Access to health services: analysis of barriers and strategies in Medellin, Colombia/Acceso a servicios de salud: analisis de barreras y estrategias en el caso de Medellin, Colombia/Acesso aos servicos de saude: analise de barreiras e estrategias no caso de Medellin, Colombia

Context: The access to health services is an increasingly worrying topic in the research and public policies agendas. In the case of Colombia, this topic becomes more important and attains supremacy opposite to assurance. Objective: Building a concept of access and identifying barriers, as well as strategies and alternatives to overcome them from the perspective of the actors of the health system in Medellin. Materials and Methods: qualitative research, focused on three areas of Medellin. We used techniques such as semi- structured interviews; social cartography workshops; observation and result questionnaires of the services. Results: The vision on the access is heterogeneous between actors, although some similarities and differences were identified, that allowed us to build a proposal of the concept of access. The barriers and factors that facilitate access can be attributed to factors on the offer side as well as on the demand side. Most of the barriers happen during real access, during the search and continuity of the treatment. The social characteristics of the population, such as knowledge of the system and social and community support are also determinant factors of access. Discussion and Conclusions: All actors use strategies to solve the access barriers and are affected by them on different levels. The qualitative analysis of the concept of access, of barriers and facilities, allow the identification of alternatives that may serve as components for health policies. Keywords: access to health services; health equity; access barriers; health policies; qualitative analysis; Colombia Contexto: el acceso a servicios de salud es un tema de creciente preocupacion, en el caso colombiano ha ganado importancia frente al aseguramiento. Objetivo: construir un concepto de acceso e identificar barreras y estrategias, desde la perspectiva de actores en Medellin. Material y metodos: investigacion cualitativa con enfasis en tres zonas de Medellin. Resultados: se identificaron similitudes y diferencias en la vision del acceso, las cuales permitieron construir el concepto. Las barreras y los facilitadores se atribuyen a factores de oferta y de demanda. La mayoria de las barreras se dan en el acceso real, durante la busqueda y continuidad del tratamiento. Algunas caracteristicas sociales de la poblacion tambien son factores determinantes. Discusion y conclusiones: los actores recurren a estrategias para solventar las barreras de acceso. El analisis cualitativo del co