Grupo de Investigación en Movilidad Sostenible (GIMS), Departamento de Ingeniería Civil, Facultad de Ingeniería y Arquitectura, Universidad Nacional de Colombia, Sede Manizales, Campus La Nubia, Km 7 vía aeropuerto, Manizales, 170003, Colombia
Rural Remote Health. 2021 Oct;21(4):6128. doi: 10.22605/RRH6128. Epub 2021 Oct 2.
Colombia's rural areas have suffered from government neglect, exacerbating their difficulties in relation to geographic isolation and meeting basic needs. These were some of the main reasons for guerrillas to initiate an armed conflict in the 1960s, trying to expand their forces and control through the rural and remote areas of the country. In this sense, it is necessary to construct new categories of rurality in Colombia, considering the armed conflict and the typology of isolation as variables that help policymakers and planners to make better decisions.
Based on 27 municipalities in the department of Caldas in Colombia, three accessibility measures were assessed to define isolated areas: geographical accessibility, access to health facilities and access to higher education. Health facilities were measured in three scenarios according to the flow of health care defined by the government. Higher education scenarios were defined according to Ministry of Education levels. Travel time was used as an attribute to calculate the isolation index of municipalities and was calculated using the Google Distance Matrix API using Python v3.7. As a measure of accessibility, a travel time limit was defined to delimit isolated areas. This variable was then added to the categories of rurality and armed conflict to produce the isolation typology by municipality.
A strong correlation was found between all variables. Considering geographical accessibility, 20.3% of Caldas' population is isolated. The isolated population rises from 12.2% at the first level of health care to 43.2% of the population at the third level, and 39.5% of the inhabitants are far from universities. The municipalities highly affected by the armed conflict are more isolated in terms of travel time to health care and higher education facilities than those that were not affected.
The isolation typology complements the Colombian rurality categories and can help governments make decisions about investments in road infrastructure, health, and education. In addition, some non-rural municipalities were found to be isolated, showing low accessibility to health and higher education, and the government should pay more attention to these areas. The government's neglect of municipalities highly affected by the armed conflict is shown by their continued isolation rates. The government should invest more and better in these areas taking into account this method of decision making. The typology of isolation could help the government to better plan care pathways for patients with complex health needs. In addition, it could help determine the investment for upgrading an existing hospital or building a new one, taking into account underserved areas. In terms of higher education, the isolation typology could help to understand where the community is underserved and initiate investment policies to improve access to higher education for its population.
哥伦比亚的农村地区一直受到政府的忽视，这加剧了他们在地理位置偏远和满足基本需求方面的困难。这也是 20 世纪 60 年代游击队发动武装冲突的主要原因之一，他们试图通过农村和偏远地区扩大自己的势力并控制这些地区。在这种情况下，有必要在哥伦比亚构建新的农村类别，考虑到武装冲突和隔离类型作为帮助决策者和规划者做出更好决策的变量。
基于哥伦比亚卡尔达斯省的 27 个市镇，评估了三种可达性措施来定义偏远地区：地理可达性、获得卫生设施的机会和获得高等教育的机会。根据政府规定的医疗保健流动情况，对卫生设施进行了三种情景的测量。根据教育部的级别，确定了高等教育场景。使用旅行时间作为属性来计算市镇的隔离指数，并使用 Python v3.7 中的 Google 距离矩阵 API 进行计算。作为可达性的衡量标准，定义了一个旅行时间限制来划定偏远地区。然后，将此变量添加到农村类别和武装冲突中，以按市镇生成隔离类型。
发现所有变量之间存在很强的相关性。从地理可达性来看，卡尔达斯省 20.3%的人口处于隔离状态。在第一级医疗保健设施中，隔离人口从 12.2%上升到第三级医疗保健设施中的 43.2%，而 39.5%的居民远离大学。在武装冲突中受影响较大的市镇在前往卫生保健和高等教育设施的旅行时间方面比未受影响的市镇更加孤立。
隔离类型补充了哥伦比亚的农村类别，可以帮助政府在道路基础设施、卫生和教育方面做出投资决策。此外，还发现一些非农村市镇也存在隔离，表明它们在获得卫生和高等教育方面的可达性较低，政府应该更加关注这些地区。政府对受武装冲突影响较大的市镇的忽视表现为它们的隔离率持续居高不下。政府应该考虑到这种决策方法，在这些地区投入更多和更好的资金。隔离类型可以帮助政府更好地规划有复杂健康需求的患者的护理路径。此外，它还可以帮助确定现有医院升级或新建医院的投资，考虑到服务不足的地区。在高等教育方面，隔离类型可以帮助了解社区服务不足的地方，并启动投资政策，以提高其人口获得高等教育的机会。
