When the doctor doesn't arrive: the realities of care in remote areas of Colombia

In August 2024, a pregnant woman and her baby died in El Litoral del San Juan, Chocó, without receiving medical attention.

She went into labor at home, in the midst of an armed strike by the ELN that paralyzed river transport in the region. There was no fuel, no way to transport her, no options. She died waiting for care that never arrived. That same day, in another municipality in Chocó, a 16-month-old girl also lost her life from preventable causes and for the same reason: access to healthcare was not possible.

How is it possible that in Colombia, a country that boasts universal healthcare coverage, there are still people who die simply because they cannot reach a hospital? This is the reality we have in Colombia. According to the National Statistics Institute (DANE), by 2018, nearly three million Colombians did not have access to health services.

This reality, which hits rural, Indigenous, and Afro-descendant communities hard, is a reflection of a profound crisis: the lack of access to healthcare services in remote areas. A problem that not only violates fundamental rights but also perpetuates inequality and structural neglect.

Through this blog, we are working to raise awareness of this social problem, investigating its causes, its human impact, and possible interventions.

The objective of this blog is to expose this problem from a human and critical perspective and to present a contextualized, viable, and territorially focused solution that will contribute to closing the health gap in the country's most neglected regions.

What is the real problem?

In Colombia, the right to health is enshrined in the 1991 Constitution as a fundamental right. However, in practice, millions of people living in rural and remote areas lack access to decent, timely, and continuous health services. This situation particularly affects Indigenous, Afro-descendant, and rural communities living in regions such as La Guajira, Chocó, the Amazon, and parts of Cauca and Putumayo.

According to DANE (2022), more than 25% of the rural population reported barriers to accessing health services. The main causes include geographic remoteness, lack of road infrastructure, lack of equipped health centers, and a shortage of medical personnel. Added to this are the armed conflict, armed strikes, and state neglect, which further aggravate the situation in regions such as Chocó, where the maternal mortality rate is one of the highest in the country.

From a historical perspective, the Colombian healthcare system has been marked by a strong centralization of resources and services in cities, while rural areas have lagged behind. Law 100 of 1993, which reorganized the healthcare system under an insurance model, failed to guarantee equity in access, and many healthcare providers (EPS) do not operate or operate on a very limited basis in rural areas.

The human impact of this crisis is devastating. Every year, hundreds of people die in Colombia from treatable or preventable diseases simply because they cannot reach a medical center in time. Pregnant women, malnourished children, older adults with chronic illnesses, and victims of accidents or violence are trapped in a cycle of exclusion. The Pan American Health Organization has warned that inequality in access to healthcare services is one of the leading causes of preventable mortality in Latin America.

From a global perspective, access to healthcare has been recognized as an essential component of sustainable development (SDG 3: Good Health and Well-being). The situation in Colombia highlights how structural inequalities impede the achievement of this goal, particularly in rural and ethnic contexts.

For all the above reasons, this problem cannot continue to be ignored. The lack of access to healthcare in remote areas not only violates basic human rights but also perpetuates cycles of poverty, exclusion, and violence. It is urgent to develop and implement solutions that integrate the territorial reality, the cultural needs of communities, and an intersectoral approach that transcends conventional health plans.

What is the solution?

Faced with the alarming lack of access to healthcare services in remote areas of Colombia, our proposal seeks to bring medical care directly to neglected communities, using an interdisciplinary, territorial, and sustainable model. We have designed a solution based on the implementation of Community Mobile Health Units, supported by technology, community participation, and intersectoral partnerships.

Main components of the solution:

Mobile health units adapted to the territory:

Boat-type vehicles, 4x4 trucks, or even drones (depending on the geographic setting), equipped with everything necessary to provide primary care, prenatal checkups, vaccinations, telemedicine, and medication delivery.

Technology and telemedicine:

The units will be connected to urban centers through teleconsultation platforms, enabling remote assistance from specialists and monitoring of patients with chronic diseases.

Training of community health workers:

People from the same community will be trained to identify risks, perform basic follow-up care, and serve as liaisons between medical teams and the population, respecting cultural and linguistic diversity.

Institutional partnerships and sustainability:

The project seeks to integrate with public and private health institutions, as well as local NGOs, to secure long-term funding, logistics, and technical support.

A unique and impactful approach

What makes our solution unique is its cultural and territorial adaptability. It is not about replicating an urban model in a rural setting, but rather creating a response that stems from an understanding of the territory and the real needs of the community. Furthermore, by involving the residents themselves in the process, local autonomy is strengthened and trust in the health system is generated.

A truly interdisciplinary approach

The proposal was built from different areas of knowledge that enriched its design:

From medicine and public health, the main clinical and health barriers were identified, and the most urgent basic services were prioritized.

From an engineering perspective, logistical and technological solutions were proposed to efficiently connect the mobile units with urban centers.

From a social science perspective, elements of community participation, a differentiated approach, and recognition of traditional knowledge were incorporated.

From an economic perspective, financial viability was assessed and a sustainability model was proposed through public-private partnerships.

Our solution does not aim to replace the healthcare system, but rather to close gaps that have historically been ignored, bringing dignity, care, and hope to the areas that need it most.

Impacts and benefits

The implementation of Mobile Community Health Units has the potential to transform the lives of thousands of people in rural and remote areas of Colombia. By ensuring access to basic services such as medical consultations, vaccinations, prenatal care, and medication delivery, this solution would reduce preventable deaths, strengthen prevention, and improve the quality of life of the most excluded communities.

In the short term, a decrease in emergency transfers, an increase in preventive health coverage, and greater trust in the health system are expected. In the long term, this proposal can contribute to closing historical health gaps, empowering communities, and strengthening their health autonomy.

Furthermore, our model can serve as a reference for other Latin American countries with similar contexts, such as Peru, Bolivia, and Brazil, where rural populations also lack access to health care for geographical or social reasons.

Our vision is clear: to build a territorial care model that does not depend solely on infrastructure, but on the will to reach where it has historically been unable to reach. A model that recognizes the dignity of all people, regardless of their place of residence.

Conclusion

The lack of access to healthcare in the most remote areas of Colombia is a reality that violates fundamental rights and perpetuates historical inequalities. This is not just a failure of the system, but a social debt owed to millions of people who have been invisible for decades.

Our proposal for Community Mobile Health Units seeks to be part of the solution: a way to bring healthcare to those who need it most, adapting to the territory, respecting cultural diversity, and leveraging collaborative work between communities, professionals, and technology.

Addressing this problem is not only the responsibility of the State, but also of all of us as a society. How long will we accept that being born in a remote place determines whether a person lives or dies due to a lack of medical care?

It's time to act. To bring healthcare to places it has never been before. And you, what would you do to build a more just country with healthcare for all?

Literature

Agencia, E. F. E. (2024, agosto 16). Una mujer en trabajo de parto murió por consecuencias del paro armado del ELN. El Heraldo. https://www.elheraldo.co/nacional/2024/08/16/una-mujer-en-trabajo-de-parto-murio-por-consecuencias-del-paro-armado-del-eln/