The Amazon Hope: A qualitative and quantitative assessment of a mobile clinic ship in the Peruvian Amazon

PLoS One. 2018 Jun 21;13(6):e0196988. doi: 10.1371/journal.pone.0196988. eCollection 2018.

Abstract

The Loreto region of the Peruvian Amazon faces many obstacles to health care delivery. The majority of the population is river-bound and lives below the poverty line, with some of the worst health indicators in Peru. To overcome these barriers and fill a gap in health services, an NGO-based provider known as the Vine Trust has been providing care since 2001 via a mobile ship clinic called the Amazon Hope. This study presents an assessment of the Amazon Hope, first reporting health indicators of the program´s catchment area, services provided, and program utilization. It then describes perceptions of the program by community members and health workers, the program's strengths and weaknesses in contributing to health service delivery, and provides recommendations addressing limitations. The qualitative analysis included 20 key informant interviews with community members and health service providers. In the quantitative analysis, 4,949 residents of the catchment area were surveyed about medical histories, experiences with the program, and suggestions for improvement. The survey showed poor indicators for reproductive health. The AH clinic was the main provider of health care among those surveyed. Community members reported satisfaction with the program's quality of care, and health workers felt the program provided a unique and necessary service. However, community members requested prior notification and additional services, while health workers described misunderstandings in community-tailored care, and difficulties with continuity of care and coordination. Data show that the program has been successful in providing quality health care to a population but has room to improve in its health service delivery. Suggested improvements are provided based on participant suggestions and relevant literature. The study sheds light on the important role of mobile clinics in Peru, and the methodology can serve as a model for assessing the role of mobile clinics in other remote settings.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Delivery of Health Care*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Peru
  • Quality of Health Care*
  • Ships*

Grants and funding

This project was supported by 1) The National Institutes of Health (NIH) Research Training Grant #R25 TW009345 funded by the Fogarty International Center (FIC), the NIH Office of the Direct Office of AIDS Research, the NIH Office of the Director Office of Research on Women’s Health, The National Heart, Lung and Blood Institute, the National Institute of Mental Health and the National Institute of General Medical Sciences, 2) Kuskaya: An Interdisciplinary Training Program for Innovation in Global Health Award Number D43 TW009375-01A1 funded by the FIC of the NIH, 3) Grand Challenges Canada (GCC), 4) Cienciactiva from the Peruvian National Council of Science and Technology (Concytec), and 5) Vine Trust. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, GCC, Concytec or Vine Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.