been referred to as the “Two Colombias:” a source of conflict, neglect and exclusion.

Aim and relevance of the initiative.

The objective of this project is to design and implement a healthcare model that benefits rural and remote populations in today’s sociopolitical context. Through a co-creation strategy that involves communities and the government, this project aims for Colombia to contribute to the world from an experience that creates value in healthcare; and from an endogenous and inclusive development approach, it uses a framework for the application of a new countrywide integration model.

Setting, patient description.

As we have explained, Figure 1 offers a summary of the proposed healthcare model. The center of the diagram represents the population the model targets: individuals and their relationship in/with their community. In alignment with our aim and objective, we seek to “support people to maintain a comprehensive state of health and wellbeing from before their birth and after their death.”

Methods, size & scope.

A series of different stages have been considered for the implementation of this healthcare model. The strategy for this development begins with a regional characterization that seeks to include an exhaustive description of the geographical, environmental and contextual aspects (i.e. security) of the region the model will be applied to. Following this first phase, a demographic analysis will be conducted that provides information on the population’s indicators and structure, including the identification of ethnic and other minority groups that live in the region. The phases that follow include identifying key resources, which includes those that are both specific to the healthcare sector and those that are not specific to it, but that have a considerable influence on the delivery of services. After these phases, it is proposed that a detailed analysis be conducted on the region’s levels of mortality and burden of disease, on events that are relevant to public health and on other indicators. With the information gathered from the aforementioned stages, a preliminary service portfolio would be proposed. The portfolio would address identified health problems, be designed with an appropriate differential approach and be ethnically appropriate. This preliminary portfolio would include the results of the final phase, which seeks to identify health assets and obtain the participatory appraisal of the population’s perceived needs, determined by the population itself. These mapped assets will become part of the strategies/initiatives included in the portfolio. The salutogenic phase should include the establishment of partnerships, agreements and other projects with other institutions and sectors in order to mobilize other efforts that have positive impacts on the social determinants of health. At this point, there should be enough information to establish a more broad, precise portfolio, which would be approved by the community and by local authorities at a later phase. Once all the aspects to be offered in the model have been defined, a financial analysis of the project’s financial feasibility would be conducted and refined. The model can then be implemented, which includes its ongoing evaluation and monitoring.

Formation of IPUs/collaborations/partnerships.

The healthcare model to be implemented must include public-public partnerships (collaboration among different entities, levels of government and governmental and public agencies), public-private partnerships and private-private partnerships, depending on the specific initiative and presence of each throughout the region. Their involvement should be based on a shared co-creation. Each partnership is to apply their skills, authority and role from a co-creation approach with and from the community. OSI will lead the proposed model in collaboration with the government and the Community (International Teams: US, Mexico, Colombia, Spain, Philippines, Brazil and Peru).