Access to health services and perceived quality of primary care in rural Ancash, Peru

Primary health care (PHC) is a key strategy to achieve universal health coverage; however, significant access barriers persist in rural settings, potentially compromising the quality of care. In Peru, these challenges are particularly evident in Andean rural areas characterized by geographic dispersion and structural limitations of first-level health facilities.

To analyze the association between accessibility to health services and the perceived quality of primary care in a rural population from the district of Llumpa, Áncash, Peru.

An analytical cross-sectional study was conducted among 497 adults attending first-level health facilities between July and October 2025. Accessibility to health services was assessed using the Tanahashi Health Service Coverage questionnaire, which evaluates accessibility, acceptability, contact, and availability. Primary care quality was measured using the short adult version of the Primary Care Assessment Tool (PCAT-A10). Descriptive analyses were performed, followed by Spearman's rho correlation and Generalized Linear Models (GLM) with robust estimation adjusted for sociodemographic variables.

Perception of poor quality of primary care was identified in 93.6% of participants, while 87.7% presented poor access to health services. A significant negative correlation was observed between access to health services and primary care quality (Rho = - 0.205; p < 0.001). In multivariable analysis, access to health services remained independently associated with primary care quality (B = - 0.133; p < 0.001). Additionally, the availability and contact dimensions showed significant negative associations with primary care quality.

In this rural Andean population, barriers to access to health services are significantly associated with poorer perceived quality of primary care, reflecting persistent structural gaps in the health system. Strengthening service availability and effective patient-provider contact is essential to improve primary health care performance in rural settings.