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

• Autores: Mónica Terán Hernández
• Localización: Investigaciones geográficas, ISSN 0188-4611, ISSN-e 2448-7279, Nº. 94, 2017
• Idioma: español
• Títulos paralelos:
  • Spatial Accessibility to cervical-cancer prevention and control services in San Luis Potosi. A proposal from the Geography of Health
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• Resumen
  • español

    OBJETIVO. Diseñar un método de planeación espacial del sector salud que pueda usarse cotidianamente en San Luis Potosí (SLP), acorde a las necesidades y condiciones técnicas y financieras del gobierno del estado y de los gobiernos locales. El método debe ser sencillo (acorde a las capacidades técnicas de los planificadores, sin matemáticas complicadas), y viable en términos financieros (esto es, debe evitarse trabajar con bases de datos que impliquen mantenimiento y actualizaciones con costos elevados). MÉTODOS. Deriva de la perspectiva de la geografía de la salud, que entre una de sus líneas de investigación estima la accesibilidad a los servicios médicos. Para ello se utilizó un método de interacción espacial como un indicador de la dimensión territorial del acceso potencial a los servicios de salud en tres escalas de desagregación: localidad, municipio y jurisdicción. RESULTADOS. El 73.29% de las usuarias potenciales a los servicios que ofertan las unidades médicas (UM) tiene una accesibilidad muy desfavorable, principalmente al sureste de la entidad. La distribución espacial de la oferta no se corresponde con la distribución espacial de la demanda. CONCLUSIONES. Los resultados del método evidencian la variación socioespacial del acceso a estos servicios. Se propone incorporar la accesibilidad espacial como un indicador de la dimensión territorial en salud porque permite diferenciar áreas desfavorecidas, reorganizar espacialmente los servicios, y con ello se podría atender esta disparidad que debe ser corregida por los planificadores del sector salud.

  • English

    BACKGROUND. Accessibility to health care is a key objective to meet the population health needs at a global scale, achieving equity and quality in health services (WHO, 2014). Borgonovi and Compagni (2013:34) state that "medical care should be accessible and equitable for the entire population, based on sustainable attention from the economic, social and political perspectives". Recent studies that incorporate the spatial analysis show that cervical cancer (CC) is a disease with a progression that provides a highly valuable time span for prevention. Accordingly, timely health care largely depends on accessibility to healthcare services and the spatial distribution of the associated socioeconomic factors (Mc Grail and Lorenzo-Luaces, 2009; Cheng et al., 2011; Terán-Hernández et al., 2016a). 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 affects different geographic scales. 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 aged 15 years and older (ASR 23.3, incidence rate per 100,000) each year. The incidence of CC is higher in states with high marginalization, where women have little or no access to early detection and treatment; this is the case in San Luis Potosí (SLP) state, which ranks 8th in CC mortality in Mexico (Lazcano et al., 2008), with an ASR of 52.80 per 100,000. OBJECTIVE. Design a spatial planning method for the healthcare sector that could be used routinarily in San Luis Potosí (SLP) to meet the technical and financial needs of the State and local governments. The method should be simple (the technical capabilities of planners do not cover complex mathematics), and economically feasible (e.g. avoid working with databases that involve expensive maintenance and upgrading). METHODS. The methods used  derive from the Geography of Health, which estimates global and local accessibility to healthcare services among its core research topics. We used a spatial interaction method as an indicator of the territorial dimension in the potential access to services at three disaggregation scales: locality, municipality and jurisdiction. RESULTS. In all, 73.29% of potential services offered by healthcare units have a highly restricted accessibility, located mainly to the southeast of the state. There is no match between the spatial distribution of offer and demand. The only healthcare units certified as oncological centers and to which all malignancy cases are referred to are Hospital Dr. Ignacio Morones Prieto and Hospital del Niño y la Mujer (currently under a certification process), both located in the metropolitan area of SLP city and which rank 5th and 6th, respectively, according to accessibility index calculated in our study. For most women living in inner SLP areas, away from the capital city, this hospital is not a feasible option for early detection and treatment before the disease progresses to more advanced stages. Therefore, the healthcare units are unable to meet the demand in their respective areas of influence, e.g. in the southeast. CONCLUSIONS. Our results show the spatial variation in access to these services. We propose to incorporate spatial accessibility as an indicator of the territorial dimension in healthcare that allows to identify disadvantaged areas. The spatial identification of services will make possible to identify disparities that should be corrected by healthcare planners. In addition, when the levels of access inequality between the various territorial aggregation levels are compared between areas, evident contrasts emerge that are masked when information is aggregated. Our data revealed the existence of contrasting spatial realities; therefore, the planning of services should consider the spatial dimension besides regulatory staffing issues.