This piece of work consisted in identifying and analysing the travel patterns of women accessing health services available in the Pinal de Amoles municipality in Querétaro state, Mexico, with the aim of determining the causes which limit the mobility of health service users and, based on this, to offer suggestions which might support the development of actions and programmes designed to improve said mobility, in such a way that their needs can be opportunely met.    

The Pinal de Amoles municipality is characterised by having one of the lowest indices of human development in the 18 municipalities which make up the state of Querétaro (0.665, comparable to the country of Equatorial Guinea in Africa). The municipality’s female population corresponds to 52% of the total. The municipality shows a high percentage of migration to the Mexican capital and the United States. The region where the municipality is situated is mountainous. The municipality has a highly dispersed population and possesses more than 250 kilometres of rural dirt roadways, all of them in different degrees of deterioration. 

From the field work carried out in this municipality and the use a model of analysis which inter-relates the health system and the existing transport system, the following findings were made.

The use made by women and their children of the health services in Pinal de Amoles basically depends on the sort of complaints they experience. In fact, the women “assess” their complaints and those of their children and if these are not “serious”, such as colds, temperatures, coughs, blood pressure or “general malaise”, then they stay at home, treating themselves with household remedies, teas and herbs. Nevertheless, if the illness progresses or worsens or they suffer some kind of accident then the moment arrives to visit the doctor as an emergency.    

Three out of every four women said they leave their community to see a doctor, the rest wait for the arrival of the health unit. These journeys away from the community vary depending on how far a certain community is from the health centres, on whether there is public transport, on the condition of the country roads and paths, on whether the woman can pay for the journey, on age and on weather and topographical conditions.  

It was observed that woman and children mainly attend the health centres assigned to them or the closest to their community. Apart from this, there are communities which have to be attended to by health centres in other municipalities due to the mountains which separate them from the health services available in the Pinal de Amoles municipality.

On analysing the information collected in the field, the communities visited (38 out of a total of 198) were grouped according to three types of mobility:

1. Limited mobility (37% of the communities visited). Defined as that where the isolated communities depend entirely on walking and paths to get to the nearest health centre or in other cases to reach the closest transport service to get to the doctor. In fact, the interviewees mentioned that getting sick people out has to be done stretcher-style, using a chair or carrying them. It is important to mention that also included in this category are those communities that have a rural roadway but no sort of transport service, which means that walking is the only option available. Finally, included in this category are those communities which have a rural roadway and a transport service but because people generally don’t have the economic resources to pay for transport, they opt for walking.

2. Regular mobility (39% of the communities visited). Into this category fall those communities which are characterised by having rural roadways and transport services or are close to one, which means that most of the women interviewed choose to use “micros” (popular name given to the passenger trucks) or pick-up trucks to go to the doctor or they walk part of the way to get to the transport service. 

3. Acceptable mobility (24% of the communities visited). This classification refers to those communities located next to a highway or country road and where the women and their children can make use of one of the transport services available: bus, “micro”, pick-up or taxi. Depending on the ladies’ ability to pay, they would be able to use any of the transport services mentioned as often as necessary. Another characteristic of these communities is that they are close to health services or have a health centre of their own.  

So it is, and by way of conclusion that the factors which limit the women’s mobility in accessing health centres were found to be:
- The widely scattered communities.
- The municipality’s extremely difficult topography (mountains).
- The bad condition of rural roadways, which affect the transport services’ and mobile health units’ operation.
- The transport services, due to the fact that they do not respond adequately to the needs of the Pinal population, or to their low income.  
- The women’s ability to pay which limits their access to transport services.

Finally, based on the above, we briefly touch on two of the nine recommendations put forward on the subject of transport and health:

- To use low cost technologies such as animal traction (oxen and horses with specially adapted equipment) for the maintenance and repair of country roads.
- To increase the visits of mobile units so as to help the municipality’s poor families in avoiding spending their limited means on transport services and meals when they find themselves in need of attending a health centre.  

This opinion piece was contributed by José Alfonso Balbuena Cruz,
Mexican Transport Institution, Mexico.

Contact: Alfonso.Balbuena [at] imt.mx

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