Oral health care and geographic access barriers in Nariño (Colombia)

Objectives: 1.To conduct an inventory of health care institutions and dental care providers in Nariño, one of the remote states of Colombia (in the Pacific coast, 600 km from Bogotá), 2. To identify if the number of dentists (primary and specialized) is sufficient to attend the population needs, 3. To determine the existence of geographic barriers to dental care services.
Methods: A cross-sectional descriptive study with ethnographic tools, which worked with primary sources and secondary information from the sixty-four municipalities in the state. A measurement system was developed to identify the travel time (in different means of transportation) from a municipality to the city of Pasto, only city with Specialized Dental Care. A travel time of more than 4 hours or a distance longer than 25 Km were considered access barriers. Analytic maps with color gradients were elaborated according to the access barrier identified.
Results: Nariño has primary dental care centers in the entire state and specialized dental care only in 5 municipalities. From a total of 1367 oral health providers, 670 were concentrated in three municipalities. The ratio dentist:patient was 1:6689 (WHO recommends 1:3000). The transportation in the Pacific area is possible only by river/sea/air, it is not regulated, and has a very high cost. From the 64 municipalities analyzed, 3 did not have access barriers in terms of travel time or distance.
Conclusions: The travel time and the means of transportation generate access barriers to dental care services in Nariño, accentuated in remote municipalities. Geographic location of health care providers has been worldwide identified as a determinant of access to healthcare and a potential source of inequalities. To guarantee a universal access to dental health care in Colombia, it is required a system that responds adequately with human talent in quality and sufficient availability.