The full text of this item is not available at this time because the student has placed this item under an embargo for a period of time. The Libraries are not authorized to provide a copy of this work during the embargo period, even for Texas A&M users with NetID.
Integrated Health Service Delivery Networks and Their Implications for the First 1,000 Days in Rural Colombia
MetadataShow full item record
Colombia faced a unique history of armed conflict that plagued the country for 60 years. This conflict created barriers to development, including healthcare access and availability. Over the last twenty years, government efforts focused on improving the healthcare system. Despite these improvements, maternal and infant mortality rates still remain high in comparison to other countries at similar levels of development. Maternal and infant mortality rates are more prominent in Colombia’s rural areas as well as among disparate populations (i.e., Afro-Colombians and Indigenous populations). The period from gestation to two years post-birth for a mother and her baby, also known as the First 1,000 Days, has been recognized as fundamental for human development. However, in order to take advantage of this window of opportunity, adequate care is needed to support women and their young children. In 2016, the Colombian government passed Resolution 429, which defined the strategic framework for Comprehensive Healthcare Policy with the implementation of Integrated Health Service Delivery Networks (IHSDNs) for more coordinated care at the community level. While beneficial in theory, the implications of this policy on the First 1,000 Days among rural and disparate populations is not yet understood. This dissertation research study examined how IHSDNs in Colombia affect access to maternal and infant health services for disparate populations residing in rural communities using a mixed methods approach. Three rural communities were selected as part of this study and vary based on their geographic location (rural) and ethnic makeup (Mestizos, Afro-Colombians, and Indigenous). In the first study, we conducted a systematic scoping review to understand how IHSDNs affect access to and continuity of care for Latin American women and infants during the prenatal period and post-birth. The second study explored the barriers and facilitators women and infants from rural communities face when accessing and receiving coordinated maternal and infant care in Colombia throughout the First 1,000 Days. Data collection included interviews with healthcare providers and women to identify factors that affect access to and continuity of care in each community. The third study encompassed a network analysis to identify and describe the referral networks’ structure for coordinated maternal and infant care in Colombia throughout the First 1,000 Days. Results from these studies suggest areas of improvement to support access to and continuity of care for women and their infants residing in rural areas of Colombia throughout the First 1,000 Days. These recommendations include: a) incorporate midwives and healers into the healthcare system, b) build stronger connections between first-level and higher-level providers for comprehensive and continuous care, c) develop a protocol for home visits, d) increase number of specialists within rural areas, e) enhance resources within first-level care, and f) partner with government infrastructure organizations to improve accessibility for rural populations. Future research could reveal how these strategies can be implemented in practice and assess their effectiveness. Additionally, a comparison study between urban and rural areas could also prove useful to identifying gaps within the healthcare system that should be addressed. Finally, looking at healthcare access from the perspective of specialty care could reveal important findings to enhance the healthcare continuum, as well.
Panjwani, Sonya S (2022). Integrated Health Service Delivery Networks and Their Implications for the First 1,000 Days in Rural Colombia. Doctoral dissertation, Texas A&M University. Available electronically from