Abstract
BackgroundWorldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them.MethodsData gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis.ResultsThree types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine.ConclusionsMDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients’ travel to distant health facilities.Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.
Highlights
Worldwide, rural communities face barriers when accessing health services
Serumistas posted to Health center (HC) had more diagnostic resources than those posted to Health post (HP), both groups expressed similar diagnostic challenges
Serumistas posted to facilities in the Amazon region discussed difficulties making differential diagnoses between respiratory infections, malaria and other diseases that presented with acute febrile syndrome such as dengue and leptospirosis
Summary
Rural communities face barriers when accessing health services. In rural communities worldwide health care providers often face a number of challenges and barriers when trying to provide services. Stakeholders at different levels (including innovators, donors and governments) could benefit from a deep understanding of the health related challenges and needs in the target settings. Previous studies have assessed the perceptions of rural health professionals regarding the specific needs to improve health services at their own settings, including point of care equipment for diagnosis and therapeutics [13, 14], information and communication technology [15,16,17,18] and training needs to overcome clinical problems and socio-cultural issues [19, 20]
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