Diagnosis
In 2021, 16,790 inhabitants in Vista Hermosa were registered, of which 47% were women, and 53% were men. Specifically, the rural settlement of Santo Domingo had approximately 310 inhabitants. There were many children, adolescents, and young people, specifically those between 5 and 19 years old. In contrast, there was a decrease in the population of children under five years old. There was an increase in people between 35 and 74 years old, specifically in women between 35 and 54 years old. In 2020, there were 12,886 victims of forced displacement, and the most affected were individuals between 10 and 24 years old. In 2019, there were 66 international migrants, mainly from Venezuela, almost 20 and 29 years old, and 68.2% were women [32].
In general, 68% of the municipality's population worked, 92% had informal jobs, and 4% of the children performed some work. Economic activities corresponded to the primary sector of the economy: agriculture, small-scale cattle and sheep rearing, and pig and fish rearing. Regarding education, 18% of the households had at least one illiterate member. Primary education coverage was 78%, and secondary education coverage was lower (50%) [33]. The socioeconomic level of the majority of the population was low: the percentage of unmet basic needs (UBN) in the urban center was 24%, while the UBN in rural and dispersed rural areas was 44% [34]. In terms of living conditions by the environment, electricity coverage was complete in the urban area and 52% in the rural settlements; water coverage was 96% in the urban area, and 30% in the rural area; and sewerage coverage was 95% in the urban area and 13% in the rural area. There was an extension of 813 linear meters of rainwater drainage. The sewage treatment plant was not operating because it collapsed, so the final disposal occurred directly in the Acacias and Jamuco streams [33].
In 2019, the gross birth rate in the municipality was 15.8 births per 1,000 inhabitants. The fertility rate was 2.3 births per 1,000 women aged 10–14 and 95.6 births per 1,000 women aged 15–19. The gross mortality rate was 4.8 deaths per 1,000 inhabitants from all causes. The neonatal mortality rate was 7.1 per 1,000 live births. The leading cause of death in children under one year of age was diseases of the perinatal period, with a rate of 14.7 per 1,000 newborns. The infant mortality rate was 22.1 deaths per 1,000 live births. Deaths of children aged 1–4 due to endocrine, nutritional, and metabolic diseases were reported at 83.3 per 1,000 newborns. In 2020, nontransmissible diseases such as cardiovascular diseases (20%) and genitourinary diseases (17%) were the main reason for consultations (6,926). When analyzed by sex, cardiovascular diseases were the main reason for consultations for both men and women. Neuropsychiatric diseases followed them in men, and genitourinary diseases in women. The second reason for consulting a doctor was syndromic diagnostic tests and undefined signs and symptoms (2,356). Nutritionally transmissible conditions had 929 consultations; the leading causes were parasitic diseases (64%). Maternal-perinatal states had 883 care visits, and their leading causes were maternal conditions (98%). Six hundred twelve mental health care visits were registered in 2020: women requested 53% of the consultations; adults aged 27–59 consulted most (185), followed by young people aged 19–26 (157). A total of 595 people with disabilities were identified in 2020: 61% were men, and almost all of them were over 80 years old. Regarding the type of disability, 57% had a limitation of the movement of the hands, arms, and legs [33].
In this study, we conducted surveys with a sample of 219 informants aged 16–89: 65% were women, and 35% were men; 28% of the participants were born in the municipality, and 74% reported being victims of armed conflict. Ninety-seven percent of the informants belonged to a Benefit Plan Administration Entity (BPAE), and 79% belonged to the subsidized scheme. Of those interviewed, only 16% belonged to a health program, more than 50% had a health condition, 35% suffered from some chronic disease, and approximately 60% were overweight or obese. In the last three years, 55% of the informants had been tested for human papillomavirus (HPV), 54% had been tested for cardiovascular screening, and 65% had been vaccinated to protect against tetanus. Screening rates for depression, colorectal cancer, sexually transmitted infections, and dental screening were low. On the other hand, pregnant women had laboratory tests in the first (100%), second (90%), and third trimesters (60%). Risk behaviors were assessed in approximately 80% (substance use). The figures for their support networks were low, as was their knowledge of nutrition during pregnancy, labor rights, depression, and gender-based violence.
Self-perception
When we asked informants about their self-perception of their health, they replied that it was excellent (20%), good (41%), neither good nor bad (26%), bad (11%), and terrible (2%). In terms of their satisfaction with the EPS and the services they had received over the last two years, most respondents said it was good and neither good nor bad. As a result of the community-based research, we identified five constructs related to the participants' values and beliefs about health, which we present below:
Table 1
Compendium of participants' values and beliefs about health
Construct | Values | Beliefs |
Health and disease processes | Be healthy | ● Being healthy means not needing help from others, which is the same as not being sick. ● Being healthy is a guarantee of good health care. |
Live in well-being | ● Well-being is living in an area where our basic needs are met. ● Well-being means living in an area where safety is guaranteed. ● Well-being means having good physical and emotional health. ● Well-being is not just an individual condition but a community condition. |
Health, body, and territory | Living in an inclusive territory | People with physical disabilities feel that the urban area lacks the appropriate infrastructure for them to live and move around easily. |
Have mental stability | ● The armed conflict in the region has affected people's mental health. ● Mental health is a neglected need in the community. ● There are not enough professionals to address the mental health of the local population. |
Health care | Nutritional habits | ● Nutritious food prevents disease. ● The land is not fertile enough to grow some items in the family basket because of illegal cultivation and spraying. |
P&P habits in healthcare centers | ● Lack of trust in the health institutions means people only seek out P&P practices for healthy living when sick. ● Women, children, and the elderly are likelier to participate in P&P programs than men. ● Poor service delivery by health institutions is why pregnant women do not seek prenatal care. |
The desire to have spaces for healthcare | Urban and rural areas lack infrastructure for young people and the elderly to engage in sports or other physical activities that contribute to their well-being. |
Networks of care | Family and community as a support network to address adverse health problems | The family is the most critical support network in the face of illness or disease, followed by the local community. |
The importance of self-care practices | People prefer to self-medicate when in pain or ill due to poor service delivery at health centers. |
Barriers to access | Improving access to the area | ● Access problems affect both physical and mental health. ● Improving roads could reduce the need for ambulances and other transport. ● The poor condition of the roads and the high transport cost mean that people only travel to the urban area for emergency care. |
Strengthening sexual and reproductive health education spaces | ● Young women feel that sexual and reproductive health education is out of context and does not provide the appropriate knowledge. ● Most adults feel that discussing sexual and reproductive health exposes young people and encourages them to develop unhealthy habits and inappropriate practices. |
Assets
During the study, we found that the municipality of Vista Hermosa has three essential assets for implementing the RIAS for Health Promotion and Maintenance and the RIAS for Maternal-Perinatal Health. First, several municipal, departmental, and national health actors have the installed capacity to strengthen health policies and services in favor of peacebuilding health interventions to reduce the vulnerability conditions of the population in urban and rural areas.
Second, the municipality has several assets that could improve the capacity of people, groups, communities, populations, social systems, and institutions to maintain and sustain health and well-being and reduce inequalities [35]. In terms of the government sector, Vista Hermosa has the Government Secretariat, the PTH, the Family Commissariat, the 68 Community Action Councils registered in the rural settlements, the Public Prosecutor's Office, the Court, the Armed Forces (National Army, Police Inspectorate, and Child and Adolescent Police), the National Registry Office and the Territorial Renewal Agency. In terms of the health sector, there are two HPIs: Llano Salud del Meta, which is a private company, and the Care Center of Vista Hermosa, which is a public company. There are also seven pharmacies. On the other hand, there are sports and leisure services, symphonic bands, and traditional dance schools. Network and technology mapping revealed a low level of coverage: only one telecommunications operator provides efficient services in the area.
Third, we found several enablers for the implementation of the RIAS. The municipality has the facilities to provide primary health care services: the Care Center provides emergency care, hospitalization, external consultations, and a clinical laboratory. It has two dental units, an operating room, a maternity unit, and an oral rehydration unit. On the other hand, the PUJ, in partnership with the hospital, provided health training to the HCT and the community and community leaders participating in the Health for Peace project.