Geographic and Social Barriers to Access to Specialized Care in Rural Areas of Latin America

Introduction: Health care is a fundamental human right and an essential component of health systems; however, significant barriers to access to services persist that disproportionately affect populations living in rural areas, limiting the opportunity, continuity, and quality of care (1–3). In Latin America, these inequalities are mainly explained by the inequitable distribution of human talent in health, with a concentration of medical specialists in urban areas, as well as by geographical, economic and organizational barriers, which hinders access to specialized medical care, even in basic or first-line specialties such as gynecology, pediatrics, general surgery, orthopedics and internal medicine (4–8). These limitations are associated with diagnostic delays, inadequate management, and worse health outcomes in rural populations, gaps that persist despite the implementation of public policies, particularly in countries with high geographic and social heterogeneity such as Colombia (3,9–13). Methodology: A systematic scoping review (shopping review) will be developed following the methodology of the Joanna Briggs Institute (JBI) and the PRISMA-ScR guideline. Studies in English and Spanish published over the past 10 years will be included. The population of interest will be made up of people living in rural areas of Latin American countries, where inequality in access to specialized medical care will be addressed, including gaps, barriers and inequities related to the availability, accessibility and quality of care by specialists as well as access to advanced medical technology. The search will be carried out in the PubMed/MEDLINE, Scopus, Web of Science and BIREME (LILACS) databases, complemented by a search of grey literature. The selection of studies will be carried out by eliminating duplicates, screening by title and abstract, with subsequent full-text reading of potentially eligible articles. Data extraction will be carried out in a spreadsheet (Excel) and will include the following variables: author and year of publication, country or region of study, methodological design, characteristics of the rural population, type of medical specialty evaluated, type of inequality or barrier identified (geography, economic, logistics or health system), main findings and recommendations for public policies or health practices. Expected Results: It is expected to identify and describe the existing scientific evidence on inequalities in access to specialized medical care and the availability of basic and advanced medical equipment in populations in rural areas of Latin America. The results will allow us to recognize the main structural, geographical, economic, and health system barriers that limit timely and quality access to specialized services, as well as to identify the consequences associated with these inequalities, including their impact on health outcomes, continuity of care, late diagnosis, and the resolution capacity of rural health services. In addition, it seeks to map and analyze the strategies, care models, and interventions reported in the literature aimed at reducing access gaps, improving the availability of specialized care, and strengthening access to technologies and medical equipment necessary for optimal care in rural contexts.