Assesing Health Services in Colombia: Development of a Conceptual Framework and Measurement tools based on primary data

Colombia has a mixed public-private health care system, and although official data indicate more than 95% of health coverage, research in this field has demonstrated the persistence of barriers to accessing health care services. This study aimed to analyze the conceptual framework of health services accessibility and develop measurement tools for its assessment using primary data and also to propose a method for ascertaining health services accessibility and availability using a territory-based approach. A mixed method study with concurrent design was carried out in four phases between 2014 and 2017. The starting points were a review of the literature and a documentary research that identified five conceptual frameworks for health services accessibility published between 1970 and 2013. It was found that the theoretical concept of health services availability has not been clear; the literature does not define it explicitly and does not differentiate it from the concept of health coverage. As a result, two measurement tools were developed: a Health Care Services Accessibility Household Survey and a Health Care Services Availability Questionnaire. These tools and the proposed method for ascertaining health services accessibility can be useful for government, institutions, and social and scientific organizations to monitor progress in guaranteeing the fundamental human right to health, declared in the Health Organic Law issued in 2015 in Colombia.