Browsing by Autor "Rodrigo Moreno‐Serra"

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A Light of Hope? Inequalities in Mental Health and The Peace Agreement in Colombia: A Decomposition Analysis
(2020) Sebastián León-Giraldo; Germán Casas; Juan Sebastián Cuervo-Sánchez; Catalina González-Uribe; Antonio Olmos; Noémi Kreif; Marc Suhrcke; Oscar Bernal; Rodrigo Moreno‐Serra
<title>Abstract</title> <bold>Background: </bold>The present<bold> </bold>study seeks to evaluate the evolution of mental health inequalities in the department of Meta after the signing of Colombia's Peace Agreement in 2016 with the FARC guerrilla group. Using a validated survey instrument composed of 20 questions (‘SRQ-20’), we measure changes in mental health inequalities from 2014, before the signing of the agreement, to 2018, after the signing of the agreement. We then decompose the changes in inequalities to establish which socioeconomic factors explain differences over time.<bold>Methods: </bold>Our study uses information from the <italic>Conflicto, Salud y Paz </italic>(CONPAS) survey<bold> </bold>conducted in the department of Meta, Colombia, in 1,309 households in 2018, with retrospective information for 2014. To measure inequalities, we calculate the concentration indices for both years. Through the Oaxaca change decomposition method, we disaggregate changes in mental health inequalities into its underlying factors. This method allows us to explain the relationship between changes in mental health inequalities and reduced inequality in several sociodemographic factors. It also identifies the extent to which these factors help explain the changes in mental health inequalities. <bold>Results: </bold>Mental health inequalities in Meta were reduced almost by half from 2014 to 2018. In 2018, the population at the lower and middle socioeconomic levels had fewer chances of experiencing mental health disorders in comparison to 2014. The reduction in mental health differences is mostly attributed to reductions in the influence of certain sociodemographic variables, such as residence in rural zones and conflict-affected territories, working in the informal sector, or experiencing internal displacement. However, even though mental health inequalities have diminished, overall mental health outcomes have worsened in these years. <bold>Conclusions: </bold>The reduction in the contribution of conflict-related variables for explaining mental health inequalities could mean that the negative consequences of conflict on mental health have started to diminish in the short run after the peace agreement. Nevertheless, conflict and the presence of other socioeconomic inequalities still contribute to persistent adverse mental health outcomes in the overall population. Thus, public policy should be oriented towards improving mental health care services in these territories, given the post-accord context.
Health and Peacebuilding in Colombia: challenges and opportunities of a community training process for the post-accord
(2022) Catalina González-Uribe; Melissa Arena Simbaqueba; Sebastián León-Giraldo; Luis Fernando Arias; David Alejandro Rodríguez; Ginna Esmeralda Hernández-Neuta; Rodrigo Moreno‐Serra; Óscar Bernal
<title>Abstract</title> Following the peace agreement process in Colombia and to guarantee the right to health, a national educational program to train community leaders in technical education in public health was designed and implemented. Using qualitative methodologies, we sought reflections about the impact of the training process on the 'participant's life projects, collecting information from previous and current experiences and expectations after the program. Participants (n = 44) included peasants, afro-Colombian and indigenous communities, displaced people, victims of the armed conflict, and ex-combatants of the Revolutionary Armed Forces of Colombia - Army of the People (FARC-EP). Data collection through ethnographic observation, focus groups, and individual semi-structured interviews took place between October and November 2018. Results indicate that the participants saw the program as an opportunity to meet their goals and have better opportunities for their lives; change their way of thinking, and be reflective and open to discussion. Historical governmental and institutional abandonment was identified as a barrier for trust in the program and uncertainty on its potential benefits. Daily life co-existence during the training was a challenge between participants given their diverse backgrounds in the context of conflict in Colombia. It is important to create friendly and explanatory strategies to generate trust with and among participants accompanied with psychological support, ease successful interaction, and generate wellbeing through the program's implementation.
Health and Peacebuilding in Colombia: challenges and opportunities of a community training process for the post-accord
(2022) Catalina González-Uribe; Melissa Arena Simbaqueba; Sebastián León-Giraldo; Luis Fernando Arias; David Alejandro Rodríguez; Ginna Esmeralda Hernández-Neuta; Rodrigo Moreno‐Serra; Óscar Bernal
<title>Abstract</title> Following the peace agreement process in Colombia and to guarantee the right to health, a national educational program to train community leaders in technical education in public health was designed and implemented. Using qualitative methodologies, we sought reflections about the impact of the training process on the 'participant's life projects, collecting information from previous and current experiences and expectations after the program. Participants (n = 44) included peasants, afro-Colombian and indigenous communities, displaced people, victims of the armed conflict, and ex-combatants of the Revolutionary Armed Forces of Colombia - Army of the People (FARC-EP). Data collection through ethnographic observation, focus groups, and individual semi-structured interviews took place between October and November 2018. Results indicate that the participants saw the program as an opportunity to meet their goals and have better opportunities for their lives; change their way of thinking, and be reflective and open to discussion. Historical governmental and institutional abandonment was identified as a barrier for trust in the program and uncertainty on its potential benefits. Daily life co-existence during the training was a challenge between participants given their diverse backgrounds in the context of conflict in Colombia. It is important to create friendly and explanatory strategies to generate trust with and among participants accompanied with psychological support, ease successful interaction, and generate wellbeing through the program's implementation.
Inequalities in Catastrophic Health Expenditures in Conflict-Affected Areas and the Colombian Peace Agreement: An Oaxaca Blinder Change Decomposition Analysis
(2021) Sebastián León-Giraldo; Juan Sebastián Cuervo-Sanchez; Germán Casas; Catalina González-Uribe; Noémi Kreif; Óscar Bernal; Rodrigo Moreno‐Serra
<title>Abstract</title> BackgroundThe present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016.MethodsThe study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method.ResultsThe incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3–30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability.ConclusionsConflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.