Understanding the community management of long-term physical and mental health conditions in Bolivia, Colombia and Guatemala: a situational analysis

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INTRODUCTION: Community-based healthcare approaches can improve outcomes and reduce costs for long-term physical and mental health conditions. To design, evaluate and implement such interventions, it is essential to explore the existing resources of community and healthcare institutions, understand stakeholder perspectives and identify potential barriers and facilitators to community-based care for non-communicable diseases. Our aim was to conduct a situation analysis to better understand and contextualise community-based care for long-term physical and mental health conditions in Bolivia, Colombia and Guatemala. METHODS: A multimethod approach was used, incorporating three data sources: (1) sociodemographic and morbidity indicators from selected regions and healthcare centres; (1) quantitative surveys completed by health centre management staff and (2) semistructured interviews with healthcare workers, patients, caregivers and community leaders. These tools helped assess the capacity of health centres, as well as barriers and facilitators for community-based care. Data were analysed using descriptive statistics and thematic framework analysis. RESULTS: 25 health centres across the three countries were included: 12 were of low complexity, 21 in urban areas and 20 used electronic medical records. Daily seen patients ranged from 1 to 270. Most of the centres had general practitioners and nursing staff, with 72% having psychologists, 24% psychiatrists and 50% specialists in cardiovascular or metabolic conditions. Barriers to community-based care included duration and frequency of appointments, a shortage of both administrative and clinical staff, a lack of continuity in treatment, long distances for patients to travel, inadequate facilities and mental health stigma. CONCLUSION: Community interventions aim to manage long-term physical and mental health conditions; however, identified barriers may limit their implementation within the existing healthcare infrastructure and should be addressed when introducing new approaches.

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