<by Sébastien Coquoz, Project Cycle Management Officer at the Norwegian Refugee Council in Colombia>
As the Colombian government and the FARC-EP are nearing a peace agreement, serious human rights violations are still the daily bread of many communities and individuals in impoverished and conflict-affected regions, causing protests and high levels of violence. The right to health is fundamental and illustrates well how important it is to address the root causes of the conflict and improve the human rights situation in order to achieve sustainable peace in Colombia.
This article describes some of the difficulties in impoverished and conflict-affected areas of Colombia regarding the enjoyment of the right to health, which is fundamental for the wellbeing of rural communities, ethnic groups, victims, the demobilized and the population at large in the post-conflict period.
Lack of qualified health personnel
In numerous poor and war-torn municipalities, there are no specialized doctors. Colombia is a country which can and should assign more resources to the health sector in these marginalized areas and increase efforts to incentivise qualified health personnel to work and stay in those needy areas. When hospitals or health centres exist, they do not have the adequate equipment and personnel to respond to the physical, mental and social health needs of the population. Worst, numerous hospitals have been badly managed and wages are often months overdue, which means health personnel get frustrated and sometimes decide to leave, and the already critical qualified doctor and health personnel crisis gets deeper.
Lack of information
Another major concern is the lack or inadequate articulation between the different health sector actors at local level, such as health secretariats, Department of Social Prosperity representatives, local ombudsmen, hospitals and other health entities. For instance, crucial information on the needs of children with disabilities does not always get to the responsible dependency which can thus not guarantee an adequate response to these children’s needs. Also, the civil servants and personnel’s knowledge on the right to health and the state’s obligations is often quite poor at local level. The state also needs to increase the population’s knowledge and use of mechanisms to claim their right to health, for example through favouring and supporting civil society and community leaders’ local initiatives.
Challenges in rural areas
Furthermore, the rural population is in dire need of quicker and more effective access to health services. Health centres at local level are often precarious and do not have sufficient drugs and equipment. In some communities, patients are given the same pill for all types of illnesses and diseases. The lack of roads means patients have to walk, ride horses or donkeys for hours and even days, and in some areas they depend on expensive boat fares. Several patients cannot afford the journey while others die on the way. Mobile health brigades are scarce and infrequent with several months of delay. It is thus necessary for the government to guarantee that these brigades visit rural communities more frequently and include sufficient qualified personnel.
Rural areas are also where most of the indigenous and Afro-Colombian populations in Colombia live. It is also imperative that the government strengthens its efforts to support these communities in designing and implementing their proper health systems, in line with its obligation to guarantee the right to culturally acceptable health care and collective rights of ethnic groups. For instance, the authorities should seek to facilitate traditional doctors’ access to medicinal plants, favour their work and movement across the territory, and include them into the mobile brigades, together with interpreters and members of the indigenous guard. Additionally, the authorities and the health sector actors need to adapt prevention and attention to the needs, fears and understanding of ethnic groups about what is and should be adequate health care. Lastly, they should also pay close attention to ethnic and rural communities’ claims of discrimination when seeking to access the state’s health services, particularly regarding reception and attention at municipal and departmental hospitals.
The way forward
A better attention, quality service and enforceability through legal and pacific means are therefore key in order to avoid the numerous instances of protests and use of violence and build sustainable peace in Colombia. Measures such as increasing qualified health personnel, improving articulation between the different health sector actors, ensuring better management and supervision of hospitals and extending and improving health services to rural and ethnic populations would go a long way not only in improving Colombian’s enjoyment of physical, mental and social health, but also in building the necessary trust between the state and the different segments of the population for harmonious coexistence and reconciliation.