Inequitable Access to Healthcare and the Malaria Burden in Colombia: A Value-Based Policy Approach for Sustainable...

Despite broad national health coverage, malaria outcomes in Colombia remain unequal, especially in remote and rural territories. This study assessed disparities in healthcare access influencing malaria burden, severity, and mortality across Colombian municipalities from 2010 to 2023.

A longitudinal ecological study was conducted using data from the National Public Health Surveillance System, the national statistics agency, and the healthcare provider registry. Municipal indicators included the Potential Access Index for Health Services, Annual Parasite Index (API), and malaria case fatality rate (mCFR). Multivariable logistic and correlation models examined associations with diagnostic delay, travel time to care, age, and sex, adjusting for rainfall and temperature variability.

Municipalities with lower healthcare access had higher mCFR and API. Diagnostic delay >48 hours (aOR, 4.1; 95% CI, 2.24-7.11) and very low access (aOR, 95% CI, 3.5; 1.94-6.37) were the strongest predictors. Extended travel time of >2 hours (aOR, 2.8; 95% CI, 1.62-5.15) and age <5 years (aOR, 1.9; 95% CI, 1.28-3.32) were independently associated with poor outcomes. Only 39.7% of cases were diagnosed within 48 hours. Women showed higher mCFRs across access levels, while men had greater fatality where access was poorest. The average travel time exceeded 3 hours in high-burden zones. Rainfall (aOR, 1.3) and temperature (aOR, 1.2) showed modest effects without altering access-related gradients.

Persistent inequities in diagnostic timeliness and healthcare availability remain significant barriers to malaria elimination in Colombia. Strengthening local diagnostic capacity and expanding community-based services are essential for equitable and sustainable elimination.