Accesibilidad espacial de los servicios de prevención y control del cáncer-cervicouterino en San Luis Potosí

Abstract

Background

Accessibility to health care is a key objective, internationally speaking, to the satisfaction of population health needs. Equity and quality in access to health services (WHO, 2014). Borgonovi and Compagni (2013:34) argue that “medical care should be accessible and equitable for the entire population, based on sustainable attention economically, socially and politically speaking”. Recent studies that incorporate the spatial analysis show that the Cervical Cancer (CC) is a disease which evolution provides a very valuable period of time for its prevention, for that its well-timed care depends a lot on the accessibility to medical services and the spatial distribution of related socioeconomic factors (Mc Grail And Lorenzo-Luaces, 2009; Cheng et al., 2011; Terán-Hernández et al., 2016a). The CC is the fourth most common cancer in women and the seventh overall in the world, affecting 528,000 individuals each year worldwide, with an age-standardised incidence rate (ASR) of 14.0 per 100,000 women. CC is reflected in different geographic distributions. It is a significant public health problem, especially in low and middle-income/Gross Domestic Product (GDP) countries. In Mexico, CC affects 13,960 women 15 years old or older (ASR 23.3, incidence rate per 100,000) annually. The incidence of CC is higher in states with high marginalisation, where women have little or no access to early detection and treatment. For example, in San Luis Potosí (SLP) state, which ranks 8th in CC mortality risk in the country (Lazcano et al., 2008) and ASR of 52.80 per 100,000.

Objective

Design a method of spatial planning in the health sector that can be used on a daily basis in San Luis Potosí (SLP). To be exact, that it meets the needs, technical, and financial conditions of the government of the State and local governments. It is proposed that the method should be: simple (the technical capabilities of planners do not cover complicated mathematics); and feasible in financial terms (e.g. avoid working with databases that involve maintenance and upgrades to high cost).

Methods

It derives from the perspective of Geography of health, which between its lines of investigations, deals with the theme to estimate global and local accessibility of medical services. We used a method of spatial interaction as an indicator of the territorial dimension in the potential access to services at three scales of territorial disaggregation: by locality, municipality and by jurisdiction.

Results

The 73.29% of potential users to services that offer the medical units has a very unfavourable accessibility, mainly to the southeast of the state. The spatial distribution of the offer does not correspond to the spatial distribution of demand. The only medical attention unit certified as an oncological centre and where all dysplasia cases are referred to is the Hospital Dr. Ignacio Morones Prieto or Hospital del Niño y la Mujer (in certified process), which are located in the metropolitan area of SLP city and ranks 5th and 6th according to the index of accessibility calculated in our study. For most of the women inhabiting the inner SLP states, far removed from the state capital, this hospital is not a viable option for early detection and treatment, before the illness evolves to advanced stages. Therefore, the medical units are unable to meet the demand generated in their respective areas of influence, for instance, in the southeast.

Conclusions

The results of the method show the spatial variation in access to these services. It is proposed to incorporate the spatial accessibility as an indicator of the territorial dimension in health that allows differentiating disadvantaged areas, in order to spatially reorganize services, and as a result, this disparity which must be corrected by the planners in the health sector might be solved. In addition, when comparing the level of access inequality between the different levels of territorial aggregation there are very evident contrasts by what the aggregation of information could hide very different realities as our data denote, hence you should consider the spatial dimension in the planning of services and not only regulatory aspects of staffing.