The thesis reveals the difficulties to access diagnosis and treatment and illustrates how changes in the treatment could increase access to care and decrease the costs for patients and the health system.
The main objective of this study was to investigate the health-care access among patients with cutaneous (CL) and mucosal leishmaniasis (ML) and to explore alternatives to improve the access of those patients in the poverty context of the Bolivian rainforest.
To achieve this, four specific objectives were considered: i) to assess the relationship between context and the risk of CL (sub-study 1); ii) to estimate the under-reporting level of the National Leishmaniasis Control Program (NLCP) in order to capture the lack of health-care access among patients with CL and ML (sub-study 2); iii) to explore the experiences of accessing and using health services among people affected with leishmaniasis (sub-study 3); and iv) to evaluate economically the implementation of a new treatment (Intralesional pentavalent antimonials) as first-line treatment for CL and its potential effect on health-care access (sub-study 4).
Sub-study 1 showed men were the most vulnerable group, whereas no other contextual factors were significant. Activities promoting occupational safety must be in place to prevent the disease.
Sub-study 2 revealed a high level of underreporting (73%) which portrays a low level of health care access. The NLCP needs to improve its surveillance system to be able to measure accurately the burden of the disease for a timely response to people's needs.
Sub-study 3 uncovered several weaknesses in primary care centers related to unavailability of drugs and equipment, and lack of experience of medical staff on recognizing and treating the disease, forcing patients to travel long distances. This can be a rough and expensive journey leading often to catastrophic expenditure for already poor economies. Strengthen primary care in rural areas must be ensured to protect the right to health of people in vulnerable contexts of poverty.
Sub-study 4 showed that the implementation of the new treatment would not only reduce costs but also increase the number of patients accessing the treatment. The implementation of this new treatment is highly recommended.
Sub-study 1 applied a cross sectional design and multivariate regression analysis (n=274). Sub-study 2 used a capture recapture method (n=512) and sub-study 3 a qualitative methodology (n=14). Sub-study 4 conducted a cost analysis and budget impact analysis in four hypothetical scenarios using official documents, surveys and key informants.
Daniel Eid Rodriguez comes from Bolivia where he works as a researcher at San Simon University in Cochabamba and providing medical care to indigenous groups in the rainforest. He plans to keep researching on the improvement of health care access to marginalized groups.