Better access to health services in indigenous communities

Sinergias's project is being implemented using the resources of the Health Care Innovation Award and Fundación Éxito. It has been developed jointly with Hospital San Antonio of Mitu, the Health Secretariats for the territory and the Ministry of Health and Social Protection. Probitas's support is directed at preventing and controlling six neglected infectious diseases prioritised within the territory.


CONTEXT
The initiative aims to improve access to health care in indigenous communities in the rural areas of Vaupés, adopting an intercultural approach. This area is geographically isolated from the rest of the country, the main ways of accessing it being by air and by river. Scattered rural populations only have limited access to basic health services almost all year round and have a high index of unmet basic needs. Furthermore, they have also endured the consequences of the armed conflict. Morbidity and mortality due to preventable diseases is well above national rates. The prevalence of Emerging Infectious Diseases (EIDs) is high: eye trachoma, about 15% (5 years ago it was around 26%), geo-helminthiasis approximately 95%, scabies 15% and pediculosis, 26%.

PROJECT
Sinergias are developing a project in 18 indigenous communities in the rural area of Mitú, in Vaupés in order to improve access to health services with parity between the sexes and an intercultural approach. With the support of Probitas controlling and eradicating six neglected infectious diseases will also be included. There will be two rounds of mass administration of medication (WMA), using azithromycin to control trachoma (part of the SAFE strategy), and three rounds of albendazole to control geo-helminthiasis.

Likewise, cases of tungiasis, pediculosis, scabies and cutaneous larva migrans which are also to be found in these communities, both during the rounds of mass medication delivery (which will include actively detecting these diseases), will be addressed through a process of identification and notification of cases arising from community health surveillance. All persons over 15 years of age will be screened for trachomatous trichiasis and identified cases will be channelled so the surgical referral process can be initiated.  Detection of grades 3 and 4 of pterygium  will also be carried out among the same population, and cataracts in the over 50s.

Hand in hand with WMA, micronutrients will be given to pregnant women and children under five years of age. Activities for promoting health, prevention, and surveillance of neglected infectious diseases will be prioritised using an intercultural approach.

The project focuses on preventing and controlling six neglected infectious diseases in 18 indigenous communities in the rural area of the municipality of Mitú, in the Department of Vaupés, the Amazon region of Colombia.

The expected outcomes are: effective coverage of mass medication using albendazole and azithromycin, detection and channelling trachomatous, trichiasis and other visual disabilities, detection and management of at least 80% of people with other ectoparasitic conditions, carrying out promotional activities, using educational material and setting up an Epidemiological Community Surveillance Committee for the EIDs in at least five communities.

BENEFICIARIES
The direct beneficiaries are approximately 2,100 people, 99% belonging to 24 indigenous peoples of the Amazon region of Colombia, several of them at risk of survival. Of these, 47.5% are women and 38% children and teenagers under the age of 15. They live in communities of 50 to 200 people which are based on subsistence economies. Indirect beneficiaries include local communities and institutions in the health sector, given that the project contributes to national goals for controlling EIDs.