La percepción local del acceso a los servicios de salud en las áreas rurales. El caso del pirineo navarro

BACKGROUND: While there is a growing recognition of the inequities in health protection, the rural/urban disparity in access to health services is often ignored. Rural regions accumulate not only habitat effects (dispersion, population size) but also significant demographic imbalances (ageing) and obvious socio-economic disadvantages that define barriers to accessibility. This paper analyses local perceptions of access to health services in order to identify factors that facilitate and hinder continuous primary care and follow-up of referrals. METHODS: Qualitative study conducted in the valleys of Aezkoa, Salazar and Roncal (Navarre) between 2012 and 2016. Accessibility was analysed through seven dimensions: availability, geography, affordability, accommodation, timeliness, acceptability, and knowledge/awareness. A total of 21 in-depth interviews were carried out with experts (health care personnel), key informants (related to care and local development) and sociological profiles. The information collected was checked against a conceptual framework specifically designed to facilitate the evaluation of rural accessibility policies. RESULTS: The results showed the weight given to geo-graphy, the availability of services, as well as the aging sociological environment. Accessibility was defined as a function of time versus distance and the availability of mobility alternatives. CONCLUSION: It is necessary to consider inclusive policies that address the particular features of rural populations and their territories. Ageing means a loss of general accessibility and influences demands for services. In rural and remote environments, people depend on private self-mobility as the main resource and strategy for access to health.