Impact of The Armed Conflict in Colombia: Consequences in The Health System, Response and Challenges

Abstract

Abstract Introduction In Colombia, health and conflict research has focused on mental health, psychosocial care, displacement, morbidity and mortality. Few scientific studies have assessed health system functioning during armed conflict. In the context of a new period characterized by the implementation of the peace agreement with the FARC armed group, understanding the effects of armed conflict in the health system, the functions and institutions shaped by the conflict is an opportunity for understating pathways and the scope post-conflict health policy reforms. Therefore, this study was conceived to assess the effects of armed conflict on the health system, the response and mechanisms developed to protect medical mission during the armed conflict in Colombia. Methods A qualitative study was conducted using semi-structured interviews and focus group discussion. The qualitative guide collected information in four sections: 1) conflict and health system; effects and barriers in health service provision, 2) actions and coordination to cope with those barriers 3) health policies and armed conflict 4) post accord and current situation. A total of 22 people participated in the interviews, including 8 Policymakers at national level and 7 at local level – 2 NGO´s – 5 Members of international organizations. An academic project event in December 2019 and four focus group were developed (Coffee World technique), to discuss with national and local stakeholder, the effects of armed conflict in health system and an analytical framework to analyze its consequences Results The conflict affected the health-seeking behavior of the population, limited access to healthcare provision, affected health professionals, and was associated with inadequate medical supplies in conflict areas. The health system implemented mechanisms to protect the medical mission, regulate healthcare provision in conflict areas and committed to healthcare provision (mental and physical health services) for the population displaced by the conflict. Conclusion Presence, trust and legitimacy of the state has been truncated during recent years, but its recovery is essential and must be based on the real presence of the state and health services in the territories and dispersed rural areas.