Cerrejon Standard of Living Ingles

Standard of living and health:
An Assessment of Cerrejn Area of Influence
Responsible Mining
Biblioteca Nacional de Colombia - Cataloguing in publication data Standard of living and health : an assessment of Cerrejn area of influence / edited by Fernando Ruiz, Mauricio Ferro. -- 1st. ed. -- Bogot : Pontificia Universidad Javeriana : Ecoe Ediciones, 2013 384 p. Includes glossary and bibliography ISBN 978-958-648-989-8 1. Standard of living Research - La Guajira 2. Primary Health Care Research - La Guajira 3. El Cerrejn - Medical and Health Affairs Research 4. La Guajira - Socioeconomic Conditions - Research I. Ruiz, Fernando, ed. II. Ferro, Mauricio, ed. CDD: 307.7660986117 ed. 20 CO-BoBN a840319
First edition: Bogot, May 2013 ISBN 978-958-648-989-8 Instituto Cendex - Universidad Javeriana E-mail: cendex@javeriana.edu.co Editorial coordination: Ins Mara Andrade Desktop Publishing: Astrid Prieto Cover: Wilson Marulanda Printing: Imagen Editorial E-mail: imagenimvega@yahoo.com
Printed and made in Colombia - All rights reserved

Editors
Fernando Ruiz Mauricio Ferro
Jeannette Liliana Amaya Mauricio A. Crdenas Mauricio Ferro Authors Rolando Enrique Pealoza Anglica A. Quiroga Fernando Ruiz Christine Laurine Translated by Susan Cowles Mauricio Ferro
LEN TEICHER CEO LUIS GERMN MENESES Chief Operations Officer (COO)
Responsible Mining
JULIN BERNARDO GONZLEZ Vice President, Sustainability and Public Affairs JOS LINK Expansion Project Manager
JOAQUN EMILIO SNCHEZ GARCA S.J President VICENTE DURN CASAS S.J Provost JAIRO CIFUENTES MADRID Registrar FERNANDO RUIZ GMEZ Director, Cendex MARA ALEXANDRA MATALLANA Gmez Technical Director, Cendex Rolando ENRIQUE PEALOZA QUINTERO Director, Health Economics and Policies Group, Cendex
Authors
CHAPTER I.
AREA OF INFLUENCE
MAURICIO A. CRDENAS MAURICIO FERRO
CHAPTER II.
METHODS AND PROCEDURES

JEANNETTE LILIANA AMAYA MAURICIO A. CRDENAS MAURICIO FERRO
CHAPTER III.
STANDARD OF LIVING
MAURICIO FERRO MAURICIO A. CRDENAS JEANNETTE LILIANA AMAYA
CHAPTER IV.
HEALTH CONDITIONS
JEANNETTE LILIANA AMAYA FERNANDO RUIZ
CHAPTER V.
AVAILABLE PROVISION AND QUALITY OF SERVICES

ROLANDO ENRIQUE PEALOZA ANGLICA MARA QUIROGA
CHAPTER VI.
OPPORTUNITIES FOR CHILDREN

MAURICIO A. CRDENAS MAURICIO FERRO
CHAPTER VII.
FERNANDO RUIZ
CONCLUSIONS AND GENERAL RECOMMENDATIONS

Participants in the Study:
CENDEX - PONTIFICIA UNIVERSIDAD JAVERIANA FERNANDO RUIZ ROLANDO ENRIQUE PEALOZA JEANNETTE LILIANA AMAYA ANGLICA MARA QUIROGA PAOLA ANDREA ORTIZ JAIL TAO ORTIZ Project Director, Associate Professor Associate Professor Assistant Professor Instructor Professor Project Consultant Project Consultant
CERREJN MAURICIO FERRO President, Tecnocerrejn
MAURICIO A. CRDENAS Coordinator, Research and Information Centre
Participants in the field operation

Health Conditions Survey
COORDINATOR
Rubn Cotes
SUPERVISORS
lex Gonzlez Alonso De Jess Mrquez Einer Soto Potes Israel Bermdez scar Enrique Camacho Juan Carlos Aguilar Julio Orozco Selwing Wilfredo Mosquera
INTERVIEWERS
Albert Gabriel Biscoviche Alexis Jos Campuzano Alma Rosa Barros ngel Simn Ojeda Anis Judit Campuzano Betzy Mara Parodi Ciro Segundo Montiel Edith Marina Amaya Elaines Marina Reynoso Eledis Esther Pinto rica Patricia Romero Erick Fadel Ulloque Francklin Elberto Gmez Jairo Wilfrido Pinto Jos Alfredo Molina Juan Gabriel Barros Kelis Jhoana Pinto Lidiana Cindi Castro Lisneth Katerine Guzmn Luz Mary Ortiz Manuel Gregorio Brango Manuela Antonia Cuello Mara Cristina Figueroa Mara Francisca Barros Nelson Moreno Nelvis Leonor Yepes smel Francisco Campuzano Patricia Yalena Brito Sandra Milena Cervantes Yacelis Rafaela Zrate Yajaira Estella Cuello Yeris Karina Puche Yuselys Mara Arr
Participating DANE Officials

Standard of living Survey
Hctor Maldonado Gmez Director, DANE Eduardo Efran Freire Delgado Director DIMPE Alba Luca Cadena Sarmiento Adviser, DIMPE Miyerlandi Fajardo Social Issues Coordinator Irma Ins Parra Ramrez Sampling Coordinator Leonel Castillo Sampling Specialist Luis dgar Snchez DIMPE Systems Coordinator Rafael Antonio Segura Cartographer Luz Deyanira Mateus Marketing Ruth E. Orjuela Logistics Coordinator Liliana I. vila Logistics Gabriel Tafur Thematic Specialist Ana Cecilia Olaya Thematic Specialist Carlos A. Troncoso Thematic Specialist
CONTENTS
ACKNOWLEDGMENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
CHAPTER I
Area of influence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 DEFINITION OF THE AREA OF INFLUENCE. . . . . . . . . . . 41
CHAPTER II
Methods and procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 METHODS AND PROCEDURES. . . . . . . . . . . . . . . . . . . . 47

Statistical Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Study Population and Sample Size. . . . . . . . . . . . . . . . . . . . Bias Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculating Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 48 54 56 57
CHAPTER III
Standard of living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 HOUSEHOLDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Type of dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Housing tenure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Predominant material of floors and walls. . . . . . . . . . . . . . . . Rooms in the household. . . . . . . . . . . . . . . . . . . . . . . . . . . . Access to public services. . . . . . . . . . . . . . . . . . . . . . . . . . . Sanitation services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cooking fuel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Goods and services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Socio-economic stratification and Sisben . . . . . . . . . . . . . . 61 62 62 64 64 69 69 70 71
STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence
18
PEOPLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Population by area and ethnicity . . . . . . . . . . . . . . . . . . . . . . 73 Population by age and gender . . . . . . . . . . . . . . . . . . . . . . . 76 Marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Kinship among household members . . . . . . . . . . . . . . . . . . 79 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Occupation of the labour force . . . . . . . . . . . . . . . . . . . . . . . 93 Main activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Occupational Position . . . . . . . . . . . . . . . . . . . . . . . . . 94 Empowerment of women . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Autonomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Decisions on expenses . . . . . . . . . . . . . . . . . . . . . . . . 100 Decisions regarding children and sharing in their care. 101 Wayu clans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Subjective perception of poverty. . . . . . . . . . . . . . . . . . . . . . 104
CHAPTER IV
Health conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 HEALTH AND SOCIAL SECURITY. . . . . . . . . . . . . . . . . . . 109

Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Out-of-Pocket Payment for Out-patient Consultations and Hospitalization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Average Expenditure on Out-patient Consultations and Hospitalization . . . . . . . . . . . . . . . . . . . . . 114
PERCEPTION OF HEALTH AND SERVICE USE. . . . . . . . . . 121 FOOD CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Food Habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Economic Availability and Compensation Mechanisms. . . . . 132 Frequency of Food Inequity Factors. . . . . . . . . . . . . . . . . . . . 133
PERCEIVED MORBIDITY. . . . . . . . . . . . . . . . . . . . . . . . . . 135

Oral Health Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Dental Appointment Attendance Factors. . . . . . . . . . . . 135 Location of Consultation . . . . . . . . . . . . . . . . . . . . . . . 137 Care for Young People . . . . . . . . . . . . . . . . . . . . . . . . . 139 Oral hygiene habits . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
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CONTENTS
Specific problems of children under the age of six . . . . . . . . 145 Chronic Conditions among people between the ages of 6 and 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Back and Neck Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Road Traffic Accident Injuries . . . . . . . . . . . . . . . . . . . 153 Aggression and Violence . . . . . . . . . . . . . . . . . . . . . . . 154 Respiratory Problems . . . . . . . . . . . . . . . . . . . . . . . . . 163 Associated Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Alcohol Consumption. . . . . . . . . . . . . . . . . . . . . . . . . . 169 Cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Physical Activity during Free Time . . . . . . . . . . . . . . . . 173 Nutritional Conditions . . . . . . . . . . . . . . . . . . . . . . . . . 177 Psychoactive Substance Use . . . . . . . . . . . . . . . . . . . . 179
CHAPTER V
Available provision and quality of services. . . . . . . . . . . . . . . . . . 181 HEALTHCARE PROVIDER INSTITUTIONS . . . . . . . . . . . . 183
HEALTHCARE PROVIDER INSTITUTIONS. . . . . . . . . . . . . . . . 183 Provision of Healthcare Services by the Public Network. 186 Provision of Healthcare Services by Private IPS . . . . . . 189 Analysis of services provided by the IPS public network. 192 Patient Referral Network. . . . . . . . . . . . . . . . . . . . . . . . 196 Survey at Four IPS in La Guajira . . . . . . . . . . . . . . . . . . . . . 199 San Rafael Hospital in Albania . . . . . . . . . . . . . . . . . . . 200 Nuestra Seora del Pilar Hospital in Barrancas. . . . . . . 201 Nuestra Seora del Carmen Hospital in Hatonuevo. . . . 204 Nuestra Seora del Perpetuo Socorro Hospital in Uribia. 205
USER PERCEPTION OF HEALTH SERVICES . . . . . . . . . . . 207

Survey Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Users Perception of Quality Conditions . . . . . . . . . . . . . . . . 227 Clear Information on Medical Condition and Treatment. . . . . 230 Request for Authorization to Carry out a Procedure . . . . . . . . 232 Perception of Time between Arrival at the IPS and Service. 233 Perception of Service Quality according to Priority Condition. 234
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Antenatal Checkups and Care during Delivery . . . . . . . . 234 Pap Smear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Family Planning and Birth Control . . . . . . . . . . . . . . . . . 237 Growth and Development of Children under 10. . . . . . . 237 Acute Diarrhoeal Disease - ADD . . . . . . . . . . . . . . . . . . 238 Acute Respiratory Infection - ARI. . . . . . . . . . . . . . . . . 239 Out-Patient dental care consultations. . . . . . . . . . . . . . 240 Road traffic accidents . . . . . . . . . . . . . . . . . . . . . . . . . 241 Back or Neck Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Application of vaccines . . . . . . . . . . . . . . . . . . . . . . . . 242
CHAPTER VI
Opportunities for children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 POVERTY INDICATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . UBN as poverty indicator in La Guajira . . . . . . . . . . . . Basic Opportunity Coverage - The p Component . . . . . Inequality Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The HOI for the Area of Influence. . . . . . . . . . . . . . . . . 247 247 258 262 270
CHAPTER VII
Conclusions and general recommendations . . . . . . . . . . . . . . . . 277 GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 BIBLIOGRAPHY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
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CONTENTS
List of tables
Table 1. Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Table 8. Table 9. Table 10. Table 11. Table 12. Table 13. Table 14. Table 15. Table 16. Table 17. Hamlets attached to the municipalities within the area of influence. 43 Percentage of households according to the material of the walls and floors by area . . . . . . . . . . . . . . . . 63 Rural situation of water supply and quality by community . . . . . . . 67 Population distribution by area of residence . . . . . . . . . . . . . . . . . . 73 Population distribution according to ethnicity . . . . . . . . . . . . . . . . 74 Description of the composition of households according to ethnicity 74 Population distribution according to age range, by area. . . . . . . . . 76 Comparison of the school attendance rate between La Guajira and Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Distribution of schools according to ICFES test performance categories (2000 - 2007). . . . . . . . . . . . . . . . . . . . . 92 Average amount paid at the last appointment according to type, system and area . . . . . . . . . . . . . . . . . . . . . . . . 115 Average amount paid for the last hospitalization according to type, system and area . . . . . . . . . . . . . . . . . . . . . . . . 119 Main reason for not seeking consultations in the population between the ages of 6 and 69 by system . . . . . . . . . . . 125 Distribution of households according to the number of meals normally eaten per day by area. . . . . . . . . . . . . . . . . . . . 130 Prevalence of allergies and malnutrition among children under the age of 6, by gender and area. . . . . . . . . . . . . . . . . . . . . 145 Prevalence of chronic conditions in the population between ages 6 and 69 by area . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Treatment sought for back and/or neck pain in the last week by gender and area. . . . . . . . . . . . . . . . . . . . 153 Distribution of the population between the ages of 18 and 69 according to injuries caused by traffic accidents in the past year by gender age range, and area . . . . . . . . . . . . . . . 154
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Table 18. Table 19. Table 20. Table 21. Table 22. Table 23. Table 24. Table 25. Table 26. Table 27. Table 28. Table 29. Table 30. Table 31. Table 32. Table 33. Table 34. Table 35. Table 36. Table 37. Table 38. Table 39.
Distribution of the population between the ages of 18 and 69 according to the type of aggression experienced in the last year, by gender and area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Distribution of the population according to exercise or physical activity during their free time, by gender, age range and area . . . . . 176 Prevalence of marijuana and cocaine use throughout the lives of people 18 to 69 years old by gender and area. . . . . . . . . . . 179 Prevalence of sedative and solvent or inhalant use throughout the lives of people 18 to 69 years old by gender and area . . . . . . . 180 Network of E.S.E in La Guajira and population of their area of influence 186 Installed capacity of first level hospitals in La Guajira . . . . . . . . . . . 188 Installed capacity of second level institutions in La Guajira . . . . . . . 189 Participation of healthcare services by municipality and type of entity 190 Provision of specialized consultation by the private network. . . . . . 191 Equivalent production in relative value units in the public hospitals of La Guajira . . . . . . . . . . . . . . . . . . . . 192 Production of medical consultations in public hospitals in La Guajira by level of care . . . . . . . . . . . . . . . . . . . . . . 194 Dental care in first level institutions in La Guajira. . . . . . . . . . . . . . . 194 Discharges from public hospitals in La Guajira. . . . . . . . . . . . . . . . 195 Surgeries in public hospitals in La Guajira. . . . . . . . . . . . . . . . . . . 195 Referring and receiving hospital with municipal location. . . . . . . . . 197 Human resources contracted by the week by the San Rafael Hospital 201 Human resources contracted by the week at the Nuestra Seora del Pilar Hospital . . . . . . . . . . . . . . . . . . . . . . . 202 Availability of appointments at the Nuestra Seora del Pilar Hospital 203 Human resources contracted by the week at the Nuestra Seora del Carmen Hospital. . . . . . . . . . . . . . . . . . . 204 Human resources contracted by the week at the Nuestra Seora del Perpetuo Socorro Hospital. . . . . . . . . . . . . . . . 206 Structure of the survey of out-patient consultation, hospitalization and accident and emergency service modules . . . . 208 Volume of consultation, hospitalization and accident and emergency services by municipality . . . . . . . . . . . . . . . . . . . . . . . 209
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CONTENTS
Table 40. Table 41. Table 42. Table 43. Table 44. Table 45. Table 46. Table 47. Table 48. Table 49. Table 50. Table 51. Table 52. Table 53. Table 54. Table 55. Table 56. Table 57. Table 58. Table 59. Table 60. Table 61. Table 62.
Out-patient consultation according to type of affiliation declared and gender. . . . . . . . . . . . . . . . . . . . 211 Treatment by accident and emergency services according to type of affiliation declared and gender. . . . . . . . . . . . . . . . . . . . 212 Care with hospitalization according to type of affiliation declared and gender . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Care through out-patient consultation according to Sisben level and gender. . . . . . . . . . . . . . . . . . . . . . . 213 Educational level of users of out-patient consultations by gender. 214 Educational level of users of emergency services by gender . . . . . 214 Educational level of hospitalization users by gender . . . . . . . . . . . . 215 Civil status of out-patient consultation users by gender . . . . . . . . . 216 Civil status of hospitalization and emergency service users by gender 217 Reason for out-patient consultation by gender . . . . . . . . . . . . . . . 217 Type of care received by out-patient consultation users by gender . 218 Reason for out-patient consultation, scheduled or priority . . . . . . . 219 Reason for emergency care, by gender. . . . . . . . . . . . . . . . . . . . . 220 Reason for hospitalization by gender . . . . . . . . . . . . . . . . . . . . . . . 221 Hospitalization and accident and emergency service events by gender 222 Primary payer of users bills for out-patient consultation by type of affiliation . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Users who incur out-of-pocket expenses for out-patient consultations, by declared type ofaffiliation. . . . . . . . . . . . . . . . . . . 223 Primary payer of accident and emergency service users bill, by type of affiliation . . . . . . . . . . . . . . . . . . . . . 224 Primary payer of users hospitalization bills by type of affiliation. . . 226 Users who incur out-of-pocket expenses in respect of payment for hospitalization and emergency treatment by declared type of affiliation 227 Choice of institution for out-patient consultation according to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . 228 Choice of institution for hospitalization and emergency care according to declared type ofaffiliation. . . . . . . . . . . . . . . . . . . . . . 228 Choice of preferred medical professional by out-patient consultation users, according to type of affiliation declared. . . . . . . 229
24
Table 63. Table 64. Table 65. Table 66. Table 67. Table 68. Table 69. Table 70. Table 71. Table 72. Table 73. Table 74. Table 75. Table 76. Table 77. Table 78. Table 79. Table 80. Table 81. Table 82.
Choice of preferred medical professional by hospitalization and accident and emergency service users according to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Out-patient consultation patients access to clear information on medical conditions according to declared type of affiliation . . . . 230 Hospitalization and accident and emergency service patients access to clear information on medical conditions according to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Out-patient consultation users access to clear information on treatment according to type of affiliation declared. . . . . . . . . . . 231 Hospitalization and accident and emergency service users access to clear information on treatment according to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Out-patient consultation users (%) who authorized a procedure according to type of affiliation declared. . . . . . . . . . . . . . . . . . . . . 232 Hospitalization and accident and emergency service users (%) who authorized a procedure, according to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 UBN by municipality in 1973, 1985, 1993, 2005 and 2010, by area 253 Timely Completion of Sixth Grade in 1997, 2003 and 2009. . . . . . . 259 Affiliation to the General Health System in 2008 and 2009 . . . . . . . 260 Coverage for Basic Living Conditions for 1997, 2003 and 2009 . . . 261 Econometric estimates according to the Probit Model. . . . . . . . . . . 263 Econometric Estimates according to the Logistic Model. . . . . . . . . 267 Inequality of Opportunities (Index D) in Education. . . . . . . . . . . . . . 268 Inequality of Opportunities (Index D) in Health and Housing. . . . . . . 269 HOI for Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 HOI for Health and Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 HOI and simulated years for coverage and equity. . . . . . . . . . . . . . 274 Opportunity Index for Education and Housing. . . . . . . . . . . . . . . . . 275 Human Opportunity Index Summary . . . . . . . . . . . . . . . . . . . . . . . 275
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CONTENTS
List of graphs
Graph 1. Graph 2. Graph 3. Graph 4. Graph 5. Graph 6. Graph 7. Graph 8. Graph 9. Graph 10. Graph 11. Graph 12. Graph 13. Graph 14. Graph 15. Graph 16. Graph 17. Graph 18. Graph 19. Graph 20. Graph 21. Percentage of households according to type of dwelling, by area. . . 61 Percentage of households according to housing tenure by area . . . . 62 Percentage of households according to number of rooms and number of bedrooms by area . . . . . . . . . . . . . . . . . . . 64 Percentage of households according to access to public services, by area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Percentage of households according to source of water supply for cooking by area. . . . . . . . . . . . . . . . . . . . . . . . . 66 Percentage of households according to type of sanitation service by area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Percentage of households according to type of fuel used for cooking by area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Percentage of households according to goods and services owned, by area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Percentage of households according to socio-economic strata and Sisben classification by area. . . . . . . . . . . . . . . . . . . . . . . 72 Population pyramid in the area of influence. . . . . . . . . . . . . . . . . . . . 77 Population distribution according to marital status by area . . . . . . . . 78 Population distribution according to relationship by gender and area. 79 Gross coverage rate by level of education in La Guajira (2005 - 2007). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Average years of education according to age groups by area. . . . . . . 83 Population distribution according to level of education by area. . . . . 84 Net and gross school attendance rate according to level of education by ar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Comparison of the annual fail rate between La Guajira and Colombia (2000 - 2006) . . . . . . . . . . . . . . . . . . . . . . 87 Annual municipal and national repetition rates (2000 - 2007). . . . . . . 88 Population distribution according to literacy, by area and region. . . . 89 Saber Tests Statistics (Grade 9 language results) in La Guajira and Colombia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Saber Tests Statistics (Grade 9 mathematics results) in La Guajira and Colombia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
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Graph 22. Graph 23. Graph 24. Graph 25. Graph 26. Graph 27. Graph 28. Graph 29. Graph 30. Graph 31. Graph 32. Graph 33. Graph 34. Graph 35. Graph 36. Graph 37. Graph 38. Graph 39. Graph 40.
Distribution of the population aged 12 to 69 according to main activity, by gender and area . . . . . . . . . . . . . . . . 93 Distribution of the population aged 12 to 65 according to occupational position by area. . . . . . . . . . . . . . . . . . . . 95 Autonomy of women (12 - 69 years of age) with a partner to go out alone by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Autonomy of women (12 - 69 years of age) with a partner to go out with their children by area . . . . . . . . . . . . . . 98 Autonomy of women (12 - 69 years of age) with a partner to pay everyday expenses by area . . . . . . . . . . . . . . . 99 Participation of women (12 - 69 years) with a partner in decisions regarding household expenses by area. . . 101 Shared responsibility of the parents in the care of children during the first year of life according to gender. . . . . . . . . . . . . . . . . . . . . . . 102 Distribution of the Wayu population by clan. . . . . . . . . . . . . . . . . . . 103 Percentage of households according to the opinion of the head or spouse with regard to their condition of poverty by area 104 Percentage of households according to opinion regarding current standard of living compared to five years ago by area . . . . . . 105 Population distribution according to affiliation by gender and area. . . 110 Distribution of the population by area between the ages of 6 and 69 according to out-of-pocket payments for different costs associated with their latest appointment. . . . . . . . . . . 112 Distribution of the population by area between the ages of 6 and 69 according to out-of-pocket payments for different costs associated with the latest hospitalization . . . . . . . 113 Distribution of the population (6-69 years old) according to their perception of their health by system and area . . . . . . . . . . . . . . . . . 122 Consultation prevalence in the past 30 days in the population between the ages of 6 and 69 by system and area. . . . . . . . . . . . . . 124 Average number of days per week each food is consumed in the household by area. . . . . . . . . . . . . . . . . . . 127 verage number of times per day each food is consumed in the household by area . . . . . . . . . . . . . . . . . . . . . . . . . 129 Distribution of households according to food consumption throughout the day . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Distribution of households according to compensation mechanisms used to reduce food consumption by area. . . . . . . . . . . 132
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CONTENTS
Graph 41. Distribution of households according to the frequency of compensation mechanisms used to reduce food consumption . . . . . 134 Graph 42. Distribution of the population between 6 and 69 according to reasons for not attending dental appointments by area. . . . . . . . . 136 Graph 43. Distribution of the population seen for dental appointments by location of service and area . . . . . . . . . . . . . . . . . . 137 Graph 44. Oral health habits in the population under the age of 10 by area . . . . 139 Graph 45. Adult population distribution according to oral health habits, by affiliation system and area. . . . . . . . . . . . . . . . . . . 141 Graph 46. Distribution of the population by knowledge about the causes of cavities by area. . . . . . . . . . . . . . . . . . . . . . . . . 142 Graph 47. Distribution of the population by knowledge about the causes of gum bleeding or swelling by area . . . . . . . . . . . 143 Grfico 48. Distribucin de la poblacin segn conocimiento de la frecuencia en el cambio de cepillo de dientes . . . . . . . . . . . . . . 144 Graph 49. Prevalence of high blood pressure and related controls among people between the ages of 18 and 69 by gender and area. . . 149 Graph 50. Prevalence of diabetes and related controls among people between the ages of 18 and 69 by gender and area . . . . . . . . 151 Graph 51. Prevalence of back or neck pain among people between the ages of 18 and 69 by gender and area . . . . . . . . . . . . . 152 Graph 52. Distribution of the population between the ages of 18 and 69 according to their perception about aggression among children by gender and area . . . . . . . . . . . . . . . . 155 Graph 53. Distribution of the population between the ages of 18 and 69 according to their perception about the need to use physical aggression by area 157 Graph 54. Distribution of the population between the ages of 18 and 69 according to their perception about physical aggression in family settings by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Graph 55. Distribution of the population between the ages of 18 and 69 according to factors associated with physical aggression by area. . . 159 Graph 56. Distribution of the population between the ages of 18 and 69 according to their history of physical aggression in the household by gender and area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Graph 57. Distribution of cases of aggression according to the relationship between the victim and the aggressor by area . . . . . . . . . . . . . . . . . 162 Graph 58. Prevalence of coughing in the population between the ages of 18 and 69 by gender and area. . . . . . . . . . . . . . . . . . . . 164
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Graph 59. Graph 60. Graph 61. Graph 62. Graph 63. Graph 64. Graph 65. Graph 66. Graph 67. Graph 68. Graph 69. Graph 70. Graph 71. Graph 72.
Prevalence of phlegm in the population between the ages of 18 and 69 by gender and area. . . . . . . . . . . . . . . . . . . . Prevalence of wheezing in the population between the ages of 18 and 69 by gender and area . . . . . . . . . . . . . Prevalence of dyspnoea in the population between the ages of 18 and 69 by area. . . . . . . . . . . . . . . . . . . . . . . Distribution of the population between the ages of 12 and 69 according to their risk for alcoholism by gender, age range and area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prevalence of current smokers and former smokers by gender and age range. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distribution of the population by pattern of light or vigorous exercise by age range and area . . . . . . . . . . . . . . . . . . . . . Distribution of the population according to pattern of overall exercise by age range and area. . . . . . . . . . . . . . . Distribution of the population according to BMI by age range and area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distribution of services by municipality in La Guajira. . . . . . . . . . . . . Distribution of healthcare services according to entity type by municipality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distribution of beds by entity in La Guajira . . . . . . . . . . . . . . . . . . . . Installed capacity in intermediate and intensive care units and rooms in La Guajira by type of entity . . . . . . . . . . . . . . . . . Referral and counter-referral map of the public network in La Guajira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Human Opportunity Index Summary . . . . . . . . . . . . . . . . . . . . . . . . . Taken from the World Banks 2008 study -shows an example of the probability gaps for calculating the D-index.. . . . . . . . . . . . . . .
166 167 168
170 172 174 175 178 183 184 185 185 196 273 367
ACKNOWLEDGMENTS
We are most grateful to the communities of La Guajira for their generosity in sharing their perceptions, their problems and the resources they have at their disposal to deal with life, to ensure their wellbeing, and to satisfy their families health needs.
We would like to acknowledge the families of those of us who strive every day to gain a deeper insight into our communities and gradually come to understand the vibrant diversity of our country and its problems, seeking somehow to contribute to their solution.
FOREWORD
We are pleased to present to the communities studied, to La Guajira Department and to the National Community, as well as to both the national and the international stakeholders, an initial study of the health and Standard of living baseline of the area of direct influence of Cerrejn coal mine in La Guajira Department (Colombia) in 2009. This area of direct influence includes the main towns of Albania, Barrancas, Hato Nuevo, Uribia, two kilometres on either side of the railway used to transport coal to Puerto Bolvar, the hamlets (rancheras) adjacent to the port itself, the rural areas and the communities bordering on the different pits of the mine. This territory generates royalties (FCFI, 2009) and the payment of other taxes levied on the mining activities directly involved in mining the thermal coal produced and exported by Cerrejn to the municipalities. With a view to future expansion projects, it also includes the bank of the River Ranchera from the mine to its estuary in Riohacha. The purpose of this joint effort, carried out under agreements between DANE (Colombian National Department of Statistics) and Cerrejn, on the one hand, was to gather data through the Standard of Living Survey (SLMS)1, and between CENDEX, Pontificia Universidad Javeriana and Cerrejn for the Health Conditions Survey (HCS)2, on the other, is to provide researchers and analysts with databases containing valid, reliable information allowing rigorous, in depth studies of health and welfare indicators in order to design, follow up and evaluate public policies for Cerrejn area of direct influence in order to ensure sustainable development in the short, medium and
1 http://190.25.231.249/aplicativos/sen/NADA/ddibrowser/?section=overview&id=26 2 In 2007, Cendex, Centro de Proyectos para el Desarrollo (Development Projects Centre) of Universidad Javeriana conducted a National Health Survey under a contract with the Ministry of Social Protection and Colciencias (Colombian Administrative Department of Science, Technology and Innovation), based on the PAHO/WHO methodology for Health Situation Analysis surveys. See: Epidemiological Bulletin/PAHO (1999) and Rodriguez, et. al (2009)
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long terms. As mentioned below, this forms an integral part of Cerrejons Corporate Social Responsibility endeavours. In August 2007, Cerrejn and its shareholders Anglo American plc, BHP Billiton and Xstrata Coal, commissioned an independent panel headed by John Harker, President of Cape Breton University in Canada, to review the management of its corporate social responsibility programmes and practices and the companys relations with the neighbouring communities3 of the mine. The World Business Council for Sustainable Development (WBCSD, 2000) defines Corporate Social Responsibility (CSR) as companies commitment to the Standard of living of their employees and their families, the local community and society in general, to supporting sustainable economic development and to contributing to achieving this goal. As the panel has rightly said: In the area of Social Responsibility, Cerrejn always endeavours to achieve the very best results, rather than limiting itself to the legal limits or minimum standards set for the industry. Cerrejn not only complies with the strictest international standards, but also strives to include the best practices existing worldwide and to keep at the forefront in understanding and implementing Social Responsibility policies that cover its entire complex multi-dimensionality. On the one hand, it works to contribute to sustainable economic development, to improve the Standard of living in the area of influence and to achieve a reduction in the poverty of the region, while at the same time contributing proactively to strengthening social inclusion, human cohesion and social capital, particularly in all aspects concerning the issues of gender equality and the participation of aboriginal ethnic groups. On the other hand, it defends Human Rights and environmental protection through responsible management of the risk of pollution and the possible degradation of the habitat of the regions flora and fauna.
3 http://www.cerrejon.com/secciones/CERWEB/HOME/MENUPRINCIPAL/NUESTRACOMUNIDAD/ COMITEIND/seccin HTML.jsp
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FOREWORD
Good intentions, however, are not enough in themselves. Results have to be obtained and measured and the mechanisms to achieve these goals have to be explained. Measurements must be independent, objective, valid and reliable, conducted in accordance with the strictest international methodological standards, in order to allow both longitudinal (before and after) and crosssectional comparison with other regions and areas of Colombia, and also with other countries and other mines and/or major projects that impact their environment and its inhabitants. At this point in time, it is beyond the capacity of any private company to replace the state. Therefore, a key part of social responsibility lies in contributing to citizen participation in the achievement of civil society goals. This requires results from the state and the political class responsible for administering government institutions and establishing social and economic policies in the region. It helps to strengthen democracy, good governance and accountability, a fundamental component of transparency in the management of the state apparatus at municipal, departmental and national levels. This cannot be achieved without fixing objective indicators by which to measure results. Both surveys follow the relevant methodologies and are accessible to the scientific community and stakeholders in accordance with DANEs rules on Standard of living data and those of CENDEX on health related data. We have included an introduction to the methodology followed, a description of the findings and, by way of an example, an initial analysis of what will be required of further studies in order to formulate policies to improve the health and wellbeing of the communities of La Guajira.
INTRODUCTION
This publication presents the results of the Standard of living Survey (SLMS) and the Health Conditions Survey (HCS) in the area of influence of Cerrejn, an open-pit thermal coal mining project, which includes, as we shall explain in further detail below, the urban areas of the towns of Albania, Barrancas, Hato Nuevo and Uribia, as well as the rural areas of those same municipalities, and the railway corridor that connects the mine itself with Puerto Bolvar from which the coal is exported by sea. It also includes the rural area of the banks of the Ranchera River from Albania to its estuary in Riohacha. This publication starts out, in Chapter I, with an explanation of the territorial demarcation of Cerrejns area of influence. Chapter II specifies the methods and procedures associated with the study: statistical design, surveys conducted, study population and sample size, bias control and calculation of observed accuracy. Subsequent chapters contain an explanation of the results of the surveys, as indicated below. Chapter III, Section 1 discusses the Standard of living conditions of households and Section 2 those of people per se. These sections contribute some topics of interest obtained from the HCS to the results of the SLMS with. Chapter IV refers to the health conditions of the population in the area of influence based on social security conditions, followed by perceptions of health, the use of services and ending with food conditions and the perceived morbidity of the population. The available provision and quality of services are explored in Chapter V, which explains the situation of the Health Care Providers (IPS) and patients perception of the health services they receive. The former gives a description of the health services network in the Department, the provision of services and the results of the surveys applied to four IPS in La Guajira, while the
36
latter focuses on the results obtained from the survey of patients on coming out of a doctors surgery, a hospital or an accident and emergency service. Chapter VI contains a very pertinent application of the Human Opportunities Index, which explores the type of opportunities children have in the territory based on a multi-dimensional approach. It also follows the methodology proposed by the World Bank for focusing on equality and the search for opportunities for the childrens future, based on their conditional probabilities of achieving certain goals given the nature of the environment in which they are born. The results of the two surveys are descriptive in nature and are intended to establish ratios, rates and proportions comparable with similar previously collected measurements. On the one hand, the Standard of living indicators of Cerrejn area of influence are comparable with those of the total national SLMS of 2008 and with the results for the Atlantic Region produced by DANE in 2010. The health results are also comparable with the 2007 National Health Survey (Rodrguez, et. al., 2009) with regard to the following three inputs: 1) an epidemiological profile of the population, showing the characteristics of the perceived prevalence and risks of disease, which will make it possible to define intervention and design priorities for specific programs; 2) an analysis of the technical capacity of the IPS, based on which priorities for investment in human resources, equipment and consolidation can be established in order to structure more competitive and efficient service projection units, and 3) a user perception profile of the quality of services, aimed at enabling health care institutions to develop quality policies designed to improve services. The results presented in this publication, as well as the databases, constitute an invaluable ingredient for the creation of inferential studies, to facilitate analysis of causality or to establish statistically significant interactions. All of this warrants the effort that will lead to specific developments and, moreover, by integrating the socio-economic characteristics of the population collected in the SLMS, it will facilitate a complete description of the population. It is therefore a positive baseline for evaluating interventions and programs.
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INTRODUCTION
For Pontificia Universidad Javeriana, through Cendex, the implementation of the Health Conditions Survey represents a challenge and an invaluable technical process, as well as an opportunity for the private sector to support health care system development. This is particularly so due to the scope of the study, which includes the micro-conditions of a population with high necessity and vulnerability levels, as in the case of residents in Cerrejn area of influence.
CHAPTER I
Area of influence
Mauricio A. Crdenas Mauricio Ferro
41
CHAPTER I Area of influence
DEFINITION OF THE AREA OF INFLUENCE

The area of influence is not a random geographical demarcation defined by Cerrejn as it pleases, but rather relates directly to the impact caused by its mining operation and associated activities, specified mainly in the environmental licence granted by the Colombian Government at the beginning of the mining project in the late 1970s. In addition, to define the zone or area of influence with a view to carrying out the Standard of living survey, the guidelines of the SEAT4 tool were followed in order for the coverage to facilitate a more complete analysis of the socioeconomic reality in which Cerrejn operates in La Guajira Department. The tool SEAT states that an area of influence is a zone in which both direct and indirect impacts can be expected to be caused by the operation. Typically, an area of influence is unique to each operation. It is larger than the actual size of the operation, covers its environmental impacts and problems and also addresses the health and socio-economic issues within its boundaries. Taking into account SEAT guidelines Cerrejon area of influence includes the following: The area receiving the primary physical impact caused by the mining operation. This covers the main location of the project and its associated infrastructure (including contractors infrastructure), such as power transmission corridors, pipes, access ways, etc. The area receiving the secondary physical impact caused by mining development. This would include impacts caused by chain reactions and the cumulative effects of the mining operation, as well as any future expansion project. Associated facilities not financed as part of the mining project, but whose viability and existence depend exclusively on the mining
4 SEAT (Socio-Economic Assessment Toolbox) is a set of methods to assess both the positive and the negative social and economic impacts caused by the mining operations of Anglo American PLC. It was designed to help Anglo Americans operations engage more effectively with local stakeholders and to identify and optimize the management of its social responsibility programs. See: Anglo Americans SEAT Toolbox. http://www.angloamerican.com/aal/development/social/ community-engagement/seat/
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operation and whose goods and services are essential for the mine to operate (for example, means of transportation such as roadways and trains). Primary areas which can provide the operation with manual labour and in which consumption is created as a direct result of the presence of the mine. These areas cover the neighbouring populations and communities directly affected by the mining activities, but also potentially more distant areas which could provide workers or be influenced by the creation of consumption. Surrounding areas which could eventually be impacted by the operation, both positively and negatively, such as locations with high biodiversity levels, protected areas, etc Taking these elements into account, the area to be considered as that of the study population was limited to the main towns of Albania, Hatonuevo, Barrancas and Uribia and their respective rural areas (the Aboriginal reservations of the Wayu of Provincial, Trupio Gacho, San Francisco, and Cuatro de Noviembre). The Wayu communities adjacent to Puerto Bolvar are also included. In the urban area, the hamlets attached to the municipalities within the area of influence were also taken into account, as shown in Table 1. The adjacent corridor (2 km on either side of the railway) is also a part of the area of influence throughout the 150 kilometre railway that connects the mine with Puerto Bolvar, which carries coal for shipment to clients by sea, as well as the banks of the Ranchera River from the mine to its estuary in Riohacha. The great majority of this rural population belongs to the Wayu ethnic group. The following map shows the location of Cerrejn area of influence defined for the study.
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CHAPTER I Area of influence
Table 1. Hamlets attached to the municipalities within the area of influence

MunicipalitY Albania Cuestecitas Los Remedios Carretalito Papayal San Pedro Nuevo Oreganal Barrancas Patilla Chancleta Roche Barrancn Las Casitas Manaure Aremasahin La Gloria Hamlet
Source: DANE Census Mapping
Map 1. Demarcation of the study area of influence

REPUBLIC OF COLOMBIA
NATIONAL ADMINISTRATIVE DEPARTMENT OF STATISTICS Department of La Guajira - 44 AREA OF IMPACT OF THE CERREJN TAILROAD
N
1:132.008
0 4.450 8.900 17.800 26.700
METERS
35.600
SOURCE NATIONAL GEOSTATISTICAL FRAMEWORK 2007 STANDARD CARTOGRAPHIC SUPORT SYSTEM - DIMPE
URIBIA
MANAURE
RIOHACHA ALBANIA HATO NUEVO
MAICAO
CONVENTIONS ROADS
BARRANCAS DISTRACCIN FONSECA SAN JUAN DEL CESAR
Railroad GEOSTATISTICAL FRAMEWORK Railroad Area of Influence Ranchera River Area of Influence
CHAPTER II
Methods and procedures
Jeannette Liliana Amaya Mauricio A. Crdenas Mauricio Ferro
47
CHAPTER II Methods and procedures
METHODS AND PROCEDURES

This chapter describes the methodology used in the design and application of the two surveys, as well as the sample size to ensure that they were both representative and valid. The content of each of the surveys: Standard of living Survey and Health Conditions Survey, the basis on which the estimates in the following chapters were made and, finally, the procedure to determine the accuracy or margin of error of the estimates.
Statistical Design
To calculate the representative sample for the Standard of living Survey (2009) in Cerrejn Area of Influence, DANE used a stratified, multi-stage, probabilistic cluster procedure. The Health Conditions Survey was based on the same sample and therefore followed the same selection process. With this design, each sampling unit had a known selection opportunity greater than zero. This methodology makes it possible to determine the desired accuracy of the estimates in advance and then to calculate that of the results obtained. Two pre-defined domain strata were defined: urban, consisting of the towns and hamlets within the municipalities of the area of influence, and rural, consisting of the sparsely populated areas of the zone defined as the area of influence. The main advantage of this stratification is an increase in the accuracy of the results. In the urban stratum, the primary sampling units are the blocks or groups of blocks that contain at least one size measurement (SM); the secondary units are segments or SM. In the rural areas, the primary sampling units are communities; the segments or SM are the secondary sampling units. To begin, primary units are first randomly selected, and then secondary units among them, also at random, so that the desired sample size was ensured. This procedure is known as multi-stage sampling. Clusters are the different groups of units formed, which facilitate the process of identifying and selecting the sampling units. For this study,
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the municipality is taken in the first instance and the urban area within it, then the blocks and within them, the segments; in the rural area, the communities and, within them, the segments, are all taken into account (DANE, 2009).
The Surveys
The Standard of living Surveys were designed to obtain a set of indicators to describe the target population based on the different dimensions involved in the wellbeing of households and of the people that are their members. Measuring poverty, whether from an objective, subjective, structural or circumstantial perspective, forms an integral part of the goals of this type of study. It allows a more in-depth analysis of wellbeing factors such as health, education, jobs, ownership of goods in the household and access to public services. Ultimately, what is required is access to information that shows us and explains the factors that can help to improve wellbeing or to reduce poverty and, therefore, enable us to carry out an objective, rigorous follow up of the variables necessary for the design, implementation and monitoring of public policies, especially those related to achieving the Millennium Development Goals (FCFI 2010) in a relatively underdeveloped region such as this one. The indicators obtained during this study represent a baseline (DANE, 2004), because, by comparing them with the results of subsequent studies that measure the same variables, it is possible to systematically follow up and evaluate the policies, programs and projects carried out to assess progress and achievements. With time, these can be used to improve the design and decision-making process for sustainable development and better Standard of living. In the past 20 years, there has been a great deal of methodological progress in both the design and the implementation of population surveys, especially since the beginning of the decade of the nineties. On the one hand, improvements have been incorporated on the basis of World
49
Bank experience in the Measurement of Living Conditions (Grosh M. & Glewwe, P., 1995) aimed at ensuring good data quality and, on the other hand, the Inter-American Development Banks Technical Cooperation Programme for the Improvement of Surveys and the Measurement of Living Conditions in Latin America and the Caribbean (MECOVI). The SLMS applied in this research is the same as that of the national study carried out by DANE5 in 2008, but with the above mentioned methodological improvements. It was a pioneer study, as it was the first SLMS of small municipalities with a significant scattered rural population belonging almost entirely the Wayu Aboriginal ethnic group, whose language is Wayunaiki. DANE had previously conducted six Standard of living surveys (SLMS)6 and subsequently, in 2010, conducted an additional survey of the entire country by regions. It was a multi-purpose survey with direct informants and using personal digital assistants, with an average duration of 2.4 hours per interview in the household. A process to raise awareness before field collection began was carried out and the number of households used for the sample was updated prior to the survey. Questions that had not been representative during the 2008 national survey were not included in the SLMS in Cerrejn area of influence. These were related to the following: Dwellings affected by floods, landslides and subsidence Dwellings near airports, refuse dumps, industries, water channel and transportation routes
5 Cerrejn made the decision to financially and logistically support DANE, Colombias National Statistics Department, in carrying out this study so that the data collected would be of the best possible quality and available to any national or foreign researcher in accordance with international standards, as well as to government entities. This arrangement also helped protect the privacy of those surveyed. Poverty and Standard of living survey in Santa Fe de Bogot, 1991. City and locality totals. 1993 National Standard of living Survey. National, municipalities, and for four major cities. 1997 Standard of living Survey. National, by regions. 2003 Standard of living Survey. National by regions and Bogot by localities. 2007 Standard of living Survey. Bogot, by localities. DANE under an agreement with the District. 2008 National Standard of living Survey. National, by regions.
6 a. b. c. d. e. f.
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Drops in voltage or abrupt changes in energy or the major causes of power outages Quality of garbage collection services Noise, interference or faults in telephone service Childcare Fertility in girls and women of 12 years of age and over Level of life satisfaction or dissatisfaction The possibility or otherwise of choosing health care Health Provider Institutions (IPS), i.e. the health centres, clinics and hospitals where medical services are provided Knowledge of the Obligatory Healthcare Plan (POS). Information on the tenure of rural property such as parcels and smallholdings and ownership registration The household expenses module (weekly, monthly, quarterly, and annually). Likewise, people who participated in the processes of supervision and collection of survey information were selected and evaluated according to the recommendations of the manual on field work in the World Banks 1999 Standard of Living Measurement Studies. Bilingual Spanish/Wayunaiki speakers, the majority of whom were Wayu, received rigorous training, emphasizing adoption of the concepts, objectives and scope of the research to ensure that the information gathered would be valid and reliable. To avoid bias in the way questions were formulated and following the World Banks methodological recommendations, the questionnaire was translated into Wayunaiki so that all respondents in rural areas would be answering exactly the same questions and not those spontaneously translated by the person asking them. The first chapter of the Standard of living Survey compiles information on dwellings, including access to public services and the number of households included in each unit. The concept of household is referred to in the
51
epidemiological sense, so that they can be compared with census data and national and international household surveys. A household consists of an individual or a group of people living under the same roof and sharing at least one meal (eating from the same pot), without this necessarily implying family ties. When a single housing unit is inhabited by various groups of people who cook separately, each group is considered a different household. The section on household services records the payment and quality thereof. The use of sanitation services is also determined. Questions regarding the tenure of housing units were to learn the occupation of housing, the number of units possessed, the number of months during which they are occupied and the reasons for moving from one to another, if any. This section thus enables us to identify critical overcrowding. The chapter on the characteristics and composition of households has two objectives. The first is to identify the people who make up the household, their relationship with the head of the household, as well as whether they belong to an aboriginal community - in this case, the Wayu - and their marital status. The head of the household is a regular resident who is recognized as such by other members of the group. The second objective is to track migration of household members. All household members, who identified themselves as belonging to the Wayu aboriginal group, were asked if they spoke Wayunaiki as well as the caste or clan to which they belonged in order to determine the size of the different clans in the area. The brief chapter on health examines social security coverage, peoples perception of their own health and some of the household healthcare expenses (diseases and health management). The purpose of the questions about caring for children under the age of five is to identify the person or institution responsible for their upbringing and care and to estimate the coverage of public and private establishments dedicated to protecting and educating children. The questions also seek to estimate the household total expenses spent on school fees during the year, monthly food and other expenditures on looking
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after, caring for and bringing up minors until they begin their basic primary education. The chapter on education gathers information on the main educational traits of the population of five years and over, such as illiteracy, school attendance (current grade) and level of education (last grade passed). It also covers the amount of money spent by households on education and identifies where or with whom pre-school and primary pupils spend their time when they are not at school. The chapter on the workforce has three objectives: to determine which members of the household have jobs, which of them earn an income and which would be able to do so, either as a result of being in the job market or from other types of activities; to examine employees working conditions, such as access to social security, hours worked and income and to classify those who are out of work or inactive, establishing whether they receive an income from other sources, such as assistance from relatives, friends, institutions, or others. Household living conditions are approached from a subjective perception of poverty, the occurrence of events which cause tension or concern and the households income capacity to cover its minimum expenses. The survey also verifies the goods owned by the household, not only as patrimony, but also those that satisfy its needs. Having such goods is an indicator of the comforts a family or household enjoys, which may be considered a need for their wellbeing in the modern urban context. The information in this chapter enables us to analyse violence and the victims of aggressive acts, perception of security and also how parents correct their children under the age of 18. In addition to the Standard of living Survey, the Health Conditions Survey was applied in order to investigate the peoples demographic and socioeconomic conditions and the health conditions of the population within the area of influence. This survey used the same sample of households as those of the SLMS and, therefore, it is equally representative. Surveyors were equipped with computers in order to capture information electronically.
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Before field work began, a process of raising awareness of the population was undertaken and the team responsible for the application, supervision, verification and revision of the surveys were selected and trained in order to reduce any possible bias associated with the process and to ensure the validity and reliability of the information gathered. The original design of the NHS (2007) was used to gather information. The structure of the survey provided parameters for comparing the situation of the population studied, not only with national, but also with regional and departmental totals. Two sub-modules were added to the original design of the survey, both related to regionally important issues: 1) the Food Habits Module, in which variables in consumption patterns were integrated with the populations food safety conditions and, 2) the Respiratory Disease Module, which studied the frequency of respiratory symptoms among different age groups. The following three of the four original NHS modules were applied: 1) Households Survey Module, which collected information on the population between the ages of 0 and 69; 2) User Survey Module, applied in the four hospitals located within the defined area of influence, and 3) the Health Provider Institutions (IPS) Module, which analyzed the installed capacity of health services in four IPS of La Guajira Department. The households survey consisted of four Modules. It began with the application of Module 1 regarding the data of the housing unit and the household, whose informant was either the head of household or another adult member. As part of this Module, a list of all members of the household was drawn up, from which the population for the application of the Modules was selected. Module two was applied to young people between the ages of 6 and 17 and to a sub-sample of people from 18 to 69 years of age. Firstly, respondents were asked about certain population characteristics, such as education, the workforce and the empowerment of women. Questions were then asked about health conditions in relation to: perceived morbidity, demand and use of services, chronic conditions, dental care, risk factors for chronic diseases,
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such as cigarette smoking, alcohol consumption and lack of physical activity and knowledge and treatment of certain diseases with a major impact on public health (high blood pressure, diabetes and back pain are some of these). Questions were also included about food conditions and the respiratory problems faced by people over 6 years of age. Module 3 of the household survey was targeted to all children under the age of 6 for whom their mother, father or a guardian were responsible. This module gathered information on childrens health conditions with relation to perceived morbidity, specific conditions, vaccinations and dental care. Module 4 was only applied to a sub-group of people between the ages of 18 and 69, in which respondents were asked about sensitive topics involving aggression, psychoactive substance use and sexually transmitted diseases. Surveys were also applied to each of the four IPS to investigate the data of the institution, consultations on specific protection and early detection, characteristics of paediatric and adult hospitalization and emergency services and surgical and support services. A description of out-patient services was also defined, as was the functioning of the provision of out-patient and obstetrics consultation services was also verified. User surveys were applied immediately following the respective service of hospitalization or out-patient consultation, the latter referring to those received by users of an IPS, including: general or specialized medical consultations, dental appointments, pre-natal or growth and development check-ups, family planning appointments, consultation for diagnostic or therapeutic examinations or procedures, vaccinations and ambulatory surgery, among others. This survey included questions about patients perception of access to, and the quality of the service they received.
Study Population and Sample Size

The study population comprised the civilian, non-institutional population living in Cerrejn area of influence, as defined in Chapter I. The sample selection framework was based on a previous count of dwellings and households with their respective geo-referential information in order to not only identify
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the sample and observation units, but also provide basic information for the respective estimates and for coverage control. Likewise, health care institutions (IPS) were included in the study population, from which four institutions were selected: San Rafael Hospital, Nuestra Seora del Pilar Hospital, Nuestra Seora del Carmen Hospital and Nuestra Seora del Perpetuo Socorro Hospital in the municipalities of Albania, Barranca, Hatonuevo and Uribia, respectively. A sample of users was selected from each hospital at the levels of out-patient consultation, hospitalization and the emergency service in order to ascertain their perception of access to and the quality of the services. Observation units thus consisted of housing units, households and the people within them for both the SLMS and the HCS household Modules. Likewise, in the HCS, the IPS and their technical personnel are included in the observation units, as well as the users of hospitalization, emergency and out-patient consultation services. The sample required for application of the Standard of living Survey was 2,496 households, with sampling accuracy or error at 5% for both the urban and the rural areas, for rates or ratios greater than 10% with a reliability level of 95%. Frequencies of less than 10% increase the possibility of error and reduce reliability. By expanding these data, based on the 2005 census, the population covered by the survey included 65,659 people: 36,315 rural and 29,344 urban, located in 14,146 housing units, of which 7,463 were in rural areas, and 14,284 households, of which 7,492 were in rural areas. These data were collected between 1 and 30 September 2009 in urban areas and between 3 November and 2 December 2009 in rural areas. For the Health Conditions Survey - HCS - field work was carried out in April and May 2010. Population sub-groups were needed because of the scope of the study and according to the Module to be applied as explained below. The sample comprised 2,739 households surveyed in Module 1, with a total of 11,484 persons. Once all the members of the household were identified in Module 1, Module 2 was applied to all people between the ages of 6 and 17 (3,251 persons) and a population sub-group between 18 and 69 (6,254
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people). Module 3 collected information on all children under the age of 6 from informants who were either their mother, father or a guardian (1,692 children). Finally, due to the sensitive nature of the questions, Module 4 was applied to a sub-group of 3,003 people between 18 and 69 years old. The initial conditions for expanding the household sample for the HCS required the use of the sample framework established for the SLMS; however, this proved impossible and an adjustment of the SLMS expansion factors was necessary in order to avoid biased indicator estimates. The adjustment took into consideration refusals to reply due to rejections or displacements and the replacements that were necessary to cover the pre-established sample. As subgroups of different age groups were needed depending on the survey Module to be administered, another adjustment factor was required in addition to the final expansion factor. At institutional level, four IPS were consulted, as were a total of 322 of their service users: 216 out-patient consultations and 106 hospitalizations or emergencies. The results obtained from these samples were not expanded to the national total as it was impossible to obtain all the records of services provided from the four hospitals, nor was any complete report found among national statistics.
Bias Control
Possible sources of bias were identified: unequal selection probabilities for the final observation units (households, persons, IPS and users), the difficulty of complete coverage of the selected samples, possible imperfections in the sampling framework used to select the samples, possible design errors in the measurement instruments and occasional deficiencies in selecting and training the surveyors in data collection and processing. Potential problems in instrument design were controlled through testing and validation processes. Possible deficiencies in training and data collection and processing were reduced to a minimum thanks to a controlled, structured collection process, strict personnel selection guidelines, theoretical and
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practical training, detailed manuals of functions, procedures, and exhaustive supervision and quality control plans. Any bias originating in the different selection probabilities and failure to cover certain selected sampling units was controlled by applying an adjustment factor to the expansion factors calculated for the SLMS in Cerrejn area of influence, thereby guaranteeing unbiased estimates of the research populations absolute values. Although the IPS and user results are presented without expansion, strict sample selection and control of the above mentioned processes reduced possible biases.
Calculating Accuracy
All estimates of the characteristics of the study population based on probability samples are approximate, which is why it is important to establish their degree of accuracy or margin of error. The appropriate indicator is the standard or sampling error, calculated as the proportion between the standard error and the indicator, which measures the variability of sample randomisation. The mathematical formula for calculating standard error is a function of the type of sample, selection stages and the respective probabilities. For the design described above, formulae appropriate to a stratified sampling, of unequal clusters, were adapted for two levels of clustering (see, for example, Kish, 1965). The STATA statistical package is basically programmed according to the Taylor series method, which was used to calculate standard errors in this study. Due to the complexity of the sample designed, calculations of the specific estimates are affected by sampling and non-sampling errors which must be controlled. Non-sampling errors, which generally arise during the process of collecting and processing data, were minimized by careful survey design, surveyor training and exhaustive supervision during collection in the field, as well as information coding, purging and processing. Sampling errors were estimated with an algorithm that produces very reasonably accurate approximations.
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Because the 2009 Standard of living Survey was a complex, multi-stage sampling, special formulae had to be used to take the effects of stratification and clustering into account. Thus, the sampling errors associated with SLMS estimates were calculated by DANE (National Statistics Department). The sampling errors for the estimates obtained from the Health Conditions Survey were calculated using the survey data procedure (svy command) in STATA version 10. This procedure applies to complex designs and takes the expansion factor of each selected sample or sub-group into consideration. In general, the selection of a cut-off point in the relative standard error or coefficient of variation, on the basis of which the decision was taken to declare the estimate of the population value given because of the considerable magnitude of the associated sampling error, is arbitrary and essentially depends on the type of measurement effected and its desired use. For example, if one wanted to evaluate the quality of a serial production of highprecision instruments through a sampling study, the acceptable differences between the estimate and the population value must obviously be quite small. In other cases, such as samples of households or other observation units studied through personal interviews on various topics of interest, a level of accuracy no higher than 15% or 20% of the relative standard error is generally accepted (EUSTAT 2005, DANE 2006, INEC 2004).
CHAPTER III
Standard of living
Mauricio Ferro Mauricio A. Crdenas Jeannette Liliana Amaya
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CHAPTER III Standard of living
HOUSEHOLDS
Type of dwelling
The following graphs show each population groups household conditions, identifying important gaps in their access to public services, especially that of basic sanitation. Graph 1 shows the information by type of dwelling, the predominant type in the rural area being aboriginal (the Wayu settlement) at 68.2%. 31.1% of the rural and 82.1% of the urban population live in houses.
Graph 1. Percentage of households according to type of dwelling, by area
%
90 80 70 60 50 40 30 20 10 0 Urban House Apartment Rented Room Rural Room in Another Type of Structure Total Aboriginal Residence
Source: DANE Calculation - Standard of living Survey, Cerrejn, 2009
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Housing tenure
With respect to housing tenure (Graph 2), 86.6% of the rural population have their own completely paid house. This percentage is explained by the fact of collective ownership on aboriginal reservations, which, in accordance with Articles 63 and 329 of the Political Constitution ...are inalienable, are not subject to any statute of limitations nor to seizure. Reservations are a special legal, socio-political institution made up of one or more aboriginal communities with a collective title and the guarantees of private ownership, they possess their territory and are governed for their management and their internal life by an autonomous organization protected by the aboriginal jurisdiction and under their own system of laws (Osorio and Salazar, 2006). Among households in the urban area, 53.1% live in their own completely paid houses and 36.7% are rented or sub-leased (see Table 1, Appendix 1).
Graph 2. Percentage of households according to housing tenure by area
Urban
Owned, completely paid for Rented or subleased In usufruct Possessin with out deed (de facto... Owned, being paid for No information Owned, completely paid for Tented or subleased Insufruct Possessin with out deed (de facto... Owned, being paid for No information
Rural
Owned, completely paid for Rented or subleased In usufruct Possessin with out deed (de facto... Owned, being paid for No information
Total
50
% 100
50
% 100
% 0 50 100
Predominant material of floors and walls

Table 2 shows that 56.7% of residences are built of blocks, bricks, stone or hardwood, which is low compared to nearly 80% at national level. These materials are followed to a lesser degree by unplastered (18.1%) and plastered adobe (15.4%), considerably higher than the percentages reported for the entire country, which were 2.1% and 3.0%, respectively. Moreover, while in
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urban areas 85.3% of dwellings have exterior walls in blocks, bricks, stone or hardwood, in rural areas, this percentage is only 26.4%. There is evident participation of other important materials, such as plastered adobe (33.7%) or unplastered adobe (23.4%) walls. 92.0% of floors are in cement, gravel, earth or sand. This percentage contrasts with 37.7% at national level, where the predominant flooring materials are (49.0%) tiles, vinyl, panels, bricks or hardwood. In urban houses, 76.4% have cement or gravel floors, while in rural areas this percentage is only 32.3%. There are more earth or sand floors (64.9%) in the rural setting. These results outline a predominant type of basic dwelling that uses few industrially processed materials and finishings
Table 2. Percentage of households according
to the material of the walls and floors by area

Predominant material of eXterior walls Block, brick, stone, hardwood Unplastered adobe Plastered adobe Bamboo, cane, straw or other vegetal matter Untreated wood, board, panel Prefabricated material Zinc, fabric, canvas, cardboard, tins, waste, plastic Compressed earth, adobe No walls Predominant material of floors Cement, gravel Earth, sand Tile, vinyl, slabs, brick, hardwood Untreated wood, board, panel, other vegetal matter Marble, parquet, lacquered hardwood Rug or wall-to-wall carpeting 76.4 10.6 10.9 0.8 1.2 0.1 32.3 64.9 1.0 1.8 55.0 37.0 6.1 1.3 0.6 0.0 Urban 85.3 3.4 7.9 0.7 0.2 1.4 0.7 0.4 0.1 Rural 26.4 33.7 23.4 11.5 3.1 0.9 0.8 0.2 N/A Total 56.7 18.1 15.4 5.9 1.6 1.2 0.7 0.3 0.0
Source: Cendex Calculation- Health Conditions Survey- Households, Cerrejn, 2009.
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Rooms in the household

The average number of rooms in the household, excluding the kitchen, bathrooms, garages and those intended for business, is 2.3, which is lower than the 3.3 national average. 85.6% of households have between 1 and 3 rooms; this percentage is 94.6% in rural areas and 77.0% in urban areas. However, over half the households have one bedroom, which indicates possible overcrowding, given the average number of persons per household and the number of available spaces in the dwelling (Graph 3).
Graph 3. Percentage of households according to number of rooms and number of bedrooms by area
%
100 90 80 70 60 50 40 30 20 10 0 Urban Rural Total Rooms Total Urban Rural Bedrooms Total
One room
Two rooms
Three rooms
Four rooms
Five or more rooms
Source: Cendex Calculation- Health Conditions Survey- Households, Cerrejn, 2009
Access to public services

One particularly important aspect for good health is the availability of drinking water and sewage and waste water management. Despite the
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existence of water supply in urban areas, it does not ensure drinking water quality or uninterrupted supply. Of the households with water supply from a public, community or hamlet system, 40.9% do not have continuous service during the week. This is more serious in urban areas (47.4%) than in rural areas (31.5%). At urban level, waste water treatment is not adequate and, at rural level, this is one of the most complex issues to manage Graph 4 shows access to public services of households in the area of influence. Although electricity is the service with the widest coverage, it does not reach all communities in the rural area. Access to water, which influences childrens performance at school, reaches barely 38.1% among the rural population, compared to 98.6% in urban areas. Only 21.1% of rural households have access to running water, 11.8% to sewage systems and 13.2% to garbage collection. A fact which it is important to highlight is that 59.6% of the rural population reported having no access to any public services (see Table 2 in Appendix 1).
Graph 4. Percentage of households according to access to public services, by area
Urban
Telphone No utilities Natural gas Sewer Garbage collection Water Electricity Telphone No utilities Natural gas Sewer Garbage collection Water Electricity
Rural
Telphone No utilities Natural gas Sewer Garbage collection Water Electricity
Total
% 0 50 100 0 50
% 100
% 0 50 100
Similarly, it is important to analyze how water for human consumption is supplied, especially in rural areas, where 35.7% is obtained from so-called jageyes (water holes), in 19.3% of cases it is pumped from wells, in 13.4% is
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taken from rivers or streams and in only 11.4% are there public water supply systems, the latter being a source of microbiological contamination. In urban areas, 83.1% of water is supplied by public systems (see Graph 5 and Table 3 in Appendix 1)
Graph 5. Percentage of households according to source of water supply for cooking by area
Urban
Rainwater Public fountain No information Water vendor Water botties or bags Tanker truck Communal or local River, strean, spring well with pump Pumpless well, pool Public water system Rainwater Public fountain No information Water vendor Water botties or bags Tanker truck Communal or local River, strean, spring well with pump Pumpless well, pool
Rural
Total
Rainwater Public fountain No information Water vendor Water botties or bags Tanker truck Communal or local River, strean, spring well with pump Pumpless well, pool
50
% 100
Public water system
20
40
60
% 80 100
Public water system
50
% 100
Water supply quality in Cerrejn area of influence has been extensively studied by Fundacin Cerrejn para el Agua en La Guajira (Cerrejn Foundation for Water in La Guajira), Universidad del Valle and the Cinara Institute (2009)7, and by Luque, Doria, et al. (2010). The latter found cases in which water from the jageyes is used for human consumption and acts as a vehicle for spreading diseases caused by poor water supply and sanitation given the presence of viruses, bacteria, amoeba and helminths. In the microbiological analysis, 100% of the samples collected exceeded the standards allowed by environmental regulations, in particular with the presence of coliform bacteria (total and faecal) that directly impact the health
7 The water supply development intervention plan in these communities includes several alternatives to overcome the poor quality of water for human consumption, low availability, poor sanitation, high health risks, inadequate sanitary and hygienic solutions in homes and schools and poor institutional support and technical assistance. See: www.fundacionescerrejon.org
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of the population, particularly through diarrhoeic diseases. These studies also conclude that aboriginal communities, especially women and children, invest considerable time and effort resources on water supply because sources, such as jageyes, are not close enough to their homes. Table 3 summarises water supply and quality in several aboriginal communities in Cerrejn area of influence. All the water sources analyzed have a high physical-chemical risk and bacteriological contamination and, therefore, it is not fit for human consumption.
Table 3. Rural situation of water supply and quality by community
CommunitY Jurisdiction Water SupplY Water QualitY
Wasachen
Uribia
Carried from a windmill, a jagey and a tank
Microbiological contamination
Cerro de Hatonuevo
Hatonuevo
Water supply pumped from a storage system
Non-drinking water; consumption with high level of risk
Juyasirain
Uribia
Carried from a windmill, a jagey and a tank
High level of microbiological contamination
Pesuapa
Maicao
Carried from a windmill and a jagey
Trupiogacho Aboriginal Reservation
Trupiogacho - Provincial Hatonuevo and - San Francisco Regional Barrancas Water Supply System, which unfortunately is not working Carried from Ranchera River and reservoirs filled using tanker trucks
Available sources are contaminated
Provincial
Barrancas
Non-drinking water; consumption at high level of risk
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CommunitY
Jurisdiction
Water SupplY
Water QualitY
Wayajiragua Satsapaa
Uribia
Carried from different jageyes in the communities
Ishamana
Maicao
Carried from a windmill, a jagey or a tank
Warulapalen
Uribia
Carried from a dam, artesian well and a tank
Ro de Janeiro
Albania
Supply pumped from a deep well
Cerrejn 1
Albania
Supply pumped from a deep well
San Francisco
Barrancas
Carried from the Ranchera River and tanks filled by tanker trucks
Consumption at high level of risk
Media Luna
Uribia
Carried from a tanker truck and a jagey
Jiichipaa
Uribia
Carried from a tank and a jagey
Apuluwoo
Uribia
Carried from a dam, an artesian well and a tank
Consumption at high level of risk
Source: Fundacin Cerrejn para el Agua en La Guajira (Cerrejn Foundation for Water in La Guajira), Universidad del Valle, Cinara Institute, 2009
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Sanitation services
As far as sanitation services are concerned, aboriginal households are more likely to have none at all. In rural areas, 71.5% of homes have no sanitation systems - nearly 8 times the percentage in urban areas, where only 9.2% of households lack this service. 15.8% of aboriginal households have toilets connected to septic tanks and 10.5% to sewage systems (see Graph 6 and Table 4 of Appendix 1).
Graph 6. Percentage of households according to type of sanitation service by area
Urban
No information Tollet not connected to sewage system Body of water, latrine Toillet connected to septic tank Toillet connected to sewage system No sanitation service % 0 20 40 60 80 100
Rural
No information Tollet not connected to sewage system Body of water, latrine Toillet connected to septic tank Toillet connected to sewage system No sanitation service 0 20 40 60 % 80 100
Total
No information Tollet not connected to sewage system Body of water, latrine Toillet connected to septic tank Toillet connected to sewage system No sanitation service % 0 20 40 60 80 100
Cooking fuel
In the case of cooking fuel, 85.0%, an exceptionally high proportion of households in the rural area use wood firewood, wood or charcoal for cooking, while 62.8% in urban areas use natural gas and 22.8% propane gas in cylinders. Only 10.9% of urban households use firewood for cooking (Graph 7). The continued use of firewood requires immediate attention because of its impact on the living conditions of rural households through at least two ways. On one hand, it increases risks of respiratory disease related to smoke from
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wood stoves and, on the other, substituting wood with another fuel makes it easier for women and children to devote time to schoolwork, recreational activities and to family members instead of going out to collect firewood.
Graph 7. Percentage of households according to type of fuel used for cooking by area
Urban
Waste material Petroleum, kerosene, gasoline, cocinol, alcohol Mineral coal Electricity Propane gas (In cylinder or canister) Natural gas connected to public network Wood or charcoal % 0 20 40 60 80 100
Rural
Total
Goods and services

Application of the SLMS showed the main goods and services of households in Cerrejn area of influence (Graph 8). It is interesting that, in rural areas, as many as 40.8% of households own a bicycle, used by adults to travel between communities and children to go to school. Colour televisions are also a common possession, along with fans (23.1%), refrigerators (16.0%) and electric or gas stoves (15.5%). Only 3.5% of households own a car and 2.2% a motorcycle. The use of computers is low (0.6%) and connection to the Internet is almost non-existent (0.3%), which means there is very limited access to information and communication mechanisms for adults and possibilities for improving childrens performance at school. Urban households have a large percentage of electrical appliances among their possessions, mainly fans, colour televisions, stoves, refrigerators and liquidisers. The use of a bicycle is relatively significant (31.5%)
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while, unfortunately, the use of computers in the household and Internet connections tends to be low at 10.2% and 4.4%, respectively (see Table 5 of Appendix 1)
Graph 8. Percentage of households according to goods and services owned, by area
Urban
VCR or Betamax Microwave Motorcycle Air conditioring Electric oven Stereo system Washing machine Blender Electric or gas stove Color television 0 20 40 60 80 %
Rural
Total
Socio-economic stratification and Sisben

Socio-economic stratification was analysed according to tariffs for public electricity supply, which is 99.2% of urban households, 45.2% of rural households and 73.0% of all households. A large number of the latter (64.7%) belong to stratum 1, followed by stratum 2 with 20.2%. The latter percentages are similar in urban areas, as opposed to rural areas, where 90.2% of households belong to stratum 1 or lower. As to stratification by Sisben (Identification System for Potential Beneficiaries of Social Programs), it was found that the survey had covered 61.5 % of households, with a lower frequency in rural households (40.1%) than urban (81.6%). See estimates in Table 6 of Appendix 1. Most of these households were classified at Sisben level 1: 76.6% rural and 67.9% urban. According to the survey, 19.6% of households were classified
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at Sisben level two in urban areas, but in rural areas the figure was only 5.8%. It is noteworthy that 16.9% of rural households did not know the Sisben level in which they were classified, while this percentage was only 5.8% at urban level (see Table 7 in Appendix 1) The low application rate of the rural Sisben survey may be the result of local entities limited capacity to implement it. Given the vulnerability conditions, this is a factor that reduces social opportunities such as access to grants and programmes and therefore exacerbates poverty and marginalization conditions.
Graph 9. Percentage of households according to socio-economic strata and Sisben classification by area
%
100 90 80 70 60 50 40 30 20 10 0 Urban Rural Level Total Urban Rural Sisben Classification Total
Zero
One
Two
Three or higher
Unknown
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PEOPLE
Population by area and ethnicity
Of this population, 55.3% live in rural and 44.5% in urban areas, which means a little more than half of the population of Cerrejn area of influence is rural and scattered under the semi-arid conditions of the territory (Table 4). It is important, however, to clarify that most of the Wayu population in the municipalities of Albania, Hatonuevo and Barrancas live in this way in aboriginal reservations. The non-Wayu rural population is minimal.
Table 4. Population distribution by area of residence
Area of residence Rural population Urban population Total Percentage 55.3% 44.7% 100.0%
To establish whether or not a person belonged to this Aboriginal group, the criterion of self-identification, widely accepted in demographic research, was used (CELADE, 1992). The results indicate that 53.5% consider that they belong to the Wayu ethnic group and also speak Wayunaiki (Table 5). Almost all of the Wayu population in Cerrejn area of influence live in the rural area, so that the rural population is almost exclusively Wayu. When interpreting statistical results on aboriginal populations, it is important to remember that the Wayu, especially its young members, are almost all perfectly bilingual and can express themselves fluently in both Wayunaiki and Spanish. Only the older adults are monolingual in Wayunaiki. It is very unlikely that people who do not belong to the Wayu ethnic group speak Wayunaiki.
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Table 5. Population distribution according to ethnicity

Ethnic group Aboriginal population Non-Aboriginal population Total Percentage 53.5% 46.5% 100.0%
From the socio-linguistic point of view, La Guajira is a territory in which diglossia prevails. Two different languages coexist: Spanish being the official language used by the State and its institutions as well as by the betterpaid sector of the economy and the upper classes (Ninyoles, 1972), while Wayunaiki is the household language of families belonging to a minority marginalized within the national state. Table 6 summarises some of the socio-economic variables of the households and the population in the area of influence according to their ethnicity. The proportion of women is predominant in both the aboriginal and the non-aboriginal population, in the case of the former at 50.9%, as was the case in the aboriginal census of 1991, when aboriginal women were the majority (DANE, 1992). The percentage of women in the non-aboriginal population is 51.3%
Table 6. Description of the composition of households according to ethnicity
TYpe of population Size of the household (persons) Men (%) Women (%) Male-headed households (%) Female-headed households (%) Households with male head without spouse (%) Households with female head without spouse (%) Aboriginal 4.8 49.1 50.9 60.4 39.5 14.7 76.8 Non-aboriginal 4.3 48.7 51.3 60.9 39.1 12.7 75.3
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According to the 2008 Standard of living Survey, the average number of persons per household in the aboriginal community is 4.8, while in the nonaboriginal population it is 4.3, both of which are in excess of the national average of 3.7. The size of the households does not differ greatly from that of the Atlantic Coast region in general at 4.3. Growth in the number of children per household has increased the demand for care and attention and the number of dependents on the head of the household who generates the familys income. This can be a powerful mechanism that produces socioeconomic gaps, especially in view of the relatively large number of women heads of household living without a spouse and with children under the age of 18 (see Table 8 in Appendix 1). There is a notably large percentage of women heads of household living without a spouse, at 76.8% in the aboriginal population and 75.3% in the non-aboriginal population. This suggests the existence of many households in a vulnerable situation, because of the increased difficulty of earning a living sufficient to ensure survival of the family group and the existence of gender inequality in employment in the area of influence. This situation may be the result of polygamy, which is common throughout La Guajira Department and is not restricted to the Wayu population, as shown by Vergara (2010). According to the ancestral Wayu tradition, men may have several wives. These households are left under the wifes responsibility alone for long periods of time. This cultural pattern is also common among the urban population, even if to a lesser extent. Although this practice is changing, it is still prevalent and continues to bestow prestige and high value within the general population, especially among the male members of the community Vergara (2010), quoting from an interview with a Wayu woman, explains the cultural change that is taking place with respect to polygamy: When I was younger, I was never jealous; if my husband was looking for someone else, I let him, because women could accept this. Today, women have changed.
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Perhaps it is because of the alijunas [non-Wayu persons] carry a machete and a knife and their mothers never taught them how to behave. Strategies and programmes created in the short term need to be implemented taking this type of family into account in order to ensure opportunities for women and thereby contribute to the sustainability of their households. Table 7 shows population distribution in the area of influence according to age ranges. The proportion of the rural population under five years of age is high (17.3%), which requires special health care and additional efforts to guarantee affiliation of this population to the general healthcare service.
Table 7. Population distribution according to age range, by area
Age group Children under 5 5 14 15 29 30 44 45 59 Over 59 Total Urban 11.3 24.3 25.5 21.9 11.7 5.3 100 Rural 17.3 29.9 23.1 14.0 8.0 7.7 100
Similarly, a significant proportion of the population, both urban and rural, is of school age, so that educational services must be a fundamental concern in any study of wellbeing in the area. The rural population over 44 years of age is a minority and those over 59 are a marginal percentage at 7.7% in the rural and 5.3% in the urban areas
Population by age and gender

The population living in the area of influence is 48.3% men and 51.8% women, similar to the national distribution of 47.5% and 52.5%, respectively.
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As age increases, the percentages increase, such that the population over 50 years of age represents only 12% of the distribution of both genders, thus consolidating the population pyramid (see Table 9 in Appendix 1). While in the urban zone minors under 18 years of age are 42.1% male and 39.0% female, in the rural area the percentages are 48.4% and 44.4%. This increase is offset by the relative decrease in the percentage of people between 18 and 49 years of age, which means that these populations vary considerably for the different protection and social welfare policy makers. The rural population pyramid varies substantially from national distribution and requires the development and active introduction of protection, education and nutrition programmes, given the high proportion of children and adolescents.
Graph 10. Population pyramid in the area of influence
> a 69 60 a 69 50 a 59 40 a 49 30 a 39 18 a 29 12 a 17 6 a 11 <a6 30 20 10 % 0 10 20 30
Women
Men
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Marital status
Of the total number of inhabitants in Cerrejn area of influence, 58.4% stated that they were single, 29.2% living with a partner, 5.1% married, and 4.9% widowed, as illustrated by Graph 11. This distribution is quite different from the national average, in which a large part of the population (34.4%) is married or living with a partner (30.5%) and only 12.3% of the respondents are single. A breakdown by gender shows that the proportions of married and widowed people are the same; however, the proportion of people who are separated or widowed is higher among the female group and the single population is larger in males. As to results by area, the proportion of people who are single or living with a partner is higher in the rural population than in the urban area. This is largely due to the fact that the proportion of married people in rural areas is only 1.7%, compared to 8.6% in urban areas. On the other hand, the proportion of women who are widows or separated is three times greater than that of men (see Table 10 in Appendix 1).
Graph 11. Population distribution according to marital status by area
%
100
80
60
40
20
0 Urban Rural Men Total Urban Rural Women Total Urbana Rural Total Total
Married
Cohabitation
Widowed or separated
Single
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This last result would serve as a justification, if necessary, to evaluate and address the protection of women conditions in the area studied. A large proportion of women in the above situation may imply considerable differences in gender related economic equality and wellbeing.
Kinship among household members

Most of the members of households are sons and daughters (45.8%), followed to a lesser extent by the heads of household (24.5%) and their spouses (15.6%). In the group of women, although 16.7% are heads of households, a large proportion (26.8%) are spouses. The opposite is true among men, where 32.8% are heads of household and only 3.8% are in the role of a spouse. The presence of other family members amounts to 13.5%, including relationships such as: daughter-/son-in-law, grandson/granddaughter, father/ mother, father-/mother-in-law, brother/sister and brother-/sister-in-law, among others. Non-family members do not often live in family households (Graph 12). This result implies a large proportion of extended households and, to a lesser extent, compound households, with the implications of these situations on cultural, social and economic aspects.
Graph 12. Population distribution according to relationship by gender and area
%
50
40
30
20
10
Men
Women
Total
Head of household
Spouse/ Companion
Son/Daughter
Other family member
Other unrelated person
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An analysis of heads of households by gender and marital status showed that 88.8% of male heads of households are accompanied by either a spouse or partner. However, in cases of women heads of household, the larger proportion (70.5%) consisted of unattached women: widowed, separated or single. Traditionally, the family structure of the Wayu population is matriarchal. These results suggest consolidation of the matriarchal structure that affects linear relationships and a successional or family organization. However, the large population of single women heads of household suggests that both social and economic relations favour the paternal/male line. Subdivision by area shows similar pattern of distribution according to relationship, both at general level and by gender, with a smaller presence of children and an increase in other relatives in the urban area in comparison with the rural area. Thus, while the presence of children and other relatives in the urban zone is 42.3% and 16.1%, respectively, in the rural zone these percentages are 49.1% and 10.9%.
Education
Since the publication of the seminal studies by Becker (1967, 1993) and Schultz (1961) on education, human capital training and their impact on economic growth and development, there has been widespread consensus that it is only through the acquisition and development of work and social skills by a population that its sustainable socio-economic development can prosper.8 It is by developing their potential and qualities through formal and informal education that people can fully acquire their freedom and the capacity to assume responsibility, in particular for shaping their own future and controlling their destiny. Although childrens education is referred to as a fundamental right in the National Constitution (Article 44) and quality education is a pillar of the 2006-2015 National Ten-Year Education Plan, La Guajira Department still has a long way to go. The gross coverage rate, that is, the ratio between students affiliated to a specific level of education (regardless of age) and the school population
8 http://go.worldbank.org/F5K8Y429G0
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at the appropriate age for that level9, is shown, according to latest official Department data available, in Graph 13. One of the phenomena that distort educational statistics is the so-called extra-age, in which older students are still attending a school cycle that they should have already completed. This phenomenon can be attributed to repetition rates as well as truancy, due for example, in the Wayu case, to families nomadic lifestyles. This leads to school attendance rates of over 100%. The gross coverage rate in the Department is consistent in comparison with the years from 2005 to 2007, inclusive. During those three years, there was a significant change in the last year of pre-school, but the rate obtained is in line with national levels. At basic primary, basic secondary and middle school levels, the changes are not significant over time and are below the national values. In the cases of basic secondary and middle school, the differences seen in 2007 are, respectively, 49 and 57 points below the national total. Regarding school attendance, which concerns the proportion of the population within a defined age range attending a formal education centre10, La Guajira must continue improving because its rates are below the national totals in all age ranges. Table 8 lists the School Attendance Rates (SAR) according to data from the 2005 census.
9 10
The gross coverage rate (GCR) is calculated as follows: Preschool GCR = (Affiliated to kindergarten / Population between the ages of 5 and 6) x 100 Elementary GCR = (Affiliated to elementary school / Population between the ages of 7 and 11) x 100 Middle GCR = (Affiliated to middle school / Population between the ages of 12 and 15) x 100 High GCR = (Affiliated to high school / Population between the ages of 16 and 17) x 100 This indicator has been calculated for the population between 5 and 17 years of age (the ages at which the levels of basic education are studied) and for the population between 18 and 23 (age range for higher education). SAR = (Students from 5 to 17 years of age / Population from 5 to 17 years of age) SAR = (Students from 18 to 23 years of age / Population from 18 to 23 years of age)
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Graph 13. Gross coverage rate by level of education in La Guajira (2005 - 2007)
%
125
100
75
50
25
Kindergarten
Elementary
Middle
High
2005
2006
2007
Colombia 2007
Source: National Ministry of Education, Planning Department
Both the country and La Guajira are committed to improving their education indicators based on the Millennium Development Goals.11 In education, efforts are being made to reduce illiteracy and increase attendance rates to 100% for elementary education and 93% for secondary education by 2015. Analysis of the area of influence shows marked differences between the urban and rural populations, in both the average years of education and the level of education completed, and also in the indicators of gross and net school attendance. In the group from 5 to 19 years of age, the average number of years is 5.1 and 2.7 in the urban and rural populations, respectively, as shown in Graph 14. The longest average years of education (9.7 years) is achieved in the urban population in the group from 20 to 34 years of age. This value is even higher than that of the Atlantic region for 2008, which was 9.0 years. On average, the urban population completes 3.9 more years of education than the rural population, and in the age group over 35, this difference is 5.2 years (see Table 11 in Appendix 1).
11 See Millennium Development Goals at the United Nations website http://www.un.org/ millenniumgoals/ and http://www.beta.undp.org/undp/en/home/mdgoverview.html
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Table 8. Comparison of the school attendance rate between
La Guajira and Colombia

Years 5 6 7 8 9 10 11 12 13 14 15 16 Total La Guajira 55.5 60.9 67.5 67.7 69.9 69.9 73.0 71.8 72.5 70.3 64.2 59.4 66.7 Colombia 70.4 85.6 90.3 92.0 92.8 92.6 92.1 90.1 87.4 83.2 77.6 69.8 85.4
Source: DANE Census, 2005
Graph 14. Average years of education according to age groups by area

%
10 9 8 7 6 5 4 3 2 1 0
Urban Rural Total
5- 19 years old
20- 34 years old
35 and older
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Educational services in the area of influence are very precarious. In urban areas, there are not many schools and, in rural areas, there are only a few schools that provide bilingual Wayunaiki-Spanish education 12. There are substantial differences between the urban and rural populations as, among the latter, 51.9% of the population have received no education at all, 29.4% have only completed elementary schooling and 14.2% have finished middle school (Graph 15).
Graph 15. Population distribution according to level of education by area
Urban
None Middle Elementary Technical Completed bachelors Incomplete bachelors Technological Completed graduate Pre-school Incomplete graduate 0 20 40 60 % None Middle Elementary Technical Completed bachelors Incomplete bachelors Technological Completed graduate Pre-school Incomplete graduate 0
Rural
None Middle Elementary Technical Completed bachelors Incomplete bachelors Technological Completed graduate Pre-school % 20 40 60 Incomplete graduate 0
Total
% 20 40 60
Twenty five point two percent (25.2%) of the rural population have completed elementary education and 45.4% middle school. In this population group, there are records of people having completed the levels of technical (7.6%), technological (1.4%) and university (7.1%) education. The university population is very small in the area of influence due to this societys lack of optimism for the near future (see Table 12 in Appendix 1). Bearing in mind that children and young people are the future, the education levels of those living in the area of influence are
12 Among the schools in Cerrejn area of influence, eight are located in Uribia: Alfonso Lpez Pumarejo, Normal Superior Indgena, Internado Indgena San Jos, Julia Sierra Iguarn, Internado Indgena Nazareth, Internado Indgena Siapana, Internado Indgena kamusuchiwou, Institucin Etnoeducativa Camino Verde; four are located in the municipality of Barrancas: Paulo VI, Remedios Solano, Institucin Etnoeducativa Montealvernia, Jos Agustn Solano; one is in Hatonuevo: Nuestra Seora del Carmen, and one is in Albania: San Rafael de Albania.
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precarious, which means that a very great effort on the part of the public and private sectors of the region will be needed to reverse the situation. Nevertheless, even though a large number of students succeed in graduating from high school or university, a serious problem that has been analyzed by the United Nations (2009) still exists. It conducted in depth research on the dilemma faced by members of the aboriginal community after graduating, which consists of having to choose between returning to their own community or continuing their studies and living in another type of society with few chances of success. If the conditions of the regional economy are not strong, both aboriginal and non-aboriginal students will have little incentive to return home and subsequently preserve their community, culture and autonomy. For this type of population, education should be such that it is capable of inculcating in individuals of the aboriginal communities interest in participating in both state and civil society without rejecting their identity, their aboriginal community or their culture. The results of the SLMS in Cerrejn area of influence made it possible to calculate the gross and net school attendance rates for primary, secondary and university education (Graph 16). In the case of the net rate, there is an imbalance between the urban and rural populations at primary, secondary and higher levels of education. This difference is especially pronounced at secondary level since, while the attendance rate in urban areas is 69.7%, in rural areas, it is only 23.4% (see Table 13 in Appendix 1).
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Graph 16. Net and gross school attendance rate according to level of education by ar
% 140
120 100 80 60 40 20 0 Urban

Primary
Net rate
Rural
Secundary
Total
Higher Education
% 140
120 100 80
Gross rate
60 40 20 0 Urban
Primary
Rural
Secundary
Total
Higher Education
The results of the gross attendance rate show that, in the area of influence, there is school attendance outside the official age ranges, which are 7 to 11 for primary school and 12 to 17 for secondary school (including the middle and high school levels). In the case of primary school, there is a problem with students outside the official age range (the gross rate is 133.5%) in the rural area. At urban level, this problem is more marked in the case of secondary education (101.5%). Based on this analysis, we may conclude that a significant number of children in the urban and rural areas either drop out of school or have to repeat grades, and both cases are serious.
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Given the high fail rate indicators (proportion of students who fail the school year in relation to the total number of students enrolled at the same level) and the annual repetition rates (proportion of the total number of students who are repeating the school year in which they are currently enrolled) of the municipalities in the area of influence, it is easy to see that these problems persist and that they are indeed serious. Graph 17 shows the consolidated fail rates for La Guajira and Colombia, demonstrating that they have been higher than the national level in La Guajira since 2004.
Graph 17. Comparison of the annual fail rate between La Guajira and Colombia (2000 - 2006)
%
12 10 8 6 4 2 0
2000
2001
2002 La Guajira
2003
2004 Colombia
2005
2006
The annual repetition rate in Barrancas and Uribia, as shown in Graph 18, is higher than that reported for the Department and for the country as a whole. Albania and Hatonuevo have seen a significant improvement in this indicator over the last few years. At national level, the repetition rate has decreased very substantially from 5.5% in 2002 to 3.2% in 2007. Certain tutoring and remedial programs may have helped to achieve this result.
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Graph 18. Annual municipal and national repetition rates (2000 - 2007)
%
10 9 8 7 6 5 4 3 2 1 0 2000 Albania 2001 Barrancas 2002 2003 2004 Uribia 2005 La Guajira total 2006 2007 National Total
Hatonuevo
Literacy in people over 15 years of age is shown in Graph 19. Illiteracy rates are much higher in the rural than in the urban population at 39.9% and 7.0%, respectively. The 39.9% illiteracy rate in rural areas points up a severe structural problem bearing in mind the rates of 11.7% and 6.9%, respectively, for the Atlantic Region and for Colombia as a whole (see Table 14 in Appendix 1). This educational weakness is very considerable and makes it difficult to implement livehood projects that require minimum reading and writing skills, as well as digital literacy and, therefore, it is one of the issues that needs to be addressed both urgently and very specifically. In the case of the Wayu people, their ability to read and write in their native language has to be made a priority, although the real difficulty lies in the limited existence of written material in Wayunaiki. Not knowing how to read in Wayunaiki is socially and economically functional as there are practically no signs, documents or writings in this language, nor is it needed for any formal activities with the State or economic institutions. This is the diglossia phenomenon we referred to earlier.
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Graph 19. Population distribution according to literacy, by area and region

%
100 90 80 70 60 50 40 30 20 10 0 Urban Rural Total Atlantic region National total
Literate
Illiterate
None of the variables of the survey of the area of influence measures educational quality, because it does not form part of the SLMS and it is complicated to measure. The Saber tests conducted regularly by the National Ministry of Education13 measure educational quality. The results of these tests, as well as those of the state examination, or ICFES as it is more commonly known, show that there is markedly deficient educational quality, not only in the area of influence, but throughout the Department and even in the Caribbean region as a whole. The ninth grade Saber Tests ... evaluate the competencies developed by students from sixth to ninth grade (secondary school cycle). The tests take into account the basic competence standards defined by the National Ministry of Education. They are the starting point for a definition of the purposes of the evaluation as they are the common reference points for the knowledge, skills and values which all Colombian students are required to acquire during their school career, regardless of their background or social, economic and
13 For further information, go to http://www.colombiaaprende.edu.co/html/docentes/1596/article-73522.html
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cultural conditions. Because these standards are common evaluation criteria, the results enable progress to be monitored over time and are used as an input for the design of targeted improvement strategies14. According to the results of these tests, from 2002 to 2009, La Guajira was below the national average in language and mathematics, shown in graphs 20 and 21 as average scores and standard deviations. The historic results were obtained by ICFES using only some of the students evaluated originally in each sitting and, therefore, they are not entirely comparable with those of 2009. In 2009, the average score obtained by La Guajira on the ninth-graders language test was 253 points, with a standard deviation of 69; the score for Colombia as a whole was 289, with a standard deviation of 74. In mathematics, the result in La Guajira was 247, with a standard deviation of 61, while the score for the entire country was 284, with a standard deviation of 72.
Graph 20. Saber Tests Statistics (Grade 9 language results) in La Guajira and Colombia
La Guajira
500 500
Colombia
400
400
Average Score
285 (54)
253 (69)
200
Average Score
300
293 (69)
300
289 (74)
200
100
100
2002-3
2005-6
2009
2003
2006
2009
Source: www.icfessaber.edu.co
14 www.icfessaber.edu.co
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Graph 21. Saber Tests Statistics (Grade 9 mathematics results) in La Guajira and Colombia
La Guajira
500 500
Colombia
400
400
Average Score
287 (42)
247 (61)
200
Average Score
300
279 (63)
300
284 (72)
200
100
100
2002-3
2005-6
2009
2003
2006
2009
Source: www.icfessaber.edu.co
The national schools ranking, based on the results of the ICFES tests at the end of grade 11, showed that the performance of 80% of schools in La Guajira has ranged between the inferior, low and average categories. In the last year for which official information is available (2007), 71.7% of the schools fall within the low or inferior category, as shown in Table 9. At a theoretical level, the role of quality of education on the income of individuals and the distribution of income and economic growth has already been demonstrated. It has even been concluded that quality is a more reliable indicator than the number of years of schooling, to the point that quantity has disappeared as an explanatory variable (Hanushek and Woessmann, 2007). Given the complexity of the measurement and the lack of detailed information in the area of influence, it is vital for the issue of educational quality to be included on the agenda for future research, with the absolute conviction that it is one of the fundamental points for joint efforts between the public and private sectors.
Table 9. Distribution of schools according to ICFES test performance categories (2000 - 2007)
STANDARD OF LIVING AND HEALTH:
Year
No. of Schools Inferior Low Average High Superior
VerY Inferior
VerY Superior
2000 0.0 0.0 1.9 1.8 0.0 0.0 0.0 35.0 36.7 6.8 40.2 30.0 43.6 12.3 49.1 21.9 12.7 31.6 11.7 42.9 27.6 14.3 45.8 42.7 6.3 2.1 10.5 9.6 6.4 11.1 9.2 49.0 38.2 6.9 3.9
108
0.0
31.5
52.8
8.3
5.6
0.9 1.0 2.1 1.9 3.5 4.5 6.0 4.2
0.9 1.0 1.0
2001
102
2002
96
92
2003
105
1.0 1.8 2.7 4.3 3.3
2004
114
2005
110
2006
117
2007
120
Source: ICFES
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Occupation of the labour force
Main activity
The population of 12 to 69 years of age was asked to state the activity that occupied most of their time during the week prior to the survey; the results showed that there was a tendency to have been working (43.8%), doing housework (30.0%) or studying (21.3%). Only 3.8% said they had been looking for work, especially the population between 18 and 39 years of age. Graph 22 shows a breakdown by gender, revealing substantial differences in occupation with most men working and studying, in comparison with women, who spent more time on housework. This behaviour is very similar to that evidenced at national level.
Graph 22. Distribution of the population aged 12 to 69 according to main activity, by gender and area
Permanently incapacitated
Other activity (investor, pensioner)
Household responsibilities
In school
Looking for work
Working 60 40 20 0
%
20
40
60
80
Women
Men
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Evaluation of womens activities according to where they live showed a greater tendency to study, do housework and look for jobs in rural areas, associated with the low prevalence of female workers (19.7%), which increases to (22.6%) in urban areas, which implies a lack of job opportunities for the rural female population. This may be a critical factor for improving the income of rural households and, in some cases, a determining factor in their options to overcome poverty. In the case of men, there are more activities associated with working, looking for work and studying in urban areas due to the small percentage of men doing housework, which is lower than in the rural area by 8.2 percentage points.
Occupational Position
A range in the database that contains individuals from 12 to 65 years of age was selected in order to describe the distribution of jobs by category, which reflects a structure in which the rural population is involved in activities with both higher status and more income. As Graph 23 shows, the most numerous categories of jobs among the urban population are manual workers or employees of private companies (41.2%), as well as independent and selfemployed workers (38.8%). In the rural population, these values are 13.5% and 71.4%, respectively. The rural population is concentrated in the category of self-employed or independent, which includes completely informal workers engaged in non-specialized, low-income work; skilled technical workers (taxi drivers, plumbers, artisans, etc.) and a third group that includes independent professionals (see Table 15 in Appendix 1). Unfortunately, it was not possible to obtain the level of breakdown in the self-employed or freelance category of workers in the survey, but most of the rural population is most probably in two job market categories. That of purely informal workers includes street vendors, lottery ticket sellers and food vendors who do not have a fixed income to cover their basic needs, or those who work within their own economic system, including shepherds,
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artisans, intra-tribal merchants, firewood cutters and subsistence fishermen, for whom there is evidence of substantial seasonal migration.
Graph 23. Distribution of the population aged 12 to 65 according to occupational position by area
Urban
Independent contractor or self-employed Employee or worker at private company Government employee or worker Unpaid worker Domestic employee Laborer Boss or employer Other 0 20 40 60 % 80
Rural
Independent contractor or self-employed Employee or worker at private company Government employee or worker Unpaid worker Domestic employee Laborer Boss or employer Other 0 20 40 60 % 80 Independent contractor or self-employed Employee or worker at private company Government employee or worker Unpaid worker Domestic employee Laborer Boss or employer Other
Total
% 0 20 40 60 80
The testimony of Jos ngel Paz Epiayu, a Wayu aboriginal person, is enlightening as regards present labour relations in the area: Economically speaking, you could say there is not much work available in this area. Many people travel to Venezuela in search of work. There are more opportunities in Venezuela than here in La Guajira. For instance, the company - Cerrejn - doesnt offer railway work to any Wayu simply because we have no documents or education. Our parents were not as concerned about us as we are now about our children, applying for papers and taking them to school to learn. The company only employs people with an education. When Morrison15 arrived the first time, they gave everyone a job, regardless of age, living conditions and education. There were no requirements to start either. It is all very different now. They ask you for a lot of things, but in Venezuela they only ask for your I.D. Thats why the young people, starting at the age of 15, leave to work on ranches, either as watchmen, a foreman or milking
15 In 1981, the main contractor company, Morrison Knudsen, builder of the complex, was established in La Guajira.
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the cows [] they go out to sell clothes and other products so they can bring household money and food for the family [] The rest of the people who cant go to Venezuela stay here and work as fishermen, because we are near the sea. Those who have a boat sell to the alijunas (non-Wayu persons) and those who do not, buy fish on the beach and sell it in the ranchera (hamlet) settlements to make some money. Others cut firewood to sell in Cabo de la Vela. Each piece is sold at COP16 300 or COP 500; they also trade yotojoro wood, which sells well in Cabo de la Vela because they use it to build fences, huts, beds and other typical Wayu handicrafts (Vergara, 2010). The lack of sources of formal employment and low agricultural productivity in the rural area lead to high levels of unemployment or the existence of entirely informal self-employment. Nearly 11% of the urban population are employed by the public sector or the municipal administration. In the case of the rural population, 4.0% of the people are labourers or public employees. Last but not least, 5.3% of the rural population work without pay, which would indicate some type of non-conventional work practice that needs to be further investigated and studied in-depth in the future. The above results show a deplorable situation of mere survival for a large part of the population, who have to work as informal vendors. This makes it imperative for the region to create new sources of formal, good quality employment.
Empowerment of women
Womens empowerment is a very important indicator of development in any social context. Womens possibilities of professional development, autonomy and self-esteem are critical factors in overcoming poverty and consolidating modern, constructive social structures.
16
COP: Colombian Pesos, the local currency
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Autonomy
The population of women who are married or living with a partner (54.9% and 47.9% in urban and rural areas, respectively) were asked if they had the autonomy to carry out certain activities (Graph 24). Of these women, 70.8% have to tell their spouse that they are going out alone, 24.3% ask permission to do so and 4.9% neither tell their spouse nor ask for permission. These percentages are lower than those found nationally: 72%, 15.6% and 12.2%, respectively.
Graph 24. Autonomy of women (12 - 69 years of age) with a partner to go out alone by area
%
80
60
40
20
Urban
Asks permission Notifies
Rural
Total
Does not notify or ask permission
A relationship of substitution was found between the options of asking for permission and going out without saying anything, because, while the latter increases progressively with age, the former decreases. It is also important to note that the practice of telling the spouse is similar at all ages, starting at 18, with a visible increase in ages between 50 and 59. Evaluation of womens autonomy by area showed that, in rural areas, women ask their partners for permission to go out alone more often than married women or those living with a partner in urban areas (see Table 16, Appendix 1).
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In addition, women in urban areas do not often say they are going out alone or ask permission to do so, especially after the age of 50. However, this may be affected by the high proportion of single women heads of households at that age. In this sense, it would not be socially accepted autonomy, but rather a situation resulting from abandonment by, or death of the spouse. In the same population, the autonomy of women to go out with their children was analyzed (Graph 25). On average, 2.8% do not have children, most of whom are in the population range from 12 to 17 years of age. For women with children, 93.9% notify or ask their spouse for permission to go out with their children: 22.4% ask for permission and 71.5% notify; the other 6.0% do neither. The custom of notifying is higher in the population from 12 to 17 years of age (84.9%) and from 50 to 59 years of age (83.9%); in the former group, women are less likely to have full autonomy to go out with their children. Results by age range are shown in Table 17 of Appendix 1.
Graph 25. Autonomy of women (12 - 69 years of age) with a partner to go out with their children by area
%
80
60
40
20
Urban
Asks permission Notifies
Rural
Total
Does not notify or ask permiss
99
In the rural area, the tendency for women to ask for permission to go out with their children is much higher than in the urban area in all age ranges, which is offset by a smaller proportion of women who let their partners know when they are going to do so. Although this type of womens autonomy is similar by area, differences were found at the level of age, especially in women over 50 years of age in the urban area who do not have to either notify or ask for permission. Of the total number of women who are married or living with a partner, 1.8% reported not having to pay everyday household expenses (Graph 26) and therefore they do not require the autonomy to do so. Among the remaining population, to pay household expenses 70.9% of the women notify, 22.5% ask permission and 6.6% have full autonomy to do so.
Graph 26. Autonomy of women (12 - 69 years of age) with a partner to pay everyday expenses by area
% 80
60
40
20
Urban
Asks permission
Rural
Notifies
Total
As age increases, the proportion of women who ask for permission decreases, in which case this action is replaced by notifying payment of household expenses. The proportion of women with full autonomy at this level is
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similar at all ages, except in women under 18. Results by age range can be found in Table 18, Appendix 1. As in the previous cases, there are substantial differences by area, because, while in urban areas 15.6% of women ask permission to pay household expenses, the percentage is double that in rural areas. Notifying (76.7%) and acting autonomously (7.7%) are higher among urban women in comparison with the 63.8% and 5.3%, respectively, in the rural area. The greater tendency to ask permission among women in the rural area is even in the different age ranges
Decisions on expenses
This section discusses womens level of participation and autonomy in decision-making on household expenses. Graph 27 shows that in more than half the cases, decisions regarding expenditure on clothing and shoes for children, food, and those associated with household improvements, furniture or appliances are made by the mother in the company of another person. These decisions are the responsibility of the father or another man/woman at household in less than 12% of cases and the mother only in approximately 37% of cases. Analysis of the results by area shows that decisions on these expenses by the mother or the mother in the company of another person are more frequent in urban areas, where the participation of men in this regard is low. Specifically, while in rural households spending on clothing and shoes is decided on by the mother (36.6%) or the mother with another person (51.1%), in urban households these percentages rise to 39.2% and 53.0%, respectively, which means the participation of men in this aspect is less than in urban areas. The situation is the same in the case of decisions regarding spending on food and other extra expenses. Distribution by age range is shown in Table 19 of Appendix 1.
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Graph 27. Participation of women (12 - 69 years) with a partner in decisions regarding household expenses by area
%
100
80
60
40
20
0
Urban Rural Total Urban Rural Food expenses Total Urban Rural Total Clothing and footwere expenses for the children Additional expenses for fixing the house or buying furniture or appliances
Only the father or someone else
Only the mother
The mother makes the decision with someone else
Decisions regarding children and sharing in their care

Sixty two point six percent (62.6%) of the total population from 12 to 69 years of age have children under the age of 6 living at home; this figure is a little higher in the rural (66.5%) than in the urban area (59.4%). In households where there are children under 6, certain aspects of shared responsibility for caring for their children between parents were found. A comparative analysis between men and women is shown in Graph 28. The overall responsibility for the care and attention of children during the first year of life lies essentially with the women, who, in more than 80% of cases, are in charge, all or most of the time, for calming them at night, feeding them during the day, bathing them, changing diapers and playing with them. These activities are carried out only part of the time by men at no more than 70%. Between 15% and 30% of the men reported never having played a role in this type of care and no more than 18% have helped out all or most of the time.
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Graph 28. Shared responsibility of the parents in the care of children during the first year of life according to gender
%
100 80 60 40 20 0
Men Men Men Men Women Women Women Women Men Women
Gets up al night
Feeds the child during the day
Bathes the child
Changes diapers
Entertains the child during the day
Always or a majority of the time
Sometimes
Never
An analysis was conducted of whether this behaviour was found to be different according to the area where the household is located, but no major variations were detected. However, it is important to emphasize that, while 20.9% of men in rural areas never take care of their children at night, in urban areas, this percentage goes down by half (10.4%), indicating greater responsibility on the part of fathers. For further details, see Tables 20 and 21 of Appendix 1. The results indicate a high level of mens absence in family responsibilities. This factor may indicate deep cultural considerations which may be related to customs that interfere with family life, as well as difficulties based on the type of work involving absence in the rural area or mining. This finding, however, must be qualitatively characterized as to its causes and implications.
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Wayu clans
The Standard of living survey provided information on the largest Wayu clans in Cerrejn area of influence. Six clans make up 78.1% of the Wayu population. The Epinayuu is the largest (22.4%), followed by the Jayaliluu (13.1%), Pouliyuu and Teuteuyuu (both with 12.5%), the Ipuana (10.7%) and the Epieyuu (6.9%), as seen in Graph 29. Each Wayu aboriginal person has three names: his/her given name, his/her Spanish surname and a name that indicates his/her caste or clan. Each clan is identified with an animal that is usually considered sacred and can therefore not be eaten. The most usual animal among the clans is the jaguar or puma. Blood, which the Wayu believe holds the secret of life, has enormous importance for this people. It is not seen as personal property but, rather, as belonging to the entire clan17.
Graph 29. Distribution of the Wayu population by clan
Juusayuu Uriana Unaalayuu Pshaina Other Epinayuu
Pausayuu
Epieyuu Ja'yaliluu
Lipuana
Pouliyuu Teuteuyuu
17
Taken from: http://www.periodicoelsol.net/noticia.php?Id=48
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Subjective perception of poverty

Through the implementation of the Standard of living Survey in Cerrejn area of influence the Wayu community revealed its subjective perception of poverty18. Seventy five point three percent (75.3%) of the population in the area of influence is considered poor (Graph 30). According to the 2008 Standard of living Survey, at national level, this figure is 48.3% and in the Atlantic region, 65.9%,. In the rural area (predominantly Wayu), 83.9% of the population is considered poor (see Table 22 in Appendix 1).
Graph 30. Percentage of households according to the opinion of the head or spouse with regard to their condition of poverty by area
%
90 80 70 60 50 40 30 20 10 0
Urban
Rural
Consider themselves to be poor
Total
Do not consider themselves to be poor
These responses show that perception of the inter-generation change has not been as great as might have been expected, given the growth in income of both the Department and the municipalities in the area of influence and of
18 Subjective poverty is understood to be the way individuals classify themselves in terms of the perception of their own wellbeing. Numerous studies have found consistency between the incidence of subjective and objective poverty. See Lucchetti (2006) and Palomar (2005), for example
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one part of the population. One may wonder, then, why this is the case and what would have to be done to produce the necessary change. The answers to the question on the perception of the current standard of living in comparison with five years ago is shown in Graph 31. We may infer that life does not change for the rural Wayu population, while a notable group of the urban population have perceived positive changes in their situation (see Table 23 in Appendix 1).
Graph 31. Percentage of households according to opinion regarding current standard of living compared to five years ago by area
60 50 40 30 20 10 0 -10
Better The Same Worse
Urban
Rural
Total
As accepted in the literature, poverty is also a subjective phenomenon because, ultimately, it depends on peoples perception of their own individual situation and that of their families, as well as its evolution over time. People perception of their own poverty is linked to information available on the situation of other people, either in the same region, in the outlying areas or in other parts of the country or in neighbouring Venezuela. People, especially the Wayu, feel extremely poor. Therefore, public policies and the actions
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of private companies have to explore alternative ways forward, based on the community and the people themselves, in order to build a different future. The above analysis represents a starting point that quantifiably determines the degree of social backwardness in Cerrejn area of influence and endeavours to explain the causes and determining factors of poverty and the lack of development in the area, drawing attention to some basic variables on the basis of which an agenda can be created for concerted efforts between the private sector and the regional and national public authorities. In the future, progress in the peoples levels of well-being in the area of influence can be analyzed by holding another, similar survey that is comparable in methodology, representative sample and design.
CHAPTER IV
Health conditions
Jeannette Liliana Amaya Fernando Ruiz
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CHAPTER IV Health conditions
HEALTH AND SOCIAL SECURITY

With Law 100 of 1993, Colombia embarked on the search for equality and progress in access to health services and financial protection for families facing catastrophic health expenses (Amaya, et al., 2010). In 2009, Colombia achieved a level of coverage that, at 88.2%, was close to universal insurance (Garavito, 2009). However, regional differences within the country may be a factor in social security inequality.
Insurance Coverage
Survey questions on affiliation and health expenses were used to analyze the coverage of the General Social Security System. The result of these showed that coverage of the subsidized system is four times greater than that of the contributory system. Between the two of them, 84.6% of the population is covered, in contrast to national coverage in which the contributory and subsidised regimes each cover 50% of social protection. More specifically, the majority of the population (67.6%) is affiliated to the subsidized system, while the percentage of the contributory system is only 17.0%, as shown in Graph 32. This situation is indicative of limited opportunities for formal employment in the region and the existence of restrictions preventing the population from making the contributions necessary to participate in the latter system. Because the scope of the subsidized benefits plan is less extensive than that of the contributory plan, one would expect there to be restrictions on access to portions of the care segment not indicated: specialist care and surgical operations not included in the high-cost component. The most important implication is that, because of the contributory regimes limited coverage, the characteristics of adequacy and quality of the public component of the health scheme have the greatest impact on the wellbeing of the population. Coverage of special regimes is marginal and does not account for even 1% of the population. The 14.7% of the population
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who are not affiliated to any health care system deserve special attention. Although this percentage is less than the national level, it nevertheless indicates the existence of an extremely vulnerable population and a large number of families at a high financial risk due to lack of insurance coverage.
Graph 32. Population distribution according to affiliation by gender and area
%
80
60
40
20
Urban
Rural Men
Total
Urban
Rural Women
Total
Urban
Rural Total
Total
Subsidized
Contributive
Special
Unenrolled
The major differences existing by area must be highlighted: while at urban level, 56.9% are affiliated to the subsidized system and 29.6% to the contributory system, in rural areas, 77.7% of people are affiliated to the subsidized system and just 5.1% to the contributory system. There is also a non-affiliated segment of the population in rural areas which is 4.2% greater than in urban areas. In general, there is a larger percentage of men in the contributory system and of women in the subsidized system, regardless of area. This situation suggests less formal employment among women (see Table 24 in Appendix 1).
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Out-of-Pocket Payment for Out-patient Consultations and Hospitalization

The social protection of a health system revolves around financial protection for families in the event of a health related expense, especially one that is catastrophic that affects the familys income. It is therefore important to analyze health care service use and the associated out-of-pocket expenses (Ruiz et al., 2007). This section examines health care expenses associated with both out-patient consultations and hospitalization. As Graph 33 shows, the most common expenses borne by the population are indirect, such as transportation and other related expenses. In general, the proportion of people who pay for each type of service is smaller in the rural population than urban areas. The exception would be round-trip transportation to health care institutions, an expense that gas to be paid by 9.6% of the population - 25.1% rural and 11.3% urban. In addition, 9.6% of the population spends money on other inputs, such as photocopies, which is more frequent among the urban population. Details of these estimates are shown in Table 25 of Appendix 1. The 8.9% of the population who pay the POS payment, a relatively low figure compared with the estimated 40.9% of the Colombian population in general. This percentage is positively influenced by the smaller coverage of the contributory regime, in which the POS payment tends to affect a larger percentage of the population. Whereas 12.3% of the urban population make monthly payments to the system, just 2.2% of the rural population do so. As for payment for medications, 7.5% of the population have to pay for them, a much lower percentage than the national estimate of 39.4%. Locally, 9.9% of the urban population pay for medications while only 2.8% of the rural population do so. Possible restrictions on service access must be taken into consideration. A population may be spending less due to rationing of the service and not necessarily because of greater financial protection at the time of consumption.
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Graph 33. Distribution of the population by area between the ages of 6 and 69 according to out-of-pocket payments for different costs associated with their latest appointment
Round.trip transportation Misc. items such as photocopies Required POS payment per appoinment Medications Private consultation Voucher or coupon for prepaid medicine Lab tests or x-rays Food Other treatment proced. (therapies, injections, etc) Supplies or other items necessary for service Lodging 0 Total 6 Rural 12 Urban 18 24 30
There is a segment of the population (4.2%) affiliated to private insurance and subject to deductibles for pre-paid medical services. Private consultation expenses amount to 5.6%, a figure a little lower than the national average (9.0%), and higher in urban areas (7.8%) than rural (1.4%). Another interesting finding is that only 0.2% had to pay for the materials for their treatment, which indicates that there is acceptable availability of medical supplies. Likewise, less than 1.5% of the population pay for lab tests, therapies, injections and other procedures. As to expenses related to the latest hospitalization (Graph 34), it was found that indirect expenses occur most frequently. In other words, 15.0% of the population must pay for round-trip transportation to the institution and 14.4% for other items, such as photocopies and documents. In terms of transportation, 21.3% of the rural population and 12.3% of urban patients have to pay these costs, while for photocopies and supplies, 9.9% of the rural population and nearly twice as many of the urban population are required to pay for them (see Table 26 in Appendix 1).
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Graph 34. Distribution of the population by area between the ages of 6 and 69 according to out-of-pocket payments for different costs associated with the latest hospitalization
Round.trip transportation Misc. items such as photocopies Required POS payment for hospitalization Medications Food Voucher or coupon for prepaid medicine
Hospitalization bill (private)
Lab tests or x-rays Other treatment proced. (therapies, injections, etc) Lodging Supplies or other items necessary for service
0 Total 4 Rural 8 Urban 12 16 20 24
10.5% of the population had to make the POS payment, a much lower percentage than the national average, which is 35.1%. This cost is paid by 13.7% of the urban population and only 3.0% of the rural population. 6.4% of people pay for medications, significantly fewer than the national average of 28.8%. This expense is assumed by 7.2% and 4.4% of the urban and rural population, respectively. Payment of pre-paid medicine vouchers represents a very small percentage (2.0%) in comparison with payment for out-patient consultations. This suggests low private insurance coverage in the area. Payments for private hospitalization is made in only 1.5% of cases, especially in urban areas. Only 0.2% of people pay for supplies or other care items, while the national level for this cost is assumed by 6.1% of the population. It is rare for people to pay for other procedures such as therapies, injections, orthopaedic equipment, laboratory tests or x-rays.
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Average Expenditure on Out-patient Consultations and Hospitalization

Table 10 shows the extent of out-of-pocket expenditures for different types of out-patient consultations. The average monthly payment is COP 7,503 and there are no major differences according to area. Nationally, the average payment is COP 3,092. The groups that pay the highest amount are those in the subsidized program (COP 16,376) and those who are not affiliated (COP 8,744). The national averages for these payments are lower, at COP 3,147 and COP 4,256, respectively. Because of the concentration of extreme poverty in this population, the cost of the monthly payment is disproportionate and should be revised. The average amount paid for pre-paid medicine vouchers or coupons was COP 11,272. This amount, which is higher in urban areas, is less than half of the national average expenditure (COP 25,391). The amounts vary according to the respective insurance situation. A person in the subsidized program pays an average of COP 94,226 for this service, while the amount is reduced to COP 42,874 for special systems and approximately COP 7,000 for contributory systems and the non-affiliated population. These differences should be addressed at Departmental level. The average out-of-pocket cost for a private appointment is COP 37,474, not far above the national average of COP 29,331. There are probably fewer human and medical resources in the region, which means that the amount paid tends to be somewhat higher. There are slight differences by area: COP 38,161 in urban areas and COP 30,134 in rural areas. It is interesting that the cost of a private appointment for non-affiliated persons is 34.4% less than for those affiliated to the subsidized system (COP 56,381). This situation suggests major limitations on the protection provided by the subsidized system. The out-of-pocket cost for this expense in the contributory system is COP 33,472, less than the amount paid in the subsidized system. Although the average cost of a private appointment is greater in urban areas for people affiliated to the social security system, there is not much regional variation for people who are not affiliated.
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The price paid for medications is also very high at close to COP 39,918, while the average amount at national level is COP 22,610. This cost represents an especially high out-of-pocket expense for people affiliated to the subsidized system at COP 95,525, in contrast to the payment of COP 14,577 by the contributory population. This situation runs counter to the national estimate, in which the average payment for medications is COP 14,018 in the contributory system and COP 29,644 in the subsidized regime.
Table 10. Average amount paid at the last appointment
according to type, system and area

System TYpe Area
Subsidized Contributory Special Not affiliated Total
Urban POS payment for consultation (recovery or co-payment quota) Rural Total Urban Pre-paid medicine voucher or coupon Rural Total Urban Private consultation Rural Total Urban Medications Rural Total Materials or other items necessary for service Urban Rural Total
15,376 21,077 16,376 94,226 94,226 58,265 41,808 56,381 106,808 66,633 95,525 170,854 170,854
6,888 5,523 6,781 7,221 5,846 7,102 33,472 33,472 13,816 29,350 14,577 72,000 72,000
6,040 6,040 42,874 42,874 80,000 80,000 53,881 46,611 52,614 -
8,744 8,744 7,000 7,000 19,422 19,271 19,402 -
7,473 7,827 7,503 11,745 5,846 11,272 38,161 30,134 37,474 38,103 52,654 39,918 144,470 144,470
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System TYpe Area

Subsidized Contributory Special Not affiliated Total
Urban Laboratory tests or x-rays Rural Total Other treatment procedures (therapies, injections or educational sessions) Regional Rural Total Regional Round-trip transportation Rural Total Regional Food Rural Total Urban Housing Rural Total Urban Misc. items such as photocopies Rural Total
94,184 280,000 109,302 7,627 7,627 9,032 8,461 8,670 26,149 11,902 20,033 2,000 2,000 451 268 39
6,452 6,452 8,591 8,591 20,800 20,319 20,701 21,463 100,000 28,494 1.027 328 943
15,000 15,000 12,000 12,000 -
20,986 13,475 18,198 75,000 75,000 407 265 367
49,458 280,000 58,885 7,989 7,989 13,960 9,581 11,630 23,799 33,889 27,360 2,000 2,000 569 272 484
The high out of pocket expense incurred with respect to payments for materials or other items for their treatment, which is an average of COP 144,470, should also be stressed. Although this situation is relatively infrequent, a small number of people are required to pay these high costs. This expense is borne solely by urban populations and there are differences according to the system involved, varying from COP 170,854 for the subsidized system to COP 72,000 for the contributory system.
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The average out-of-pocket costs for laboratory tests or x-rays is COP 58,885. There are major differences between the systems. Subsidized affiliates pay an average of COP 109,302 while contributory affiliates pay only COP 6,452. Payments for other procedures such as therapies, injections or educational sessions are not especially large. Finally, the amount paid in indirect expenses (food, lodging, photocopies) is in line with the particular conditions of the region. As for expenses related to hospitalization, Table 11 shows the significant monthly payments of the population affiliated to the contributory system (COP 206,744), which is much higher than the national average of COP 110,959. This amount falls to COP 49,276 for the subsidized system, higher than the national average of COP 120,629. There are marked differences according to area because this expense is three times higher in urban than rural areas. People not affiliated to any system pay an average of COP 39,136, which is lower than the national average of COP 105,834. The average voucher payment for pre-paid medical services is COP 11,621: COP 38,000 in rural areas and COP 8,369 in urban areas. These values were reported only for the population affiliated to the contributory system. The cost for private hospitalization is COP 43,619, more than four times higher for the contributory system than for people who are not affiliated. The high price paid for medications during hospitalization (COP 150,502) is three times higher than the estimated national average. This out-of-pocket cost is quite high for the subsidized population (COP 338,918), especially in urban areas. Conversely, affiliates in the contributory system who live in rural areas pay more than those living in urban centres. Although the national average out-of-pocket cost associated with supplies or other items related to service is COP 108,956, this expense is virtually non-existent within the area of influence. The population pays COP 24,836 for laboratory tests and x-rays: COP 30,000 in the subsidized system and COP 18,000 in the contributory system. Meanwhile, urban affiliates to the contributory system pay an average of COP 12,000 for other procedures.
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For indirect costs related to hospitalization, the population bears outof-pocket costs totalling an average of COP 19,026 for transportation and COP 44,647 for food. These values are greater for the contributory population than for those subsidized. Transportation costs are higher in urban areas while more money is spent on food in rural areas. These indirect expenses must be evaluated in depth in order to analyze the possibility of creating support mechanisms to reduce them. In general terms, there is extensive coverage of the subsidized system among the population of the area. However, the contributory system coverage is limited. Nevertheless, a group of the population remains that is not covered by any type of social protection, especially in the rural area. This group is in a vulnerable situation due to the financial risks posed by health problems. As for expenses incurred by people who pay out-of-pocket expenses directly, there are certain costs associated with out-patient consultations and hospitalization, the most usual ones being indirect expenses, such as transportation and photocopies. Direct costs associated with care are generally POS payments and medications. Out-of-pocket expenses for materials, procedures and laboratory tests are infrequent for both consultations and hospitalization. However, in cases of consultations, out-of-pocket payments are more frequent for pre-paid medical services and private consultations than they are for hospitalizations.
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Table 11. Average amount paid for the last hospitalization
according to type, system and area

System Type Area
Subsidized Contributory Unaffiliated Total
Urban POS payment for consultation (recovery or co-payment quota) Rural Total Urban Pre-paid medicine voucher or coupon Rural Total Urban Hospitalization bill (private) Rural Total Urban Medications Rural Total Urban Supplies or other items necessary for service Rural Total Urban Laboratory tests or x-rays Rural Total Urban Other treatment procedures (therapies, injections or educational sessions) Rural Total
31,179 73,339 49,276 436,184 10,000 338,918 500 500 30,000 30,000 -
242,484 242,484 8,369 38,000 11,621 50,795 50,795 17,290 160,000 27,757 18,000 18,000 12,000 12,000
1,500 60,000 39,136 12,000 12,000 50,000 30,000 38,863 -
219,535 70,101 206,744 8,369 38,000 11,621 12,000 43,619 178,432 42,748 150,502 500 500 24,836 24,836 12,000 12,000
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System Type Area

Subsidized Contributory Unaffiliated Total
Urban Round-trip transportation Rural Total Urban Food Rural Total Urban Lodging Rural Total Urban Misc. items such as photocopies Rural Total
14,444 12,994 13,629 27,448 15,000 26,202 40,000 40,000 1,083 731 984
33,161 4,000 31,275 83,940 100,000 87,191 4,067 4,067
8,443 16,366 14,404 445 1,000 629
23,476 13,002 19,026 43,129 54,715 44,647 40,000 40,000 2,115 779 1,839
Analysis of the actual expense associated with service delivery reveals relatively moderate out-of-pocket costs. There is, nevertheless, a group of procedures that entail high costs of medications and the supplies necessary for treatment that patients have to assume. Expenditure for monthly payments and medications is significant for hospitalization in comparison with the average amount paid for out-patient consultations, but the cost associated with supplies or other treatment items is significantly higher for out-patient consultations. The amount paid for these expenses varies according to the affiliation system and location. Direct out-of-pocket costs related to consultations are higher in the subsidized system than in the contributory system and indirect costs are higher for the population affiliated to the contributory system. In the case of
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expenses related to hospitalization, direct and indirect payments are higher for the contributory population, with the exception of the amount spent on medications and laboratory tests, which are higher among subsidized affiliates
PERCEPTION OF HEALTH AND SERVICE USE

The best predictive health service use indicators are related to gender and age variables and self-perception of persons own state of health (OMeara et al., 2003). It is well known that use evolves with age. Health services are most commonly used at very early and very advanced ages and by women during their reproductive years. Perception of a bad or very bad state of health are also linked to high levels of use. Restricted access among high-risk populations indicates problems in health system design and care models. The household survey asked about the populations perception of its health conditions (Graph 35); 86.3% of the population felt that they were in good or very good health. This perception is strongest among subsidized system affiliates and those who are not affiliated to any system. People affiliated to the contributory and special systems have a greater tendency to feel that their health is average, with percentages of 16.9% and 19.2%, respectively, while among those subsidised and not affiliated, this perception is present in less than 12% of people in the subsidized system or in no system at all (see Table 27 in Appendix 1). Although a small percentage of the population feels that it is in poor or very poor health (1.3%), this percentage is 2.1% for non-affiliates, more than 0.6% higher than affiliates. The perception of affiliates in special systems differs considerable from that of the other systems. A high percentage feel that they are in very good health (29.9%), an assessment shared in no more than 20% of cases in the other affiliation groups.
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Graph 35. Distribution of the population (6-69 years old) according to their perception of their health by system and area
%
100
80
60
40
20
Total
Total
Subsidized
Unenrolled
Subsidized
Unenrolled
Subsidized
Contributive
Contributive
Contributive
Urban Very good Good
Rural Avarage Poor Very poor
Total
Geographically speaking, there is a better perception of health in rural areas. More specifically, although 80.7% of the urban population feel that they are in good or very good health, this percentage is 11.1 points lower than the level reported in rural areas. In rural areas, 92.3% of subsidized system affiliates feel that they are in good or very good health, whereas just 80.3% of this population in urban areas do so. This difference of 12 percentage points reflects a greater tendency for the urban population to feel that they are in average or poor health. This trend is consistent for the contributory and non-affiliated populations, with differences of 8.1 and 6.9 percentage points, respectively.
A breakdown by gender reveals that 89.6% of men consider themselves to be in good or very good health and very few feel that they are in poor or very poor health. The perception of good or very good health among women is slightly lower at 84.4%. These numbers vary according where the person lives. In urban areas, 87.5% of men and 77.0% of women feel
Unenrolled
Special
Special
Special
Total
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that they are in good or very good health; in rural areas, these percentages increase to 91.5% and 92.0%, respectively. Details regarding these averages are shown in Table 28 of Appendix 1. The population between the ages of 6 and 69 were asked if they had sought help in the previous month in health-related issues, whether or not they felt ill. Of those who did feel ill, only 45.9% had sought help. This pattern differed according to affiliation. Those affiliated to a social security system exceeded this average, while those without insurance tended to seek help less frequently when they did not feel ill (33.3%). The tendency to request a consultation even when feeling well was more common in urban (49.9%) than in rural areas (38.2%). This was true across all systems, with the exception of persons affiliated to the contributory system, in which case rural populations requested consultations more frequently than urban populations. The national average for effective demand for treatment of health problems is 75%., but the results of the survey were 30 percentage points below it. This may indicate that: 1) there are cultural restrictions or geographical barriers that prevent people from accessing these services; 2) institutions are rationing access to service; 3) it is a consequence of a new level of social protection and new participation in the contributory system and 4) monthly payments restrict access. In any event, it is possible that a combination of all of these factors is affecting access to health services. These considerations evidence the lower health expenditures described in the previous chapter and it is very possible that lower expenditure may be related to less effective access. Given the characteristics of the region, its geographic isolation and its cultural barriers, services should actively reduce the accumulated health risk. An active outreach policy and mobile service units could help to reduce the accumulated risk and improve the populations wellbeing and Standard of living cost-effectively. The highest rates of consultations in the previous month by persons without health problems were those of affiliates to the special system (34.9%), followed by the contributory system (16.9%) and then the subsidized system (11.8%). Among the uninsured population, the rate was only 6.2%. In rural
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areas, 8.3% of the population consulted when not feeling ill. This percentage increases to 16.2% in urban areas (Graph 36).
Graph 36. Consultation prevalence in the past 30 days in the population between the ages of 6 and 69 by system and area
%
100 90 80 70 60 50 40 30 20 10 0
Total
Subsidized
Unenrolled
Subsidized
Contributive
Contributive
With health problems Urban Rural Total
Felt well
The greatest differences by zone are in the non-affiliated and subsidized populations: 12.0% of urban residents not affiliated to a health system made appointments without having any health problems, while only 1.8% of non-affiliated rural residents did so. Of the subsidized population, 15.9% consulted in urban areas and 9.0% in rural areas. Conversely, in the special systems, the tendency to seek medical assistance without feeling ill is more common among the rural population (see Table 29 in Appendix 1).
Unenrolled
Special
Special
Total
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Table 12. Main reason for not seeking consultations in the
population between the ages of 6 and 69 by system

Reason Neglect They felt a consultation was not necessary The service centre is very far away They do not like to consult Consultations are very expensive or they had no money They recovered without treatment Too much EPS/ARS/IPS processes The hours were inconvenient or they did not have time There was nowhere for them to go Poor service They did not know they were entitled to consult They did not trust the doctors or service providers They did not know where the service was provided They had to wait too long for an appointment They were not given an appointment or it was too far in the future They were afraid, nervous or embarrassed They attended an appointment, but were not seen Subsidized 31.4 19.3 18.1 9.8 2.6 5.9 3.6 2.0 2.1 0.7 1.7 1.8 0.8 0.3 ContributorY 38.6 23.9 3.2 8.7 5.2 2.1 6.4 6.1 1.5 2.0 2.3 Nonaffiliated 20.4 10.0 18.3 21.9 3.8 7.3 2.2 7.0 6.4 1.0 1.7 Total 31.2 19.5 14.4 7.1 6.3 4.9 3.3 2.6 2.3 2.0 1.4 1.3 1.3 1.2 0.5 0.3 0.2
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Questions were asked as to why persons did not seek consultations according to their type of insurance coverage and, of all the responses, 65.1% were for three principal reasons: neglect (31.2%), not feeling that a consultation was necessary (19.5%), and distance from service centre (14.4%). In the contributory system, 62.5% of non-consultations were related to neglect and thinking that consultation was not necessary. These reasons were equally important in the subsidized population, for which distance from the service centre was also a major factor. Although the three reasons mentioned above are also important in the nonaffiliated population, the main reason why they did not seek consultations was that consultations were very expensive or they had no money (21.9%). On the other hand, 13.7% of the non-affiliated population did not seek consultations because there was no service centre for them to go to, because they were unaware of their rights or because they did not know where the service was provided.
FOOD CONDITIONS
In contrast to the design of the National Health Survey (NHS), the peoples food habits were analyzed when the survey was applied in Cerrejn area of influence. A new module was designed which included the peoples perception of the alimentary customs according to which they took decisions. This was related to their cultural characteristics in the areas of territory and traditions, which could have an important impact on the populations nutritional situation.
Food Habits
The first question in the alimentary habits module was on the average number of days per week on which food is consumed in the household. The population was sub-divided by rural or urban location. The decision to use this subdivision relates to the particular traits of the Wayu
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population, who tend to live in rural areas. Food habits could typify idiosyncratic cultural patterns to some extent. Graph 37 shows the different alimentary groups according to the internationally accepted classification. Foods most usually consumed are fats and oils on 5.3 days per week. The second most common are cereals and derivatives, consumed on 4.4 days per week, followed by vegetables and derivatives (3.9 days per week), milk and derivatives (3.5 days per week) and eggs and derivatives (3.2 days per week).
Graph 37. Average number of days per week each food is consumed in the household by area
Fats and oils Grains and derivatives Vegetables and derivatives Milk and derivatives Meats and derivatives Eggs and derivatives Fruits and derivatives Legumes and derivatives Fish and shellfish Candy and desserts Alcoholic beverages 0 1 2 3 4 5 6
Total
Urban
Rural
There is a low consumption of meats and derivatives (3.3 days per week) and fruits and derivatives (3.0 days per week); fish and shellfish are only eaten 1.8 days per week, an interesting result for a population living close to the sea. It was clear that the populations diet is relatively unvaried. As to availability, there is a strong emphasis on fats and cereals, restrictions on protein consumption and limited consumption of fruits and vegetables (see Table 30 in Appendix 1).
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At urban level, there are considerable differences compared to the most rural population. In fact, urban residents maintain the high consumption of fats and oils 5.2 days per week, followed by vegetables and derivatives (4.4 days per week) and cereals and derivatives (4.1 days per week). Milk is consumed 4.0 days per week, exceeding that of eggs. The role of meats in the diet increases slightly with an average consumption of 3.9 days per week and shellfish is eaten only 1.5 days per week. Among rural populations, the most commonly consumed food group is that of the fats and oils 5.3 days per week. Cereals form a major part of the diet and are consumed 4.6 days per week. Other foods, such as vegetables, milk, eggs and derivatives are eaten less frequently on just over three days out of the week. These results indicate a diet fundamentally concentrated on two types of foods, i.e. fats and oils. Both are low-cost, which evidences the rural populations limited income. The low consumption of foods derived from animal protein is interesting and suggests relative homogeneity of the eating habits of this population group. Comparison between urban and rural populations shows clear differences in the consumption of nutrients, which revolves around the opportunity of eating vegetables, fruits and their derivatives. It is significant that these foods are not the most expensive and, therefore, the result suggests potential problems in the food distribution chain for the population located in rural areas. The second part of the Food Habits Module asked the population to state the number of times per day they eat each type of food in the household based on the number of days each type of food is consumed. The results shown below must be analyzed according to the number of times food is eaten per day, restricting the days per week on which that the respective type of food is not consumed. Graph 38 shows a high intensity of fats and oils consumed during the day. Fats and oils are followed by vegetables, cereals, milk, meat and eggs, which are eaten at more than one meal per day according to the reported data. The confidence intervals tend to be very narrow, which suggests that the
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population has rather homogeneous eating habits. It is noteworthy that this evidences that the population consumes few sweets and desserts.
Graph 38. Average number of times per day each food is consumed in the household by area
Fats and oils Vegetables and derivatives Grains and derivatives Meats and derivatives Milk and derivatives Eggs and derivatives Fruits and derivatives Fish and shellfish Legumes and derivatives Candy and desserts Alcoholic beverages
0,0 0,2 0,4 0,6 0,8 1,0 1,2 1,4 1,6 1,8 2,0
Total
Urban
Rural
The high frequency of fat and oil consumption among the urban population at twice a day is maintained. Vegetables, fruits and meats are eaten at one and half meals per day and other food groups less frequently. These results are substantially different from those of the rural population, especially in terms of fruits and derivatives, which are not eaten at even one meal a day. Another important difference is the lower consumption of milk in rural areas. There are very important similarities between the areas in terms of eggs, legumes, alcohol, sweets and dessert consumption (see table 31 in appendix 1). The following results should initially be analyzed on the basis of the number of meals eaten per day. The population faces limitations as to the size of their meals. Table 13 shows the number of main meals a household generally eats per day.
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Table 13. Distribution of households according to the number
of meals normally eaten per day by area

Urban Number of main meals Rural Total
Estimated value
Est. relative error (%)
Estimated value
Estimated value
0 1 2 3
0.4 0.5 10.4 88.7
0.1 0.1 0.6 0.1
0.1 4.5 25.1 70.4
100.0 13.6 4.0 1.7
0.3 2.4 17.5 79.8
18.5 12.4 2.8 0.8
0.3% of the population consume less than one meal per day; 2.4% eat only one meal in the entire day, while 17.5% only have two meals a day. Nearly 80% eat three meals a day. These results vary between urban and rural populations and the frequency of one meal per day increases to 4.5% among the rural population and 25.1% have two meals a day. This indicates a critical food security problem in rural areas in both the type and the quality of the food consumed, as well as the number of meals eaten per day. Graph 39 expands upon the results on the distribution of households according to the types of foods they eat. The graph combines the time of eating with the type of food consumed throughout one day. The most commonly consumed food before breakfast is milk and its derivatives. These are consumed by 3.5% of the rural and 4.5% of the urban population and 2.5% of the latter eat some type of fruit before breakfast.
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Graph 39. Distribution of households according to food consumption throughout the day
Milk and derivatives Fruits and derivatives Eggs and derivatives Grains and derivatives Fish and shellfish Fats and oils Legumes and derivatives Vegetables and derivatives Alcoholic beverages Candy and desserts Meats and derivatives
0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5
Total
Urban
Rural
In general, breakfast consists of milk and derivatives (79.2%) and fats and oils (53.5%) and there is no great variety in the type of foods. The urban population eat 6.5% more eggs and derivatives and 2.1% more legumes. The consumption of foods before lunch is very limited and primarily consists of fruits and derivatives. Lunch consists mainly of meat and derivatives, fats and oils, vegetables, cereals and fruits. The most relevant difference between the urban and rural populations is the almost 20% increase in cereal and derivatives in rural areas, in addition to more fish, shellfish, meat and derivatives. This is offset in the urban population by a higher consumption of fruits and vegetables. Finally, evening consumption is somewhat low and consists mostly of fats and oils (32.8%), milk and derivatives (31.1%), and cereals (27.2%). Compared to the rural area, the urban area has a higher consumption of fruits, meats and fats.
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Economic Availability and Compensation Mechanisms

Graph 40 shows the food related economic limitations in the population studied. It is noteworthy that 37.2% of the population stated that they did not have enough money to buy food. There is a major difference of 15 percentage points in availability of money to buy food between the urban and rural populations, which are 29.6% and 45.4%, respectively. This situation reveals that the lack of economic resources to buy food is the primary factor food insecurity in rural areas. Of the population which did not have enough money to buy food, 73.0% had to decrease the number of their meals as a compensation mechanism. This proportion is much higher in rural areas, where 84.9% of the population had economic limitations and had to eat less at mealtimes. This situation affected only 55.7% of the urban population.
Graph 40. Distribution of households according to compensation mechanisms used to reduce food consumption by area
Reduction in the number of meals Adult ate less than he/she wanted Adult missed a major meal Adult ate less at a major meal Adult went to bed hungry Adult remained hungry Purchase of fewer indispensable foods Child or youth ate less at a major meal Child or youth complained of hunger Youth missed a major meal Child or youth went to bed hungry Lack of money to buy food Reduction in usual quantity of food 0 20 40 60 80
Total
Urban
Rural
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Another compensation mechanism to limit food consumption is to reduce the size of the meal for one of the adults in the household. Mothers usually sacrifice full meals in order to benefit their children and spouses. This situation was found in 72.5% of the population with economic limitations on food purchases, especially in rural areas. Skipping a meal during the day to compensate for economic restrictions occurred in 69.7% of households and was more common in rural than in urban areas at 80.9% and 53.4%, respectively. Of the population with economic limitations, one adult in 63.5% of households went hungry due to lack of food. This situation was more common in rural than urban areas at 75.5% and 46.0%, respectively. The percentage of children or young people who went without a main meal during the day due to economic limitations was 51.5%, and the figure in rural areas (63.9%) is nearly twice that of urban areas (33.6%). The situation was similar in smaller meal sizes for children in 54.1% of cases and nearly twice as high in rural than in urban areas. The percentage of young people or children who go to bed hungry is 49.0%, which increased to 61.6% in rural areas and reflects a major food security problem for the youngest populations. Details of these results are shown in Table 32 of Appendix 1.
Frequency of Food Inequity Factors

Graph 41 shows the frequency of restrictions on the acquisition or consumption of food during the last month by area. 31.2% of the total population suffer from frequent chronic money shortages for purchasing foodstuffs. This situation is even more frequent in rural populations, where 44% state that their food buying is always limited, while this percentage falls to 12.7% in urban areas. With regard to occasional economic limitations, classified as occasional or rare, it is more frequent that people have lacked money to buy food at some time, which represents a proportion of 59.8%. Constant limitations in the number of meals are three times more frequent in rural than urban areas. The same is true of reduced food consumption in adults. This distribution
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also applies to the number of adults who skip meals, eat less, go hungry or go to bed hungry. In just over 50% of cases, young people have at some time not had a main meal, eaten less, gone hungry or gone to bed hungry. The population of rural young people in permanent food insecurity situations is nearly triple that of the urban population. These results paint a picture of severe food insecurity in the area studied, principally in the rural areas suffering from a lack of economic resources to buy food. There are also limitations in two other aspects: 1) in the food supply chain, especially with regard to access to fruits and vegetables in rural areas, and 2) cultural factors that emphasize the consumption of certain foods over others
Graph 41. Distribution of households according to the frequency of compensation mechanisms used to reduce food consumption
Child or youth went to bed hungry Child or youth complained of hunger Child or youth ate less at a major meal Youth missed a major meal Purchase of fewer indispensable foods Adult went to bed hungry Adult remained hungry Adult ate less at a major meal Adult missed a major meal Adult ate less than he/she wanted Reduction in the number of meals Lack of money to buy food
0 10 20 30 40 50 60 70 80 90 100
Always
Sometimes
Rarely
The importance of the situation of permanent food deficiency for certain specific populations in rural areas, which affects adults and is particularly notable in the population of minors, should be highlighted. This situation merits generic intervention in the food supply situation for the population
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within the area of influence and it could be compensated by specific programmes to complement or supplement food supply and limit the deficits revealed by the study.
PERCEIVED MORBIDITY
Oral Health Factors
The Dental Module was applied to the entire population between the ages of 6 and 69 in the area of influence analyzed, in line with similar questions posed in the NHS survey. In general, this Module analyzed: 1) the characteristics of dental care and access to dental treatment, and 2) the populations perception of oral hygiene. Only 15.4% of the population attends dental appointments at least once per month. These appointments are more common in urban than rural areas at 18.5% and 12.3%, respectively.
Dental Appointment Attendance Factors

The first aspects analyzed were the reasons why people did not attend consultations. 41.5% of the population stated that they did not attend due to neglect (Graph 42), a percentage that remains even in both urban and rural environments. Other major factors were distance from the dental surgery (13.8%) and unwillingness (12.1%). The other reasons are much less frequent. However, there is evidence that other conditions that affect service are rooted in the populations own perceptions of reluctance, such as believing that no consultation is necessary (7.1%) or being too frightened or embarrassed to attend (7.7%). Together, these two reasons hold more weight in the non-affiliated and subsidized populations, with percentages of 21.4% and 13.5%, respectively.
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There is a considerable difference in the perception of distance or proximity to services among the population according to location. This affects attendance in 35.0% of rural cases. In municipalities, individual problems such as neglect or the belief that the situation will get better on its own represent more than 59.1% of the reasons why people do not seek dental treatment (see Table 33 of Appendix 1).
Graph 42. Distribution of the population between 6 and 69 according to reasons for not attending dental appointments by area
Carelessness
The service center is very far
Doesnt like to go
The problem got better on its own
Another reason
Scared, nervous or embarrassed
Felt a consultation was not necessary 0 10 20 30 40
Urban
Rural
Total
Breakdown by affiliation regime showed increased neglect as a factor of failure to attend appointments, with emphasis on the contributory (64.3%) rather than the subsidized system (49.0%). Among the non-affiliated population, the main reasons for not attending consultations were distance to the service (27.7%), reluctance (19.6%), neglect (16.2%), and fear (13.2%).
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Location of Consultation
50% of cases are seen at government clinics or hospitals and 21.0% at government health centres. Private hospitals or clinics and EPS service centres cover only 19.1% of the populations dental care. This number is even lower among the rural population (18.4%) as treatment is more often provided at government health centres. More specifically, 40.9% of rural care is provided at government health centres, as shown in Graph 43
Graph 43. Distribution of the population seen for dental appointments by location of service and area
%
60
50
40
30
20
10
Government clinic, hospital
Government health center
EPS/ARS service center
Private practitioner or office
Private clinic or hospital
At work, school or somewhere else
At home
At a pharmacy
Healer, Acupuncturist Aboriginal alternative doctor, or similar medicine proviler practitioner
Urban
Rural
Total
This distribution changes substantially when broken down into the subsidized or the contributory system (see Table 34 in Appendix 1). In the subsidized system, 59.9% of care was provided at government clinics and 26.6% at public health centres. In the contributory system, the proportion of care provided at government clinics was 30.9%, while 38.7% were treated at EPS service centres and 13.4% at private clinics. Overall, 5.7% of the population sought dental care through private consultations: 3% subsidized
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and 9% contributory populations. This indicates significant differences between the type of treatments received by the different populations. In the subsidized system, 86.9% of the urban population receives treatment at government centres in comparison with the rural proportion at 85.9%. The percentage of care provided by private clinics in the subsidized system is marginal. The parameters are different in the contributory system. The government serves only 38.0% of the population, whereas 52.1% are treated by private institutions. The pattern is the reverse in rural areas, where 56.5% of the population is served by the government and 39.0% by private institutions. These results show that the service centre for consultations depends on affiliation, which is very important. As to the type of consultation, differences were found based on the type of place for the appointment. When the service distribution is analyzed by age group, it is clear that the majority of the population receive dental care in institutional and service environments, whether public or private. Approximately 1% of the population visit healers, aboriginal doctors or alternative medicine providers. Less than 1% seek assistance from pharmacies and most of these are young people. Dental care at work or in educational settings is very limited and at institutional level most treatment is provided at urban and rural government clinics. 61% of treatment for children between 6 and 11 years old is provided in urban areas, while rural areas account for 28%. The populations which most often seek institutional care are between the ages of 18 and 29 or over 50. The institutional care profile changes significantly in rural areas, where the majority are treated at health centers - between 28% and 46% of the population, depending on age. The population that receives the most care at institutional health centers are children between 6 and 11 years old; however, it is notable that a percentage of between 24% and 49% of the rural population are treated at Government hospitals or clinics, which suggests that patients are required to travel to receive treatment.
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Care for Young People

One of the most predominant aspects in the effectiveness of oral health care is early and effective treatment for children under the age of 10. Graph 44 illustrates good oral health habits for people over the age of 12, those who have children less than 10 years old who live with or are dependent on them. Only 23.6% of cases believe that dental care must include brushing teeth with toothpaste and only 7.8% believe that educating children about their oral hygiene is important.
Graph 44. Oral health habits in the population under the age of 10 by area
%
25
20
15
10
0
Cleaning gums with floss Eating fruits and vegetables Learning about keeping their mouth clean Being sent to clean their teeth Brushing teeth without toothpaste Restricted candy consumption Brushing teeth with toothpaste Having mouthwash and floss Using plaque-revealing pills Regular dental check-ups Cheking their toothbrush Drinking milk Flossing Nothing
Urban
Rural
Total
It is important that other critical aspects, such as the use of dental floss and plaque removal treatments, are habitual in less than 1% of the population under the age of 10. Only 4% of the population take their children to regular dental appointments. These proportions do not change between the nonaffiliated population and the population affiliated to the subsidized system. The population affiliated to the contributory system have more appreciation for habits such as flossing gums and checking their toothbrush. They are also
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more aware of the benefits of oral health in children. The three major types of dental treatment for children under the age of 10, reported by regime, are shown Table 35 of Appendix 1. There are better oral health habits among the urban population and among those affiliated to the contributory system, which suggests important differences linked to the populations socio-economic conditions. These results reveal a low level of appreciation of oral health care among the population studied and the need to implement oral health promotion and prevention strategies.
Oral hygiene habits

An analysis of the general populations oral health care shows that approximately 20% follow adequate basic oral health strategies, such as using dental floss, fluoride rinses, and sealants, as shown in Graph 45. This percentage is especially low in the population studied. The figure improves slightly in urban environments where, for example, the percentage of the population which recognizes the benefits of using dental floss increases to 30.4% and 26.7% recognize the importance of rinses. In general, these parameters vary greatly between the population affiliated to contributory and special systems and the population affiliated to the subsidized system or no system at all. Floss use is more than twice as high in the urban areas contributory and special system populations than in their subsidized populations. There is a similar phenomenon in rural areas in which the population affiliated to the special and contributory systems use floss, rinses, and sealants more regularly. The previous results show low use of preventive oral health strategies among the population and the need to implement important promotion and prevention activities among the population (see Table 36 of Appendix 1).
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Graph 45. Adult population distribution according to oral health habits, by affiliation system and area
90 80 70 60 50 40 30 20 10 0 Total Total Subsidized Subsidized Subsidized Unenrolled Unenrolled Contributive Contributive Contributive Unenrolled Special Special Special Total
Dental floss (6-69 years old)
Fluoride applications or rinses (6-19years old)
Sealants (6-15 years old)
Urban
Rural
Total
Residents were also asked why they thought they suffered from cavities. In general, 73.3% of the population believes that not brushing their teeth is a important factor for cavities and another 17.1% mentioned eating sweets as a physical-pathological factor. Equally, 20.2% do not know the causes of dental cavities. Other aspects, such as decalcification, poor diet, antibiotics, not flossing and infection were not considered important by some members of the population, which indicates a poor level of awareness of the factors that cause cavities. Graph 46 shows the differences between urban and rural populations knowledge of the causes of cavities. Although 83.5% of the urban population feels that failure to brush their teeth causes cavities, only 63.1% of the rural population recognizes this factor. In urban areas, 24.8% of the population believe that eating candy is a negative factor, while this percentage is only 9.3% in the rural setting.
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Graph 46. Distribution of the population by knowledge about the causes of cavities by area
%
90 80 70 60 50 40 30 20 10 0 Descalcification or weakness
Poor flossing or no flossing
unknown
Candy consumption
Poor diet
Infection
Using someting used by someone with cavities
Devices
Poor brushing or no brushing
Urban
Rural
Total
Source: Cendex Calculation- Health Conditions Survey- Households, Cerrejn, 2009.
The contrasts between the contributory and the subsidized systems in the urban area are not particularly significant, but there is more differentiation in the subsidized population between urban and rural areas. The results demonstrate that a significant part of the population are aware of the principal causes of cavities. Nevertheless, it is notable that, in spite of recognising that lack of brushing is a factor, the corresponding preventive habits are not accepted in the same proportion. The most important reasons for cavities mentioned are shown in Table 37, Appendix 1, by affiliation system. As to opinions on gum bleeding or swelling, Graph 47 shows that only 52.3% of the population associated poor brushing with diseases of the mouth. Gum deterioration was identified by nearly 19.8% of the population and only 15.8% presented with periodontal infection, which is a major physio-pathological periodontal problem. Urban populations identified the negative effects of poor brushing nearly 20 percentage points higher than rural populations and they were also
Genetic predisposition
Antibiotic use
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generally more aware of other factors. This indicates that the urban population differs in terms of recognizing physio-pathology such as bleeding or periodontal problems. Although no major differences between affiliation systems were noted, a smaller percentage of the subsidized population were aware of the causes of bleeding gums and periodontal disease (see Table 38 of Appendix 1).
Graph 47. Distribution of the population by knowledge about the causes of gum bleeding or swelling by area
%
60 50 40 30 20 10 0 Poor flossing or no flossing Problems with the body Poor diet Gum weakness Unknown Infection Poor brushing or no brushing Harsh brushing Devices Cavities
Urban
Rural
Total
Finally, Graph 48 shows the reasons for changing ones toothbrush. Only 34.9% of the population identified reduced bristle strength as a reason for changing their toothbrush. Thirteen point five percent (13.5%) knew that toothbrushes should be changed at least once every three months, that is, the recommendation made by oral health experts. There are no major differences according to area. The results show that, in terms of oral health, the population uses limited strategies to prevent cavities and periodontal disease and also seeks treatment
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from institutions on a limited basis. Actions and activities to prevent oral problems are also limited as well. These results are more prevalent among rural population and those affiliated to the subsidized regime, which suggests the need to undertake a series of educational and promotional interventions, mainly for the youngest populations, given the low coverage of fluoride treatments, sealant use, and strategies to ensure that young people enjoy a future with good oral health.
Graph 48. Distribution of the population according to knowledge about how often toothbrushes should be changed
%
35
30
25
20
15
10
0 When the bristles are worn When they look dirty Every month Every 2 month Every 3 month Every 6 month Every year Other
Source: Cendex Calculation Health Conditions Survey - Households, Cerrejn, 2009
These results are more prevalent among rural population and those affiliated to the subsidized regime, which suggests the need to undertake a series of educational and promotional interventions, mainly for the youngest populations, given the low coverage of fluoride treatments, sealant use, and strategies to ensure that young people enjoy a future with good oral health.
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Specific problems of children under the age of six

Mothers were interviewed in order for us to establish the diagnosis of two problems with great impact on the population under the age of six: allergies and malnutrition (Table 14). Two point four percent (2.4%) of children have been diagnosed with allergies and 1.7% with malnutrition. These percentages are much lower than the national averages of 12.5% and 5.7%, respectively, and prevalence levels 0.8 percentage points higher among males than females.
Table 14. Prevalence of allergies and malnutrition among children
under the age of 6, by gender and area

Allergies Gender Urban Male Female Overall 4.7 4.2 4.4 Rural 1.3 0.7 Total 2.8 2.0 2.4 Urban 2.2 1.5 1.9 Rural 1.9 1.0 1.5 Total 2.1 1.3 1.7 Malnutrition
Allergies and malnutrition are more frequent among urban children: specifically, 4.4% of children in urban areas are diagnosed with allergies compared to 1% in rural areas. As for malnutrition, the rates for this diagnosis are 1.9% in urban environments and 1.5% in rural areas.
Chronic Conditions among people between the ages of 6 and 69

The Colombian population is in the process of an epidemiological transition that entails a longer life expectancy, a greater presence of chronic disease and a lesser proportion of infectious or mother-child (vertical) disease. Nevertheless, mother-child and infectious diseases may be concurrent and are still important indicators in certain populations, especially rural, where there are still significant levels of acute diarrhoea and respiratory infection.
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However, the inconsistency of chronic factors and acute factors in disease implies greater pressure on health services given these conditions. The National Health Survey form was used to analyze chronic disease as part of the survey, which investigates the prevalence of chronic disease and its causes. The results are broken down by rural and urban location, as differences may exist between the two populations. They have also been divided by gender because chronic disease can vary significantly between men and women. The initial analysis relates to the populations perception of chronic disease as the form only includes questions as to whether the disease was diagnosed and if the individuals had effectively recognized the respective condition. This is different from diagnosis-based prevalence, for which a medical examination or laboratory test is necessary to ensure a more accurate assessment. The profile of chronic disease among the population shows a prevalence of 6.1% for back or neck pain, 3.2% for high blood pressure, 2.5% for asthma, and 1.4% for diabetes, as shown in Table 15. In general, the estimated values in urban areas tend to be higher than in rural areas. For example, back or neck pain is perceived in 8.9% of the urban population but only 3.5% of rural people. The same is true of other types of chronic pain, with 6.1% in the municipalities and 2.8% in rural areas. It is notable that high blood pressure was reported in urban areas nearly three times more frequently than in rural areas. The only result that does not follow this general pattern is that of tuberculosis, which is more prevalent in rural settings.
Table 15. Prevalence of chronic conditions in the population
between ages 6 and 69 by area

Chronic Conditions Back or neck pain or discomfort lasting more than two weeks Any other type of pain which lasts for more than two weeks Allergies diagnosed by a physician Urban 8.93 6.10 4.58 Rural 3.50 2.84 3.04 Total 6.17 4.44 3.79
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Chronic Conditions Thrombosis or strokes Heart attack (infarction) Heart disease High blood pressure (hypertension) Asthma Tuberculosis Other long-term lung disease, such as emphysema Diabetes or high blood sugar Stomach or intestinal ulcer Irritable bowel syndrome HIV/AIDS Epilepsy or seizures Cancer Other long-term or terminal illness
Urban 0.21 0.79 1.46 4.92 3.30 0.09 0.49 1.80 1.21 3.25 0.04 0.28 0.28 1.21
Rural 0.13 0.56 0.52 1.45 1.68 0.18 0.45 1.09 0.36 0.46 NA 0.06 0.02 0.81
Total 0.17 0.67 0.98 3.15 2.48 0.14 0.47 1.44 0.78 1.83 0.02 0.17 0.15 1.01
These results may indicate, first of all, that the differences identified between urban and rural areas are linked to lower access to health services among rural populations, which in turn implies more restricted access to laboratory tests to diagnose diseases and, therefore, prevalence is closely tied to access to health services. It is interesting that the prevalence of diabetes and irritable bowel syndrome is lower than the national average. This suggests the need to analyse access to health services through strategies and campaigns to improve these services. Differentiation between men and women shows that all diseases tend to be more prevalent in women. This difference is more pronounced in the urban area, where prevalence is twice as high for women as it is for men for diseases including high blood pressure, diabetes, ulcers, and irritable bowel syndrome.
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This may mean that women have more access to health services in urban settings while womens and also mens access in rural areas is more limited. In the case of high blood pressure, the prevalence among urban women is 6.3%, while it is 1.5% among rural women, a difference which could be attributed to these populations degree of access to services. The results demonstrate an urgent need to extend health services to rural populations, most especially preventive services that promote health and identify the populations most critical health risk factors. One example of a relevant service would be early diagnosis so that treatment and rehabilitation, as well as early diagnosis, in order to provide curative and rehabilitation treatments to avoid severe deterioration and death as a consequence of chronic illness or situations that have a very major effect on the general population.
High Blood Pressure

The population between the ages of 18 and 69 were asked about variables associated with high blood pressure, from the moment of diagnosis: taking medications to control it, attendance at nutrition and psychological consultations and being taught exercises to improve health. Graph 49 shows that 3.6% of people reported that they had been diagnosed with high blood pressure at two or more appointments, with higher prevalence among women (4.0%) than among men (2.4%). The percentage of people with hypertension was below the national average, which is 8.8%. Breakdown by area showed a prevalence of 5.2% in the urban zone In urban areas, the prevalence was 5.2%, while in rural areas it was 1.9%. Women once again accounted for a higher percentage.
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Graph 49. Prevalence of high blood pressure and related controls among people between the ages of 18 and 69 by gender and area
% 6
0
Total Rural Rural Total Rural Total Rural Total Rural Urban Urban Urban Urban Urban Total
Told that they suffered from high blood pressure at two or more appointments
Currently take medications for high blood pressure
Have gone to a nutrition consultation at some point
Have gone to a psychology consultation at some point
Have been taught exercises to improve their health
Men
Women
Total
The prevalence of high blood pressure drops to 3.0% if only those taking medications for high blood pressure are counted. This percentage is substantially lower than the national average of 6.75%. The prevalence is still higher among women, specifically at almost twice the number of hypertensive men. There are also twice as many cases of high blood pressure among urban populations than in rural areas. The percentages drop to 1.6% (1.1% for men and 1.8% for women) when based on attendance at nutrition consultations to improve diet and to learn to eat better. These numbers are half the national average and the percentages vary greatly by area. In urban areas, 2.3% of people between the ages of 18 and 69 have attended a nutrition consultation since being diagnosed with hypertension; in rural areas, this percentage is less than 1%. Meanwhile, in urban areas, women attend this type of appointment more frequently than men, while the opposite is the case in rural areas.
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The figures for psychological consultations (0.5%) to learn how to relax and manage stress in day to day life and this percentage is lower than the estimated national average (0.94%). Although there are no significant overall differences between the genders, there are variations by area: 0.8% of the urban population has attended this type of appointment in comparison with 0.3% of the rural population. Women attend more frequently for the former and men for the latter. The percentage of people who have received instructions on exercises to improve their health is similar to the result for attendance for nutrition consultation. In this case, though, there are no overall differences by gender (see Table 39 of Appendix 1).
Diabetes Mellitus
The prevalence of diabetes mellitus among people between the ages of 18 and 69 is 2.0%, substantially below the national average of 3.5%. The diagnosis of this disease does not differ by gender, but breakdown by area shows greater prevalence in urban areas (see Graph 50). The proportion decreases to 1.4% when counting the population with diabetes and are currently taking medications to control it, which is lower than the national average of 1.78%. The prevalence is higher among women (1.5%) than among men (1.1%) and in urban settings (2.0%) than in rural ones (0.7%). The percentages for nutrition consultations to improve diet and healthier eating (1.0%) are lower than the averages for medication use to control diabetes. Nutrition consultations are slightly more common among women and in urban areas (1.3% versus 0.7% for rural areas). Finally, only 0.7% of the population from 18 to 69 years of age have received instructions on exercises to improve health and control diabetes. These instructions are given more frequently in urban areas (1.0%) than in rural areas (0.4%). Detailed results by gender and area are shown in Table 40, Appendix 1
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Graph 50. Prevalence of diabetes and related controls among people between the ages of 18 and 69 by gender and area
%
3
0 Rural Rural Rural Urban Urban Urban Urban Rural Total Total Total Total
Diagnosed with diabetes
Currently take medication to control diabetes
Have gone to a nutrition consultation at some point
Have been taught exercises to improve their health
Men
Women
Total
Back and Neck Pain

The population between the ages of 18 and 69 was also asked about back pain during the previous week and 13.2% stated that they had suffered this, a figure below the national average of 28.5%. Graph 51 shows how this type of pain varies by gender and area. On the one hand, it is experienced by 11.8% of men and 13.8% of women and, on the other, it is reported by 17.3% of people in urban areas (more commonly by women) and 8.9% in rural areas (more commonly by men).
152
Graph 51. Prevalence of back or neck pain among people between the ages of 18 and 69 by gender and area
%
30 25 20 15 10 5 0 Rural Rural Rural Urban Urban Urban Urban Rural Total Total Total Total
Have had back pain
Back pain radiates to legs
Have had neck pain
Have had back and/or neck pain
Men
Woman
Total
The prevalence of back pain that radiates to the legs is less common (3.9%) and below the national average (8.7%). This trend varies by area, because, while 5.4% of people in urban areas suffer from back pain, only 2.3% of people in rural areas do so. It is more common among women (4.2%) at 1.2 percentage points higher than among men. This is also true of urban areas, where 5.9% of women and 3.8% of men report this type of pain. The prevalence of neck pain in the previous week was much lower than that of back pain. It was reported by 11.2% of the population, with minimal variation by gender: 11.3% for women and 10.9% for men. However, the problem is more prevalent in urban areas (13.3%) than in rural ones (9.0%), in the former with higher incidence among women and in the latter more among men. The prevalence of one of these two problems (back or neck pain) is 19.2% and it has a stronger presence among women and in urban areas (see Table 41, Appendix 1).
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As shown in Table 16, 18.4% of people seek treatment for back or neck pain, higher than the national average of 13.1%. In general, no differences were observed by area, except that women are more likely to seek help for this problem in urban areas while men are more likely to do so in rural areas.
Table 16. Treatment sought for back and/or neck
pain in the last week by gender and area

Urban Gender Est. relative error (%) 2.6 1.3 1.0 Rural Est. relative error (%) 19.7 12.2 9.9 Total Est. relative error (%) 9.4 4.0 3.6
Estimated value (%)
Estimated value (%)
Estimated value (%)
Men Women Total
16.4 19.0 18.4
19.6 18.0 18.5
17.7 18.7 18.4
Road Traffic Accident Injuries

The population between the ages of 18 and 69 was asked about possible injuries in traffic accidents in the past year and prevalence was found to be 1.4%, substantially lower than the national average of 3.5%. In the past year, 2.3% men were involved in a traffic accident compared to 1.0% women. This ratio was maintained for all age ranges. Injuries from this type of accident tend to decrease with age, as the population aged 60 to 69 reported no injuries, while the 18 to 29 age group suffered the highest number. Table 17 shows more injuries from accidents in urban areas (1.9%) than in rural areas (0.9%), with higher numbers among men than women. In contrast to the general pattern, in which the greatest number of injuries are observed among the population from 18 to 29 years of age, injuries are most
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common in rural areas among the 40 to 59 year-old population. In both areas and in all age ranges, it is mainly men who are involved in this type of accident.
Table 17. Distribution of the population between the ages of 18 and 69
according to injuries caused by traffic accidents in the past year by gender age range, and area
Urban Age Men Women Total Men Rural Women Total Men Total Women Total
18-29 years of age 30-39 years of age 40-49 years of age 50-59 years of age Total
5.6
2.5
3.4
0.6
0.8
0.7
2.8
1.7
2.0
3.0
0.6
1.3
1.3
0.5
0.7
2.2
0.6
1.0
0.8
0.8
0.8
3.8
1.1
1.9
2.3
0.9
1.3
1.1
0.5
0.7
3.0
0.0
1.0
2.0
0.3
0.8
3.2
1.3
1.9
1.4
0.7
0.9
2.3
1.0
1.4
Source: Cendex Calculation Health Conditions Survey - Households, Cerrejn, 2009
In these types of accidents, bruises, pain or muscular stiffness are the most frequent injuries (70.3%), followed by cuts, grazing, burns or skin injuries (56.3%). Fractures and dislocations are less common (19.5%) and more serious injuries occur in fewer than 8% of cases, with lesions to internal organs or internal bleeding, head injuries or loss of consciousness and temporary or permanent loss of function of an organ or part of the body.
Aggression and Violence

This section describes the perceptions and beliefs held by people between the ages of 18 and 69 with respect to the way to deal with conflict, justification
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of the use of violence in certain situations and some causal factors. It also identifies experiences of aggression and violence, the nature of such situations and of the aggressors, as well as the causes and the measures taken by the victims in response to acts of aggression.
Guidance for sons and daughters on their response to conflict

In the first place, parents educational practices to teach their children how to deal with conflict at school were identified. In response to the question: If other children insult or hit your child, would you tell him/her to insult them or hit them back and not to give in to them, in general, in 78.4% of cases parents disagreed with this and 10.1% completely agreed. These percentages are different from the national average, in which 83.7% of the population totally disagree and 13.8% of agree. These percentages do not differ greatly by gender, although women show more disagreement and men have more doubts (Graph 52).
Graph 52. Distribution of the population between the ages of 18 and 69 according to their perception about aggression among children by gender and area
%
100
80
60
40
20
0 Women Women Women Total Total Total Men Men Men
Urban
Rural
Total
Agree
Uncertain
Disagree
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Although there is a generalised tendency to disapprove of children defending themselves against an attack by another child, there is a very high percentage of people who are uncertain or who agree with using aggression as a way to deal with conflict. In rural areas, 19.2% of the population doubt the advisability of this type of behaviour in children, while this percentage drops to 4.1% in urban areas. This is compensated by higher rates of agreement (12.6%) and disagreement (83.4%) in urban environments, as against rural responses (7.5% and 73.3%, respectively) (see table 42, appendix 1).
Need for Physical Aggression

Questions were asked as to the need for physical aggression in order to educate their children on how to earn respect and solve problems. Although 12.4% of people between the ages of 18 and 69 considered that corporal punishment is necessary to discipline children, this is below 5% in the case of gaining respect or resolving problems by aggression. These are below national percentages, which is an indication of greater awareness of avoiding the use of aggression (Graph 53). The level of doubt regarding the three statements is very similar, with higher incidence in rural areas, where between 18% and 20% of the population were uncertain as to how to respond. Taking the foregoing into account the, the level of total disagreement is 75.6% in the case of corporal punishment to educate children and is higher among urban males and rural females. This percentage increases to over 80% in response to questions on the need to use aggression to earn respect or solve problems, and disagreement is highest among women, both urban and rural (see Tables 43 through 45 in Appendix 1).
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Graph 53. Distribution of the population between the ages of 18 and 69 according to their perception about the need to use physical aggression by area
%
100
80
60
40
20
0 Rural Rural Urban Urban Urban Rural Total Total Total
Physical punishment is sometimes necessary to discipline children
Physical aggression is necessary to earn othersrespect
Physical aggression is sometimes necessary to resolve problems
Agree
Uncertain
Disagree
Physical Aggression in Family Settings

The population was asked for their opinion on the use of physical violence against women and the way this type of situation should be handled in the household (Graph 54). The high percentage of people (7.5%) who agree with the statement when a man hits a woman its sure to be because she gave him a reason to do so should be taken into consideration. A similar situation was identified when respondents were asked about the statement there are situations that justify a man slapping his wifes face, which garnered 5.1% agreement. In both cases, there agreement was greater among men. There is a higher percentage of doubt and less agreement in rural areas. While 7.6% of the urban population had doubts about the first statement and 10.6% agreed, 19.8% of the rural population had doubts and 4.4% agreed, while 3.5% of the urban population had doubts and 6.9% agreed with the second statement. The results were reversed for the rural population, in which 20.1% had doubts and 3.2% agreed.
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Graph 54. Distribution of the population between the ages of 18 and 69 according to their perception about physical aggression in family settings by area
%
100
80
60
40
20
0 Urban Urban Urban Urban Rural Rural Rural Rural Total Total Total Total
If a man hits a woman, its probably because she gave him a reason to
There are situations that justify a man slapping his wife or parther
Physical aggression between members of the same family is a private matter
Physical aggression should only be a crime if someone outside of the family is hit
Agree
Uncertain
Disagree
The population was also asked about their perception of privacy in situations of physical violence and when cases should be considered a crime. Twelve point seven percent (12.7%) of the population agreed with the statement physical aggression between family members is a private matter, increasing to 16.7% in urban zones, but lower in rural areas (8.5%). In comparison with urban areas, a large number of people in rural zones were doubtful (20.9%) and the lowest percentage of people completely disagreed (70.6%). 82.8% of the population completely disagreed with the statement that physical aggression should only be a crime if someone outside of the family is hit. The highest level of disagreement was shown in urban areas (88.8%), 12.4 percentage points lower within the rural area where the degree of doubt was high (19.2%). Based on the foregoing, it is possible to infer that the population considers physical aggression to be a crime even if the victim is a family member and only 5.8% believe the opposite (see Tables 46 too 49 inclusive, Appendix 1).
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Beliefs regarding physical aggression

Graph 55 shows the level of the populations agreement with some beliefs or situations associated with physical aggression. Between 82% and 86% of the population do not consider that reporting physical aggression is an act of cowardice, that it gives more power to the aggressor or that it occurs essentially in poor populations. The tendency is to believe that physical aggression is associated more often with drinking (6.6%) or a disease of the aggressor (6.9%). These were the responses with the highest percentages of agreement.
Graph 55. Distribution of the population between the ages of 18 and 69 according to factors associated with physical aggression by area
%
100
80
60
40
20
0 Urbana Rural Total Rural Total Rural Total Rural Total Rural Urban Urban Urban Urban Total
Not responding to physical aggression makes you a coward
Physical violence is related to drinking
People who are more Physical violence only physically violent have occurs among poor more power than people other people
People who commit physical violence are sick
Agree
Uncertain
Disagree
A common trend is the high level of doubt among rural populations, which is compensated by lower levels of disagreement compared to the levels found in urban environments (see Tables 50 to 54 inclusive, Appendix 1).
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Experiences of Physical Aggression

Questions about past histories of violence or physical aggression in the household (Graph 56) revealed that 30.4% of the population had been the victim of some type of physical punishment while under 18 years of age. This varies by gender: 36.3% of men and 28.0% of women had suffered violence. Household aggression toward children under the age of 18 was more frequent in urban (34.8%) than rural areas (25.8%). See details in Table 55, Appendix 1.
Graph 56. Distribution of the population between the ages of 18 and 69 according to their history of physical aggression in the household by gender and area
%
40 35 30 25 20 15 10 5 0 Men Woman Total Men Woman Total When you were growing up (in other words, before you turned 18), where you ever physically punished at home? Were your parents physically violent toward one another?
Urban
Rural
Total
In addition, 11.4% of the population, and more men than women, reported physical aggression between their parents. 11.2% of women and 12.0% of men stated that they had witnessed this type of situation in their household. Among urban populations, 12.9% reported physical aggression between their parents, which was 3 percentage points lower in rural areas. It is notable that 6.7% of people did not respond to the first question and 7.7% refused to answer the second.
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Types of Aggression
In Cerrejn area of influence, 5.7% of people have been victims of at least one incident of aggression in the past year. This percentage increases to 7.5% for men and drops to 5.0% for women. Table 18 shows that 3.3% of people between the ages of 18 and 69 reported that someone had pushed or shaken them in the past year. 2.6% of women and twice as many men (4.9%) reported such incidents. There were fewer incidents of aggression using hard objects (1.2%) or punching, kicking or dragging (1.0%), both reported more often by men, who reported a higher frequency for all types of aggression.
Table 18. Distribution of the population between the ages of 18 and 69 according
to the type of aggression experienced in the last year, by gender and area
Urban TYpe of Aggression
Men Women Total Men Women Total Men Women Total
Rural
Total
Pushed or shaken Struck with a hard object Punched, kicked or dragged Bitten Attacked with a knife, gun or other type of weapon Threatened with a knife, gun or other type of weapon Attempted strangling or burning Burned Raped or sexually assaulted
8.6 3.2 3.5 2.4 0.9 0.7 0.9 0.4 0.4
3.9 1.6 0.8 0.3 0.1 0.2 0.1 0.1 0.1
5.2 2.0 1.5 0.9 0.3 0.3 0.3 0.2 0.2
1.4 0.3 0.6 0.4 -
1.1 0.4 0.3 0.3 0.5 0.3 0.3 0.3 0.3
1.2 0.4 0.4 0.2 0.3 0.3 0.2 0.2 0.2
4.9 1.7 2.0 1.2 0.4 0.6 0.4 0.2 0.2
2.6 1.0 0.5 0.3 0.3 0.2 0.2 0.2 0.2
3.3 1.2 1.0 0.5 0.3 0.3 0.3 0.2 0.2
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A breakdown by area shows more incidents of aggression in urban areas. While 1.2% of the rural population had been pushed or shaken, only 5.2% of the urban population had been. Likewise, being struck with a hard object or being punched, kicked or dragged was one percentage point more common in urban than rural areas. There are other types of aggression which, although less frequent, represent an important percentage of the population without major differences by area
Relationship with Aggressor

As to relationships between victims and aggressors, 34.9% of violent acts were committed by a companion/partner or ex-companion/ex-partner (13.9%), by one parent or a step-parent (10.9%) or by a sibling or step-sibling (10.1%). Less frequent aggressors are friends or acquaintances (14.8%) and strangers (15.7%). In incidents of aggression against women, 43.3% of the perpetrators are family members or relatives, usually the current spouse or companion (10.6%) or the father or step-father (9.8%). A Violence against men is another story: 49.1% of the aggressors are friends, acquaintances or strangers.
Graph 57. Distribution of cases of aggression according to the relationship between the victim and the aggressor by area
%
40
30
20
10
0 Urban Its a stranger Its a friend or acquaintance Rural Total Its your father/mother/step-father/step-mpther Its your sibling/step-sibling or another relative
Its your spouse/partmer/ex-spouse/ex-partner
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Strangers are the least frequent aggressors in urban areas (19.6%), followed by friends or acquaintances (22.1%) and relatives (27.2%). In rural areas, however, relatives are the most common aggressors (46.6%) and friends and acquaintances account for only 4.0% of cases. Regardless of area, there is still a marked trend of aggression against women perpetrated by relatives: 36.0% in urban and 53.9% in rural areas. A large percentage of respondents chose not to answer this question - 34.5% overall, 31.2% in urban areas and 39.4% in rural areas.
Respiratory Problems
Chronic respiratory problems have become more and more prevalent in Colombias epidemiological profile. In urban areas, increased atmospheric pollution is a major risk factor. In rural zone, the widespread use of firewood as a cooking fuel poses the greatest risk. Occupational risks must also be considered, including those associated with the mining and chemical industries. Because of the regions environmental conditions and the presence of the mine, arrangements were made to perform an analysis of the most important aspects of respiratory conditions in the populations at-risk, which was not investigated in the National Health Survey. A special module was created for the purpose, which included a set of questions mainly on the presence of respiratory symptoms among the population in general, which differed from diagnoses based on medical examinations. This module was targeted to the population between 18 and 69 years old. Coughing was the first symptom analyzed and was evaluated by gender and area (graph 58). Seven point eight percent (7.8%) of people considered that they had a cough with very little difference between urban and rural areas. As for cough frequency, 73.8% said that they coughed 4 or 6 times a day on 4 or more days in the week, with slightly greater frequency in rural areas.
164
Graph 58. Prevalence of coughing in the population between the ages of 18 and 69 by gender and area
%
100 90 80 70 60 50 40 30 20 10 0 Men Women Total Men Women Total Men Women Total Do you usually have a cough? Do you usually have a cough more than 4-6 times per day 4 or more days per week? Do you usually have a cough this way most days for 3 consecutive months or more throughout the year?
Urban
Rural
Total
The presence of chronic coughing, that is, for more than three consecutive months, affects 48.8% of the population who reported frequent coughing, without major differences by gender. The average duration of coughing reported was 2.9 years and results were higher among men (3.5 years) than women (2.7). The prevalence of chronic coughing in urban populations is 14.8 percentage points lower than the urban rate (56.4%). Results by gender and area are shown in Table 56, Appendix 1. Breakdown of coughing by age group revealed greater prevalence among people between 60 and 69 years of age, which begins to increase after age 50. Frequency of coughing over the course of the week is fairly consistent. However, in the case of chronic disease, the distribution is slightly higher in elderly populations and the number of years a cough lasts increases after age 50. A comparison by area shows increased prevalence in the younger urban population and the older rural population.
165
Questions were also asked about productive coughs based on the populations recognition of phlegm associated with coughing. Graph 59 shows that 6.3% of the population usually expectorate. The presence of phlegm twice per week was reported by 51.3% of those who reported the presence of phlegm, 27.7% said that it had been chronic over an average period of 4.2 years. Given the special characteristics and conditions of marginalization or the fact of living in rural areas, as well as potential overcrowding, tuberculosis, may be an issue that requires more in depth analysis. The results would highlight the need to create programmes in these aspects in order to evaluate the type of phlegm and other secretions. Differences between the respiratory symptom of phlegm were analysed according to urban and rural conditions and it was found to be more prevalent in urban than rural areas and among women more than men and the opposite was true of urban and rural men, suggesting that phlegm symptoms last longer in urban men (see Table 57, Appendix 1). This symptom tends to be more prevalent in urban areas than rural, with the single exception of the rural population over 60 years of age. The frequency of phlegm is more variable in urban than rural areas and the population over 50 may be slightly more susceptible. Among those with respiratory symptoms, chronic presence of phlegm tends to be a little more common in rural areas, while its duration is in fact greater in urban areas, especially among the elderly. Differences in phlegm symptoms between men and women are not as significant as age in terms of the rural versus the urban area. Both prevalence and duration are higher in the older population.
166
Graph 59. Prevalence of phlegm in the population between the ages of 18 and 69 by gender and area
70 60 50 40 30 20 10 0 Men Women Total Men Women Total Men Women Total Do you usually cough up phlegm from your chest? Do you usually cough up phlegm two times per day 4 or more days per week? Have you had phlegm for three or more consecutive months during the last year?
Urban
Rural
Total
The third respiratory symptom analyzed as part of the study was the presence of wheezing and specific questions were asked about the presence of acute wheezing, its characteristics and whether or not it was chronic. As shown in Graph 60, in the presence of wheezing, prevalence was 5.9%, with more incidence in the urban zone, while the duration of this symptom, on average, of 2.7 years, without major differences between urban and rural areas. Analysis of gender based differences in both urban and rural areas did not reveal any important contrasts in the presence of wheezing with colds or any of the other characteristics analyzed, although it increases in line with age related characteristics, particularly after the age of 50.
167
Graph 60. Prevalence of wheezing in the population between the ages of 18 and 69 by gender and area
%
8 7 6 5 4 3 2 1 0 Men Women Total Men Women Total Men Women Total Is there any wheezing in your chest when you have a cold? Is there any wheezing in your chest when you do not have a cold? Is there any wheezing in your chest most days or nights?
Urban
Rural
Total
The prevalence of wheezing without a cold is relatively low, but there is a slight increase after age 50, especially in urban populations. Chronic wheezing among those with respiratory symptoms is slightly more prevalent among urban residents over the age of 60 and it is more frequent among women than men. The presence of wheezing with a cold is more prevalent in women and the increase in this symptom especially notable in rural men and women over the age of 50. Wheezing lasts longest in women over 60, for whom the average duration is 4.6 years. In rural areas, the analysis revealed similar characteristics of longer duration in both men and women. Graph 61 shows findings on dyspnoea in the 18 to 69 year-old population and that 9.6% of the population has at some point had suffered from breathlessness. In general, this type of episode was first identified at the relatively young age of 25.8 years. Only 7% reported two or more incidents of breathlessness and 3% required medication (see Table 59, Appendix 1).
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Nine point six percent (9.6%) state that they have been short of breath when walking uphill and 5% have had to walk more slowly on flat surface. Only 1.7% said that they had suffered extreme difficulty breathing while dressing or undressing. The differences evidenced between urban and rural areas show more breathlessness in urban areas, with a larger number of episodes of dyspnoea in all the aspects analysed. This is more marked in urban than rural areas.
Graph 61. Prevalence of dyspnoea in the population between the ages of 18 and 69 by area
Have had breathing problems when dressing or undressing Have needed to stop to breathe after walking on a flat surface for a few minutes Have needed to stop to breathe when walking on a flat surface Walk slower than other people the same age due to interrupted breathing Have experienced shortness of breath when running or walking uphill Have needed medications or treatment for interrupted breathing Have had 2 or more episodes of interrupted breathing
Have experienced shortness of breath or interrupted breathing 0 2 4 6 8 10 12
14
Urban
Rural
Total
Gender differences between urban and rural environments were analyzed and it is possibly women who have a higher rate of all dyspnoea related respiratory symptoms in both urban and rural areas. However, the differences by gender are more pronounced in the urban setting, where 14.0% of women have suffered dyspnoea, in comparison with only 9.6% of urban men; the respective rural percentages are 6.8% for women and 4.7% for men. These results indicate a difference in the prevalence rate and contrasts between men and women.
169
According to age groups, the most permanent presence of dyspnoea was found in the urban population over the age of 50, it was lower in rural areas. It is nevertheless important to bear in mind that these estimates are not significant because the associated relative error is high.
Associated Risk Factors

The determining causal chain of this disease and disability includes behavioural and biological risk factors, which should be added to those of the social setting, which were weighted in the analysis of households and services conditions. The distribution of biological and behavioural risk factors for non-transmittable diseases are shown in this section.
Alcohol Consumption
The CAGE Questionnaire, which is commonly used as a screening test in demographic surveys (Saz et al., 2002), was applied in order to identify the population over age 18 at risk for alcoholism. The questionnaire asks the following questions: Have people ever annoyed you by criticizing the way you drink? Have you ever thought you should cut down on your drinking? Have you ever felt bad or guilty about your drinking habits? Have you ever felt you needed a drink first thing in the morning to steady your nerves or get rid of a hangover? People who answer yes to two or more of these questions are considered to be at risk for alcoholism. The results (Graph 62) show that 2.7% of the population between the ages of 12 and 69 are at risk of alcohol dependence, which is lower than the national average of approximately 7.6%. Men (4.9%) are at a greater risk of alcohol dependency than women (1.6%). Prevalence of the risk of alcoholism increases with age and so young people between the ages of 12 and 17 are at the lowest risk and those between 60 and 69
170
are at the highest. The risk is lower among 40 to 49 year olds (2.4%) than in the 30 to 39 year old age range (3.7%) and this trend is similar among women. The risk is higher for men in all age ranges. Prevalence is 14.2% for men between the ages of 60 and 69, 5.4 percentage points higher than the rate among 50 to 59 year old men. In contrast, just 1.5% of women in these two age ranges is considered to be at risk. By area, there is a higher risk in urban environments (4.2%) than rural ones (1.2%), which is still always higher among men. In urban areas, the highest risk is found in the 60 to 69 year old population (7.3%), followed by the 30 to 39 age group (6.4%) and from 50 to 59 (5.1%). The lowest prevalence was found among the 12-to-17-year old population and the 40 to 49 year old population, both of which were less than 2%. An interesting result is that while 60 to 69 year old men are at the highest risk for alcoholism (18.2%), the female age group at the highest risk is between 30 and 39 years old (6.1%).
Graph 62. Distribution of the population between the ages of 12 and 69 according to their risk for alcoholism by gender, age range and area
%
20 18 16 14 12 10 8 6 4 2 18-29 years old 30-39 years old 40-49 years old 50-59 years old 60-69 years old 12-17 years old 18-29 years old 30-39 years old 40-49 years old 50-59 years old 60-69 years old 12-17 years old 18-29 years old 30-39 years old 40-49 years old 50-59 years old 60-69 years old 0 12-17 years old
Urban
Rural
Total
Men
Women
Total
171
The percentages are much lower in rural areas and the risk is highest is among 60 to 69 year olds (5.0%), followed by 50 to 59 years olds (2.3%) and 18 to 29 year olds (1.6%). The lowest prevalence levels are in the three age groups between 12 and 39 years at less than 2%. Between the sexes, men 60 to 69 years old (12.0%) and women between 18 and 29 (0.7%) are at the highest risk. Estimates by age range are shown in Table 60, Appendix 1
Cigarette smoking
The results shown here are the result of processing the replies of the persons interviewed to the four questions below: Have you ever in your life smoked a cigarette? Was the first time you tried smoking a cigarette the only time? Have you smoked at least a hundred cigarettes, or five packets, a day all your life? Do you currently smoke cigarettes every day, on some days or have you given up smoking? These data were used to fix indicators of the prevalence of adolescent (12-17 years old) and adult (18-69 years old) smokers and former smokers. Current adolescent smokers: young people between 12 and 17 years old answered yes to question 1, no to question 2, and daily or some days to question 4. Former adolescent smokers: young people between 12 and 17 years old responded yes to question 1, no to question 2, and stopped smoking to question 4. Current adult smokers: adults responded yes to question 1, no to question 2, yes to question 3, and daily or some days to question 4. Former adult smokers: adults responded yes to question 1, no to question 2, yes to question 3, and stopped smoking to question 4.
172
Graph 63 shows that the prevalence of current adolescent smokers is 0.1%, below the 2.5% national average. The percentage of former smokers is 2.5%, while girls between 12 and 17 said they had never smoked, which is less than the 1% for boys, both smokers and former smokers. There are no reports of adolescent smokers in rural areas. In municipalities, girls said they had tried smoking but had not continued and, in the case of boys , 0.6% are smokers and 0.3% have given up smoking (see table 61, appendix 1).
Graph 63. Prevalence of current smokers and former smokers by gender and age range
%
7 6 5 4 3 2 1 0
Men Woman 12- 17 years old Total Men Woman 18-69 years old Total
Smoker
Ex-smoker
Cigarette smoking is more prevalent among adults 18 to 69 years old (3.3%): 6.3% among men and 2.7% among women. These results are much lower than the overall national average of 12.8%, 19.5% men, and 7.4% women. There are more current adult smokers in urban (4.2%) than rural environments (2.4%) and smoking is more common among men. The prevalence of former smokers in adults 18 to 69 years old is 2.5%, lower than the national average of approximately 8.4%, and higher among
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men (3.8%) than women (2.0%). These figures reflect the national average, in which 12.0% of men and 5.5% of women are former smokers. There is a higher population of both smokers and former smokers in urban areas. Males account for a higher percentage of both (see Table 62, Appendix 1). Smoking in the adolescent and male adult population is nearly twice that of women and also higher in the urban setting, especially among adults. This is almost half as high in rural areas.
Physical Activity during Free Time

The population between 12 and 69 years of age were asked about their physical activity during their free time. The questions covered vigorous physical activity with a substantial increase in respiration or pulse rate and considerable sweating and light physical activity when it slightly raises levels of sweating and respiration or pulse rate. This analysis divided the population into the two major age ranges shown in graph 64: adolescents (12 to 17 years of age) and adults (18 to 69 years of age), as the criteria and behaviours are different in these two populations. A regular, vigorous exercise pattern (which is beneficial to health) was considered to consist of 20 minutes physical activity at least three times per week for adults and at least 60 minutes each time for adolescents. A regular, light exercise pattern was defined as an activity of 30 minutes, 5 days a week. For this to be a regular pattern in adolescents, they must also declare sessions of 60 minutes. Finally, an overall exercise pattern was identified by taking into account the frequency of the two types of exercise (light and vigorous), for which a new variable was created to identify the greatest frequency for each type. Thus, regardless of whether the exercise is light or vigorous, regular exercise takes precedence over irregular exercise and the latter takes precedence over inactivity, which is the classification of persons who do no exercise at all. It is estimated, on the one hand, that 5.2% of the population exercise regularly or engage in light physical activity in their free time, which is much lower than
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the national average (14.0%). The exercise pattern of adults (6.0%) exceeds that of adolescents (2.0%), but both results are lower than the national averages of 15.7% and 5.6%, respectively. The urban population tends to do more light exercise, whether regularly or irregularly, than the rural population and young peoples exercise pattern is more irregular than that of adults. This trend is offset by the high levels of lack of light exercise in rural areas, especially among adults. Details of the prevalence of light physical exercise in the 12 to 69, 12 to 17 and 18 to 69 year old populations are shown in Tables 63 to 65, Appendix 1.
Graph 64. Distribution of the population by pattern of light or vigorous exercise by age range and area
%
100
80
60
40
20
0 Rural Rural Rural Urban Urban Urban Urban Rural Total Total Total Total
Light exercise
Vigorous exercise 12-17 years old
Light exercise
Vigorous exercise 18-69 years old
Never
Inactive
Irregular
Regular
6.4% of the 12 to 69 year old population engage in regular vigorous physical activity. This figure is low compared to the country as a whole of 21.6%. The results show that 2.9% of adolescents and 7.3% of adults exercise vigorously, while the national averages are 12.5% and 23.5%, respectively. As in the previous scenario, the pattern of vigorous exercise is more frequent in urban
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areas and incidence of irregularity is higher among young people. Results on vigorous physical exercise in the 12 to 69, 12 to17 and 18 to 69 year old populations are shown in Tables 66 to 68, Appendix 1. Four patterns of exercise (regular, irregular, inactive and none) in light and vigorous physical activity were identified. As proof of a global exercise pattern, the latter two variables were consolidated into one. The results in Graph 65 show a large number of people who never carry out physical activity (77.7%). The prevalence for both irregular (10.5%) and regular (7.9%) exercising is low and an irregular exercise pattern is more common among adolescents (28.4%). This percentage drops to 6.1% in the adult population, which is typified by a lack of physical activity during free time. Although 9.1% of adults perform regular physical exercise, only 3.1% of young people do so. For information on estimates for large age groups, see tables 69 to 71, Appendix 1.
Graph 65. Distribution of the population according to pattern of overall exercise by age range and area
%
100
80
60
40
20
0 Urban Rural 12-17 years old Total Urban Rural 18-69 years old Total
Never
Inactive
Irregular
Regular
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In comparison with urban areas, the percentage of people in rural areas who do no physical exercise at all results in less incidence of irregular or regular exercise, which includes both young people and adults. On the one hand, 71.9% and 83.6% of the urban and rural populations, respectively, do not exercise and, on the other, 4.8% of urban adolescents engage in physical exercise, while only 1.5% of rural adolescents do so. The prevalence levels for adults in urban and rural areas are 10.9% and 4.8%, respectively. There are differences between mens and women exercise patterns in their free time. Populations who never exercise and those who do so regularly, at either a light or vigorous level, were defined. Table 19 shows that men engage in more regular exercise than women at rates of 8.9% in light and 9.5% in vigorous exercise; for women, the percentages of light and vigorous exercise are 3.4% and 4.9%, respectively. Consequently, the percentage of people who do no exercise at all is higher among women (83.4%) than men (66.2%).
Table 19. Distribution of the population according to exercise or physical activity
during their free time, by gender, age range and area

12-17 years of age 18-69 years of age
Urban Rural Total
12-69 years of age

Urban Rural Total
Pattern
Gender
Urban Rural Total
Men Regular light exercise Women Total Men Regular vigorous exercise Women Total Men Never exercise Women Total
6.3 1.0 3.7 7.5 1.0 4.4 46.1 58.9 52.3
1.0 0.3 0.6 2.4 0.8 1.5 71.0 74.8 73.0
3.5 0.6 2.0 4.9 0.9 2.8 58.9 67.9 63.5
15.8 5.3 8.2 16.2 7.2 9.7 61.1 82.0 76.2
6.7 2.3 3.6 6.9 3.8 4.8 76.9 90.9 86.5
11.1 3.9 6.0 11.4 5.6 7.3 69.3 86.2 81.2
13.0 4.7 7.4 13.7 6.4 8.7 56.7 79.0 71.9
5.0 1.9 3.0 5.6 3.3 4.1 75.2 88.1 83.6
8.9 3.4 5.2 9.5 4.9 6.4 66.2 83.4 77.7
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Analysis of the two major age groups shows more gender based differences among adults. Although non-activity is more prevalent among women, the difference between the sexes is 9.0% in adolescents and 16.9% in adults. Likewise, the prevalence of regular light exercise among young men is 2.9 percentage points higher than among young women. In the case of adult men, prevalence is 7.2 percentage points higher than in that of women. Rates of vigorous exercise are also higher among males, varying from 4.0% in young people to 5.8% in adults. These results show a greater tendency for men to exercise, whether the pattern is light or vigorous. Geographically, exercise is more common in urban areas. In rural areas, a larger percentage of the population do no exercise at all. This trend remains consistent for both men and women. Specifically, 77.7% of the total population, 71.9% urban and 83.6% rural, do not exercise. Geographical differences are even more pronounced among the adolescent population
Nutritional Conditions
Obesity and malnutrition are the two morbid extremes in the nutritional situation of a population. A previous section referred to the results of food habits and access to nutrients. This section will provide an evaluation based on the Body Mass Index (BMI), as shown in Graph 66. Estimates of the different BMI levels for the major age groups and overall are shown in Tables 72 to 74, Appendix 1. Reported height and weight were used to calculate the BMI for persons between the ages of 12 and 69, which enabled us to estimate the prevalence of excess weight and obesity in this population. It should be noted that 42.0% of the population chose not to answer at least one of the questions associated with height or weight, 29.2% in towns and 55.0% in rural areas. Therefore, the analysis only included people who had reported their height and weight so that their BMIs could be calculated
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Graph 66. Distribution of the population according to BMI by age range and area
%
70 60 50 40 30 20 10 0 Urban -10 12-17 years old 18-69 years old Rural Total Urban Rural Total
Underweight
Normal
Overweight
Obese
There was a large proportion of approximately 30% of children between the ages of 12 and 17 who were below the normal weight for their age and height, with a higher incidence in males. There was also a significant prevalence of overweight (11.4%) and obesity (2.9%) in this same population. The percentage of children with a normal BMI is 51.3% in urban and 61.9% in rural areas. In urban environments, the prevalence levels of adolescents who were underweight (31.3%), overweight (13.0%) and obese (4.4%) were higher than those in rural areas, where the percentages were 28.2%, 9.3% and 0.7%, respectively. In contrast to the adolescent population, the BMI ratio between adults who are under weight and those who are over weight or obese is inverted. That is, while only 5.5% of the adult population is underweight, prevalence of overweight is 28.8% and of obesity is 11.5%. 54.1% have a normal BMI. The prevalence of overweight and obese adults is higher in urban areas, whereas in rural areas this is true of underweight adults.
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Psychoactive Substance Use

The population between the ages of 18 and 69 was evaluated for psychoactive substance use, specifically the consumption of marijuana, cocaine, nonprescribed tranquilisers and solvents or inhalants in the past year. In particular, table 20 shows low prevalence of the consumption of marijuana (0.5%) and cocaine (1.1%), which are lower than the national estimates of 6.9% and 1.8%, respectively.
Table 20. Prevalence of marijuana and cocaine use throughout the
lives of people 18 to 69 years old by gender and area

Urban Marijuana and Cocaine Gender
Estimated amount (%) Est. relative error (%)
Rural
Total
Men Marijuana Women Total Men Cocaine Women Total
2.6 0.1 0.8 6.9 0.2 2.1
5.7 0.8 5.2 9.6 0.8 8.6
0.8 0.2 0.3 0.1
49.8 49.7 99.1 100.0
1.7 0.1 0.5 3.5 0.1 1.1
12.8 1.8 11.8 10.4 1.8 9.5
Consumption is much higher among men at 1.7% who have used marijuana and 3.5% cocaine at least once in their lives, only 0.1% of women have done so. These levels are more closely associated with urban populations, which is where consumption of these substances is concentrated, specifically (0.8%) marijuana and (2.1%) cocaine, mainly among men. The results show that 0.3% of the 18 to 69 year old population have taken sedatives and only 0.1% solvents or inhalants at some time in their lives. These percentages are below the national averages, both of which are 1.7%. There is no major variation by gender; however, there are certain differences by area in the consumption of tranquilisers, which is 0.5% in urban and 0.1% in rural areas (table 21).
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Table 21. Prevalence of sedative and solvent or inhalant use throughout the lives
of people 18 to 69 years old by gender and area

Urban Sedatives and Solvents or Inhalants Gender
Rural
Total
Men Tranquilisers Women Total Men Solvents or inhalants Women Total
0.1 0.6 0.5 0.1 0.1
0.5 0.8 0.7 0.8 0.7
0.3 0.1 0.2 0.1
100.1 99.9 4.8 3.1
0.2 0.3 0.3 0.1 0.1 0.1
70.6 1.8 16.5 2.5 1.8 1.5
CHAPTER V
Available provision and quality of services
Enrique Pealoza Anglica Mara Quiroga
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CHAPTER V Available provision and quality of services
HEALTHCARE PROVIDER INSTITUTIONS

HEALTHCARE PROVIDER INSTITUTIONS
The aim of this section is to describe the network of healthcare service providers in the area of influence of Cerrejn mine. Although it occupies part of La Guajira Department in services and dealing with the health problems of the population, an analysis is necessary in order to identify all the services required by the population to satisfy their health needs. The existence of public and private institutions must be taken into account in the definition of the network.
Graph 67. Distribution of services by municipality in La Guajira
VILLANUEVA URUMITA URIBIA BARRANCAS DIBULLA DISTRACCIN EL MOLINO FONSECA HATONUEVO
ALBANIA
SAN JUAN DEL CESAR
MAICAO
RIOHACHA
MANAURE
Source: Authorized Provider Database, Ministry of Social Protection, 2011
According to the Ministry of Social Protections services database, the providers are classified as independent professionals and healthcare provider institutions (IPS), whose corporate purpose is different from that of the provision of services and transportation of patients. On the date of the study,
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March 2011, there were 166 registered healthcare providers, of which 89 are IPS, 70 are independent professionals, 5 transport patients and 2 have other corporate purposes According to the legal nature of the providers, Graph 68 shows that 82.5% of these are private. In the towns of Distraccin and Barrancas, according to the services database consulted, there is only a private provider. The explanation for the difference in Riohacha is the number of independent professionals in the city.
Graph 68. Distribution of healthcare services according to entity type by municipality
70 60 50 40 30 20 10 0
Riohacha Maicao San Juan del Cesar Fonseca Villanueva Albania Barrancas Hatonuevo Dibulla Uribia Distraccin El Molino Manaure Urumita
Private
Public
As to the installed capacity of beds, it was found that the Department has 205 adult and 100 paediatric beds. In both cases, there is a larger percentage of private-sector providers, as shown in Graph 69.
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Graph 69. Distribution of beds by entity in La Guajira

% 160 140 120 100 80 60 40 20 0
Private Pediatric beds Public
Adult beds
Source: Authorization Database, Ministry of Social Protection, 2011
100% of the installed capacity of intermediate and intensive care units, with 29 and 34 neonatal intermediate and intensive care units, respectively, belong to the private IPS network (Graph 70). In addition, there are 4 intermediate paediatric care, 7 intermediate adult care and 22 intensive care units
Graph 70. Installed capacity in intermediate and intensive care units and rooms in La Guajira by type of entity
35 30 25 20 15 10 5 0
Intermediate neonatal care NICU Intermediate Intermediate pediatric care adult care Adult ICU Operating rooms Labor and delivery rooms Basic ambulances
Private
Public
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Provision of Healthcare Services by the Public Network

To date, there are three medium-complexity State Social Security Companies (E. S. E.): Nuestra Seora de los Remedios Hospital in Riohacha, San Rafael Hospital in San Juan del Csar, and San Jos de Maicao Hospital in the municipality of Maicao. There are also the following 11 low-complexity E.S.E.: Nuestra Seora del Perpetuo Socorro Hospital and Nazareth Hospital in Uribia, Armando Pabn Lpez Hospital in Manaure, Nuestra Seora del Carmen Hospital in Hatonuevo, Nuestra Seora del Pilar Hospital in Barrancas, San Agustn de Fonseca Hospital in Fonseca, Santo Toms Hospital in Villanueva, San Lucas Hospital in El Molino, Albania Hospital in Albania, E.S.E. Santa Teresa de Jess in Dibulla, E.S.E. Santa Cruz de Urumita Hospital and Donaldo Sal Morn Hospital in La Jagua. Similarly, there is an complementary network consisting of different private sector health service providers authorized to operate in the Department, which provide high-complexity services. There are also several mediumcomplexity institutions that are not authorised or available on the public network. There are three hospitals in the Department: San Agustn de Fonseca Hospital, San Jos Hospital and San Rafael Hospital, which are governed by the La Guajira Regional Health Department.
Table 22. Network of E.S.E in La Guajira and population of their area of influence
Medium complexity Hospital Municipality Riohacha Nuestra Seora de los Remedios Hospital Dibulla Maicao Manaure San Jos de Maicao Hospital Uribia Albania 144,990 23,897 27,146 141,917 84,744 2010 Population 213,046
(1)
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Medium complexity Hospital Municipality San Juan del Csar Distraccin El Molino Fonseca San Rafael Hospital Hatonuevo La Jagua del Pilar Urumita Villanueva Barrancas Low complexity Hospital Nuestra Seora de los Remedios Hospital E.S.E. Santa Teresa de Jess San Jos de Maicao Hospital Armando Pabn Lpez Hospital Nuestra Seora del Perpetuo Socorro Hospital and Nazareth Hospital Albania Hospital San Rafael Hospital San Lucas Hospital Municipality Riohacha Dibulla Maicao Manaure Uribia Albania San Juan del Csar El Molino Fonseca San Agustn de Fonseca Hospital Distraccin Nuestra Seora del Carmen Hospital Donaldo Sal Morn Hospital in La Jagua E.S.E. Santa Cruz de Urimita Hospital Santo Toms Hospital en Villanueva Nuestra Seora del Pilar Hospital Hatonuevo La Jagua del Pilar Urumita Villanueva Barrancas 13,944 20,458 2,993 15,632 25,798 30,610 2010 Population 213,046 27,146 141,917 84,744 144,990 23,897 35,189 8,079 30,252
(1)
2010 Population 35,189 13,944 8,079 30,252 20,458 2,993 15,632 25,798 30,610
(1)
Source: Authorized Provider Database, www.secresaludguajira.gov.co (1) DANE projected population, based on the 2005 Census
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Low-complexity services are provided in the municipalities by 12 hospitals, 11 health centres and 20 health posts, with important positioning of the services of promotion, prevention and treatment services in the areas of general medicine, general dentistry, basic hospitalization, midwifery and clinical laboratory tests. All entities provide general medical services through out-patient consultations and dentistry. Six institutions provide hospitalization (with a total of 69 beds in 2010) and 24-hour emergency services. Table 23 shows the installed capacity of the Departments public network of first level care.
Table 23. Installed capacity of first level hospitals in La Guajira
Description Hospitalization beds Observation beds Out-patient consultation rooms Accident and emergency service Operating theatres Maternity beds Number of dentistry units Quantity 69 15 50 9 2 9 22
The five low-complexity hospitals provide midwifery and basic laboratory services and four have basic simple radiology support. All hospitals provide health prevention and promotion services. Low/medium complexity services are provided by: E.S.E. Nuestra Seora de los Remedios Hospital, E.S.E. San Rafael Hospital and E.S.E. San Jos de Maicao. These entities also provide low-complexity services to their respective area of influence. E.S.E. Nuestra Seora de los Remedios Hospital provides mediumcomplexity services in anaesthesia, general surgery, obstetrics and gynaecology, orthopaedics and traumatology, paediatrics and internal medicine.
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E.S.E. San Rafael Hospital provides general adult, paediatric and obstetrics hospitalization services; specialized consultation in cardiology, internal medicine, neurology, ophthalmology, orthopaedics and/or traumatology, ear, nose and throat and paediatrics and general, gynaecological, orthopaedics, ophthalmological, urological and ear nose and throat surgery. E.S.E. San Jos de Maicao provides anaesthesia, general surgery, obstetrics and gynaecology, orthopaedic and traumatology, paediatrics and internal medicine services. The public network does not provide medium/high-complexity services in La Guajira Department. Table 24 shows the installed capacity of its public network for second level care.
Table 24. Installed capacity of second level institutions in La Guajira
Description Hospitalization beds Observation beds Out-patient consulting rooms Offices in the accident and emergency Operating theatres Maternity beds Number of dentistry units Quantity 44 18 16 4 3 2 4
Source: Service Provider Database, Ministry of Social Protection, 2011
Provision of Healthcare Services by Private IPS

In order to carry out the study of the presence of other IPS in the department, the Ministry of Social Protections services database, updated to March 2011, was consulted. 59.5% of the 2,222 active services in the Department and identified in the approved database are provided by private institutions. The city with the most private authorised services in the Department is Riohacha
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with 52.8%, followed by Maicao with 19.5% and San Juan del Csar with 10.4%. Table 25 shows that in 7 of the 14 territories, private-sector providers cover most of the healthcare services.
Table 25. Participation of healthcare services by municipality and type of entity
Municipality Albania Barrancas Dibulla Distraccin El Molino Fonseca Hatonuevo Maicao Manaure Riohacha San Juan del Csar Uribia Urumita Villanueva Grand Total Private 66.9 100.0 100.0 100.0 6.3 34.4 52.1 64.2 10.2 76.7 35.7 16.7 3.0 40.4 59.5 Public 33.1 0.0 0.0 0.0 93.8 65.6 47.9 35.8 89.8 23.3 64.3 83.3 97.0 59.6 40.5
With the exception of Riohacha, San Juan del Csar and Maicao, the private network does not provide hospitalization, paediatrics or obstetrics services. However, the public network is present in 11 of the 13 municipalities of the Department.
The private institutions have the following units which provide the medium/ high-complexity services in the Department: psychiatric or mental health unit, intermediate neonatal care, intermediate paediatric care, intermediate adult care, neonatal intensive care, paediatric intensive care and adult intensive care. As to surgical specialities, the private network provides, exclusively, the
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following services: cardiovascular surgery, paediatric surgery, hand surgery, breast and soft tissue tumour surgery, oncologic plastic surgery, neurological surgery, paediatric surgery and plastic and cosmetic surgery. In the case of specialized consultation, private provision serves for patient referrals to public provision in the specialities listed in Table 26.
Table 26. Provision of specialized consultation by the private network
Code 309 310 311 313 321 322 325 327 330 331 336 343 346 349 350 351 356 Description of the service Pain and palliative care Endocrinology Endodontics Stomatology Haematology Implantology Family medicine Physical medicine and rehabilitation Nephrology Pulmonology Clinical Oncology Periodontics Oncologic Rehabilitation Occupational Health Alternative medicine/ alternative therapy Speech therapy Other specialist consultations Code 361 364 365 367 369 372 373 375 379 381 385 387 391 392 393 394 396 Description of the service Paediatric cardiology Breast and soft tissue tumour surgery Dermatological surgery Gastrointestinal surgery Plastic and cosmetic surgery Vascular surgery Oncologic surgery Oncological dermatology Oncological gynaecology Hematology and clinical oncology Neonatology Neurosurgery Paediatric oncology and haematology Children's orthopaedics Oncological orthopaedics Oncological pathology Paediatric dentistry
In support services, the private network provides cardiovascular diagnosis, nephrology (renal dialysis), clinical oncology, radiotherapy,
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urology procedures, electro-diagnosis, histotechnology, laboratory and echocardiography
Analysis of services provided by the IPS public network

As part of the service analyses, the equivalent production in relative value units, UVRE, was reviewed19. It was found that the second-level hospitals (E.S.E. San Jos de Maicao Hospital, San Rafael Hospital and E.S.E. Nuestra Seora de los Remedios Hospital) account for 64% of the units in the Department. The highest production among first level hospitals was by E.S.E. Nuestra Seora del Pilar Hospital in Barrancas at 6% of the Departments production. The lowest was that of the Donaldo Saul Moron Manjarrez Hospital in La Jagua del Pilar at 0.3%. Table 27 shows hospital production by level of complexity.
Table 27. Equivalent production in relative value
units in the public hospitals of La Guajira

Municipality Maicao San Juan del Csar Riohacha Barrancas Manaure Uribia Villanueva IPS E.S.E. San Jos de Maicao Hospital San Rafael Hospital Level 2 E.S.E. Nuestra Seora de los Remedios Hospital E.S.E. Nuestra Seora del Pilar Hospital E.S.E. Armando Pabn Lpez Hospital E.S.E. Nazareth Hospital E.S.E. Santo Toms Hospital Level 2 2 2 1 1 1 1 Total 2010 2,207,503.75 1,557,015.51 1,313,000.03 464,236.78 340,487.45 304,794.52 283,779.60
19
UVRE. Relative value unit: The values recognized by the comprehensive practice of the activity, examination, study, procedure or intervention, which include, among others: the professional services provided, the technical and assistant staff resources, use of equipment, accessories and tools, use of physical areas (rooms, units, offices), consumption of any material or items (reagents, contrast media, film or photo paper, suture materials).
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Municipality Albania Uribia Fonseca Dibulla Hatonuevo Distraccin Urumita El Molino La Jagua del Pilar
IPS E.S.E. San Rafael Albania Hospital Nuestra Seora del Perpetuo Socorro Hospital E.S.E. San Agustn de Fonseca Hospital Santa Teresa De Jess de vila Hospital E.S.E. Nuestra Seora del Carmen Hospital E.S.E. Santa Rita de Cassia Hospital E.S.E. Hospital Santa Cruz de Urumita E.S.E. San Lucas Hospital Donaldo Sal Morn Hospital Manjarrez
Level 1 1 1 1 1 1 1 1 1
Total 2010 272,970.11 258,924.86 251,170.37 164,677.66 141,480.74 125,072.54 115,989.97 95,135.12 25,701.46
Source: Hospital Information System - SIHO, Decree 2193, Ministry of Social Protection, 2010
As far as promotion and prevention activities are concerned, first level institutions administered 279,056 doses of biologicals, attended 134,527 antenatal and growth and development follow-up consultations and conducted 35,643 Pap smears. Second-level institutions provided 18,698 check-ups by nurses and 7,726 Pap smears. First level hospitals attended 625,089 general medical consultations during the year 2010. Of these, 22% took place in the accident and emergency service. First level hospitals provided 7,382 specialized consultations and second level hospitals carried out 254,291 medical consultations, 33% specialized and 30% of which took place in the accident and emergency service (Table 28).
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Table 28. Production of medical consultations in public
hospitals in La Guajira by level of care

DESCRIPTION Elective Emergency general medical consultations Elective consultations in specialized medicine Total 625,089 PUBLIC HOSPITALS Level I 487,147 137,942 Level II 89,449 78,663 86,179 254,291
In the case of dental care, first level hospitals provided 136,942 checkups, 87,270 dental sealant applications, 72,378 fillings and 14,804 extractions.
Table 29. Dental care in first level institutions in La Guajira
Description Total dental consultations (evaluation) Sealants applied Teeth filled (any material) Extractions (any type) Total Quantity 136,500 87,270 72,378 14,804 310,952
There were 6,050 natural births, 59.8% of which were assisted by the three institutions at the second complexity level and 2,145 Caesarean sections, 1,858 of which were carried out by second level and 287 by first level institutions. During 2010, 25,066 discharges from hospital were reported. Of these, (30%) were from first level hospitals and the remaining 70% from second level hospitals. (37%) were obstetric, 16% surgical and 47% non-surgical.
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Table 30. Discharges from public hospitals in La Guajira

Description Discharges of obstetric patients (normal deliveries, Caesarean sections, and other obstetric services) Discharges of surgical cases (not including normal deliveries, Caesarean sections or other obstetric services) Non-surgical discharges (not including mental health, normal deliveries, Caesarean sections or other obstetric discharges) Total Level I Level II Total
3,016
6,295
9,311
309
3,745
4,054
4,151
7,550
11,701
7,476
17,590
25,066
The average hospital stay was 2.6 days in first level and 3.5 days in second level institutions. The hospital bed occupancy rate was 63.5%, 39.6% of which were at first and 77.7% at second level. There were 11,710 surgical operations, not including normal deliveries, Caesarean sections or other obstetric operations; 93% were carried out by third level and only 7% by first level hospitals. Of the surgical operations, 91.5% were for groups 2 to 10, which evidences the low complexity of the cases covered by the public network:
Table 31. Surgeries in public hospitals in La Guajira
Description Surgical operations Groups 2-6 Surgical operations 7-10 Surgical operations 11-13 Surgical operations 20-23 Total Levell I 469 319 19 15 822 Level II 5,530 4,402 770 186 10,888 Total 5,999 4,721 789 201 11,710
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Patient Referral Network

The system of referrals and counter-referrals includes all the institutions, regulations and procedures for the to transfer of patients, samples, diagnostic aids and reports between one level of care and another in order to ensure accessibility, timeliness and follow-up of persons requiring treatment at a different level or site, according to the complexity of the pathology and the treatment capacity of the different healthcare providers. The referral and counter-referral system in La Guajira Department consists of public and private institutions at four different complexity levels of. Levels one and two are mainly covered by public institutions and levels three and four by private institutions and entities outside the Department. The following map shows the public service network referral system.
Graph 71. Referral and counter-referral map of the public network in La Guajira
FIRST LEVEL HOSPITAL SECOND LEVEL HOSPITAL

E.S.E. HOSPITAL DE NAZARETH
1
HOSPITAL NUESTRA SEORA DEL PERPETUO SOCORRO E.S.E. HOSPITAL ARMANDO PABN LPEZ
E.S.E. HOSPITAL NUESTRA SEORA DE LOS REMEDIOS HOSPITAL SANTA TERESA DE JESS DE VILA
2
E.S.E. HOSPITAL SAN RAFAEL DE ALBANIA
E.S.E. HOSPITAL SAN JOS DE MAICAO
4 6 8 9 7
HOSPITAL SAN RAFAEL NIVEL II
3 15
E.S.E. HOSPITAL NUESTRA SEORA DEL CARMEN E.S.E. HOSPITAL NUESTRA SEORA DEL PILAR E.S.E. HOSPITAL SAN AGUSTN DE FONSECA E.S.E. HOSPITAL SAN LUCAS E.S.E. HOSPITAL SANTO TOMS
5
E.S.E. HOSPITAL SANTA RITA DE CASSIA
10
HOSPITAL DONALDO SAL MORRN MANJARREZ
12 11 14 13 E.S.E. HOSPITAL NUESTRA SEORA

DEL PERPETUO SOCORRO
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
Uribia Manaure Maicao Riohacha Dibulla Hatonuevo Barrancas Distraccin Fonseca San Juan del Cesar El Molino Villanueva Urimita La Jagua del Pilar Albania
Source: La Guajira Health Department
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Table 32 lists the patient referring hospital and city and the receiver hospital and city.
Table 32. Referring and receiving hospital with municipal location
Referring hospital Municipality Receiving hospital Nuestra Seora de los Remedios Hospital Municipality
E.S.E. Santa Teresa de Jess Armando Pabn Lpez Hospital Nuestra Seora del Perpetuo Socorro Hospital and Nazareth Hospital Albania Hospital E.S.E. Santa Rita de Cassia Hospital San Lucas Hospital San Agustn de Fonseca Hospital Nuestra Seora del Carmen Hospital Donaldo Sal Morn Hospital in La Jagua E.S.E. Santa Cruz de Urimita Hospital Santo Toms Hospital en Villanueva Nuestra Seora del Pilar Hospital
Dibulla Manaure Uribia Albania Distraccin El Molino Fonseca Hatonuevo La Jagua del Pilar Urumita Villanueva Barrancas
Riohacha
San Jos de Maicao Hospital
Maicao
San Rafael Hospital
San Juan del Csar
Source: La Guajira Health Department
For the referral of medium and high complexity level patients, the Departments referral and counter-referral system is supported by private institutions and regional and national entities. The following are the healthcare institutions that form the referral and counter-referral system in La Guajira Department:
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Centro Diagnstico de Especialistas CEDES Ltda., level 3 and 4 specialities in the city of Riohacha, La Guajira. Laboratorio Clnico Isabel Curiel de la Hoz, which provides medical laboratory services in the city of Riohacha, La Guajira. MEDISER IPS Ltda., comprehensive care for HIV patients in the city of Riohacha, La Guajira. Unidad Mdica Radiolgica del Carmen, radiology, diagnostic images and ultrasound, conventional and invasive x-rays, 3D and 4D ultrasound and doppler sonography, CAT and panoramic X-rays, in the city of Riohacha, La Guajira. Centro de Imgenes Especializadas, radiology and diagnostic images, ultrasound, specialized and general radiology, 3D and 4D doppler sonography, computed axial tomography (CAT), helical CT with 3D reconstruction, mammography, in the city of San Juan del Csar, La Guajira. Centro de Rehabilitacin Integral RENACER, therapeutic support and rehabilitation, neurodevelopment therapy, music therapy, water therapy, equine therapy, psychology, physiotherapy, respiratory therapy and occupational and speech therapy in the city of San Juan del Csar, La Guajira. Clnica Someda Limitada, NICU, intermediate neonatal care unit, trauma surgery, oral surgery, neurology, orthopaedics, internal medicine, urology, in the city of San Juan del Csar, La Guajira. Instituto Neuro-psiquitrico INSECAR LTDA, psychiatry, mental health unit, drug dependence, medium and high complexity day care, psychological out-patient consultations, psychiatry, occupational health, mental health emergencies, intermediate care in mental health and psychiatry, neurological out-patient consultations in the city of Santa Marta, Magdalena.
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Clnica Benedicto S.A., intermediate adult and neonatal care, intensive adult and paediatric care, day care, neurological surgery, vascular surgery, urological surgery, cardiovascular diagnosis, nephrology outpatient consultations in the city of Santa Marta, Magdalena. Centro de Imgenes Diagnsticas Santa Marta, radiology and diagnostic imaging, nuclear medicine, tomography, x-rays and MRI, in the city of Santa Marta, Magdalena. Fundacin Cardiovascular de Colombia, level 3 and 4 specialities in the city of Santa Marta, Magdalena. Fundacin Centro Colombiano de Epilepsia y Enfermedades Neurolgicas, adults and childrens general medicine, intermediate adult care, adult ICU, neurological surgery, anaesthesia, neurology, epileptology and neurophysiology, neurosurgery and neuropaediatrics, in the city of Cartagena, Bolvar. Fundacin Hospitalaria Hospital San Vicente De Paul, level 3 and 4 specialties and kidney and liver transplants, allogenic bone marrow transplants, autologic bone marrow, kidney and liver transplants in the city of Medelln, Antioquia. Instituto Nacional de Cancerologa, diagnostic activities, interventions and procedures, specialized oncology treatment and rehabilitation in the city of Bogot, Capital District.
Survey at Four IPS in La Guajira

The following is an analysis of the Healthcare Institution variables in Cerrejn area of influence. The four IPS selected for the study in La Guajira Department were: San Rafael Hospital in the town of Albania; Nuestra Seora del Pilar Hospital in city of Barrancas; Nuestra Seora del Carmen Hospital in the town of Hatonuevo; and Nuestra Seora del Perpetuo Socorro Hospital in the town of Uribia. During visits to the four IPS, the following aspects of health care service conditions were inspected: quality, installed capacity and the nature of the service model of
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these institutions. Four modules were applied to each of the hospitals, which form part of the same structure as the module used for the 2007 National Health Survey (Rodrguez et al., 2009), with personal interviews of administrators and scientific staff. The following were the modules used: Module 1. Nature of the IPS and its accredited services: Institutional data, consultations for specific protection and early detection, paediatric and adult hospital services and support, emergency and surgical services. Module 2. Nature of out-patient services: Service identification data and out-patient services. Module 3. Verification of functioning of out-patient services provision: Interviewees identification data, perception of critical conditions of care, perception of critical conditions of care for specific events and office inspection. Module 4. Verification of the functioning of obstetric services: Identification data for interviewees, perception of critical conditions in obstetric care and availability of obstetric equipment and supplies.
San Rafael Hospital in Albania

San Rafael Hospital is a level one facility with two rural health stations in the townships of Cuestecitas and Los Remedios. The Hospital provides all specific protection and early detection services (priority services in public health) and has four beds for adult hospitalization. The hospitalization service has general practitioners, qualified nurses and nursing assistants. The hospitals support services have basic diagnostic imaging and laboratory services. The emergency department has the same staff as the adult hospitalization service. This institution does not carry out surgical operations. The out-patient services provided are nursing, general medicine, general dentistry and vaccination. Table 33 lists the human resources contracted by the week by the hospital for each of the services provided.
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Table 33. Human resources contracted by the week by the San Rafael Hospital
Service Nursing General Medicine Dentistry Respiratory Therapy Physiotherapy Qualified Professionals 1 3 1 1 1 Professionals/ Hours 40 120 40 20 20 Assistants 9 1 1 1 Assistants/ Hours 180 40 40 20
Source: Cendex Calculation- Health Conditions Survey- IPS, Cerrejn, 2009
The nursing, dentistry, therapeutic and medical services were evaluated. At present they do not have referral protocols. Although they are familiar with the Ministry of Social Protection technical standard, a copy was not available in the consulting rooms. An inspection of public services for patients showed that toilets are open to the public and they have properly functioning toilets and hand basins. The doctors surgeries have an interview and examination area and the basic equipment for their activities. In the case of physiotherapy and respiratory therapy services, they were either inadequate or insufficient. At the time of the visit, the dentistry unit was out of service and problems of lack of the supplies required to duly carry out procedures were reported. This hospital does not have approved obstetrics and gynaecology services, although it does have a delivery table. There is a head nurse contracted through the cooperative assigned to this area, but she does not have a postgraduate degree.
Nuestra Seora del Pilar Hospital in Barrancas

The Nuestra Seora del Pilar Hospital has eight service points, seven of which are in rural areas. It is a level one municipal facility which provides all specific protection and early detection services, with priority services in
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public health. It has accredited paediatric and adult hospitalization services, with 5 and 15 beds, respectively. The human resources providing paediatric and adult services consist of a general practitioner (morning and afternoon), obstetrics and gynaecology specialist (morning and afternoon), paediatrician (afternoon), internist (morning), orthopaedic surgeon (morning and afternoon), general surgeon (morning), qualified nurse (morning and afternoon) and a nutritionist (morning and afternoon). The hospital has the following support services: basic diagnostic imaging (radiology and ultrasound equipment), a medical laboratory and electrodiagnosis services. The emergency department is staffed by physicians and nurses who provide adult hospitalization services, as well as a dentistry. This hospital performs surgical operations seven days a week and has two exclusive hospital beds available. This service is provided by a general surgeon, an orthopaedic surgeon and a gynaecologist. Outpatient services provided by the hospital are: anaesthesia, general surgery, dermatology, nursing, physiotherapy, obstetrics and gynaecology, general medicine, internal medicine, nutrition and dietetics, vaccination, respiratory therapy, general dentistry and orthopaedics. The human resources hired by the week at the hospital are listed in Table 34.
Table 34. Human resources contracted by the week at
the Nuestra Seora del Pilar Hospital

Service Internal Medicine Nursing General Medicine Physiotherapy Respiratory therapy Anaesthesia Nutrition Dentistry Qualified Professionals 1 80 2 2 2 2 2 5 Professionals/ Hour 20 180 56 20 20 2 30 40 1 1 1 1 2 Assistants 1 2 Assistants/ Hours 20 80 168 20 20 2 5 40
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With respect to the availability of appointments, all the services provide same-day or next-day appointments, with the exception of anaesthesia, which has an 8-day waiting period (Table 35).
Table 35. Availability of appointments at the Nuestra Seora del Pilar Hospital
Service Internal Medicine Nursing General Medicine Physiotherapy Respiratory therapy Anaesthesia Nutrition Dentistry Appointment Same day Next day Same day Next day Same day 8-day waiting period Next day Same day
With regard to the physical conditions of the services evaluated, we were informed that they were adequate for consultations, to ensure privacy and to protect patient health, with the exception of the nursing service. As far as the conditions of the furniture, equipment and supplies available at the surgeries, they are appropriate for consultations and for protecting the health of both practitioner and Patients. The hospital has an approved obstetrics and gynaecology service. At the time of the visit, however, the basic equipment for adult resuscitation, a newborn care table and a standard incubator were not available. There is a known, defined protocol for a procedure to refer patients to another institution, but it is not available in every surgery. During the inspection of public services for patients, the toilets were found to be open to the public, with properly functioning toilets and hand basins, and all the necessary supplies (toilet paper, paper towels or dryers).
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Nuestra Seora del Carmen Hospital in Hatonuevo

The Nuestra Seora del Carmen Hospital provides all specific protection and early detection services, with priority services in public health. It has approved paediatric and adult hospitalization services, with 2 and 8 beds, respectively. The paediatric and adult hospitalization service is provided by general practitioners, qualified nurses, nutritionists, physiotherapists and a paediatrician. The hospital has basic diagnostic imaging and laboratory services, but it does not provide specialized consultation services in ophthalmology, gastroenterology, radiation therapy, cardiology, urology or electro-diagnosis. The outpatient services provided by the hospital are nursing, general medicine, general dentistry and vaccination. All departments provide sameday appointments. Table 36 shows the number of practitioners and assistants hired by the week at the hospital.
Table 36. Human resources contracted by the week
at the Nuestra Seora del Carmen Hospital

Service Nursing General medicine Dentistry Vaccination Respiratory therapy Physiotherapy Professionals 1 2 2 2 2 2 Professionals/ Hours 40 80 12 80 40 40 2 5 12 200 Assistants 3 Assistants/ Hours 120
With regard to the physical conditions of the facilities, we were informed that they are suitable for ensuring patient privacy and health; however, the physiotherapy service was not considered altogether suitable for duly performing all the respective activities. The furniture and equipment
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are sufficient for patients to have their situation explained and to receive guidance regarding their treatment, but they were not considered adequate for the provision of timely consultation at the appropriate quality level. The hospital has an accredited obstetrics and gynaecology department and the procedures and activities carried out at this low-complexity service facility include the administration of parenteral antibiotics (occasionally) and manual removal of the placenta. There is no institutional protocol for patient referral and the equipment for obstetric care does not include the basic equipment for newborn resuscitation.
Nuestra Seora del Perpetuo Socorro Hospital in Uribia

The Nuestra Seora del Perpetuo Socorro Hospital has four additional service points. It is a level one facility and has accredited paediatric and adult hospitalization services, with 7 and 8 beds, respectively. It has general practitioners, qualified nurses, a nutritionists and a paediatrician (for the paediatric hospitalization service) and a physiotherapist (for adults). As far as support services are concerned, the hospital has basic diagnostic imaging (x-ray and ultrasound), a clinical laboratory and Pap smear service. Other than paediatrics, it does not provide specialized consultation services. The emergency department is staffed by general practitioners, a qualified nurse and a physiotherapist. This institution does not have facilities for surgical operations. The out-patient services provided are nursing, physiotherapy, general medicine, nutrition and dietetics, respiratory therapy, general dentistry and vaccination. Same day appointments are given. See Table 37 for the human resources hired by the week at the hospital.
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Table 37. Human resources contracted by the week at the
Nuestra Seora del Perpetuo Socorro Hospital

Service Nursing General medicine Physiotherapy Respiratory therapy Nutrition Dentistry Vaccination Professionals 1 2 1 1 1 3 0 Professionals/ Hours 40 160 40 40 40 168 3 28 120 224 0 Assistants 2 Assistants/ Hours 80
The physical conditions of the consulting room were considered suitable for protecting patient health, but not appropriate for all consultation activities or to guarantee patient privacy. The furniture and equipment are suitable for patient care. The departments have a patient referral and institutional protocols. During the inspection of the consultation area, it was noted that there are toilets, but they are not open to the public and do not have a hand basin, toilet paper or paper towels. Based on the analysis of the four IPS, it is evident that there is a definition of hierarchy by levels of complexity in the Department, which goes up to the third level of care in the public network. However, the public institutions do not have any great treatment capacity. There are multiple health problems that have to be addressed outside the Department, including cardiovascular surgery and mental health services. Within the Department, the public network inadequacies are supplemented by private IPS with major difficulties as regards functional interactions and the absence of operational standards, information systems and integrated logistics resources. Hospitals in the area of influence do not have medium and high complexity treatment capacity. While the physical conditions are
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sufficient for most of the services, the staff who perform the health procedures are contracted under independent service agreements, which does not help to inspire a sense of belonging to the institution. It is therefore necessary for the installed capacity to be adjusted to meet demand requirements in order to improve patient access to timely healthcare services and optimize the effectiveness of each level of care.
USER PERCEPTION OF HEALTH SERVICES

Evaluation of the quality health services can be made both objectively on the basis of equipment and the availability of resources, or subjectively. The NHS protocol includes both types of measurement. On the one hand, it evaluates the characteristics of the network, equipment and infrastructure and, on the other, it evaluates patient perception of the service received.
Survey Characteristics
The NHS patient survey design was in two modules: module one was applied to patients of out-patient consultations and module two, to patients in the emergency and hospitalization services. The structure of the two modules is similar and each consists of three sub-modules. The initial part includes patient identification data, gender, age, civil status, occupation, Sisben level and insurance situation. The second part contains the variables of the relationship between patients and the service during consultation, hospitalization or emergency care. The main variables have to do with service, such as waiting times, out-of-pocket expenses and the respective breakdown according to type of expenditure and the perception of the quality received. The latter is evaluated on an objective basis and also according to subjective criteria. Among the first criteria are indicators such as appointment availability, waiting times and diagnostic and complementary activities, as well as the request for the patients consent for
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actions that might compromise his or her privacy. Patients qualification of the service and care received constitutes the subjective criterion. The last part inquired about the characteristics of risk related to the process of care, the recommendations received and the procedures carried out. The objective of this component is not to analyze the service provided in isolation, but rather to measure the Patients opinion of a particular diagnosis and the various preventive, curative and rehabilitation recommendations given for each disease or priority condition. It also includes aspects such as use of medication, exposure to diagnostic events and collective health activities. Table 38 summarizes several groups of variables included in the user surveys. It assesses preventive actions such as antenatal care and Pap smears, care for chronic diseases and road traffic injuries.
Table 38. Structure of the survey of out-patient consultation, hospitalization and
accident and emergency service modules

Category Patient Variables Age, Gender, Education, SISBEN, occupation, civil status Reason for Consultation/Hospitalization/ Accident and emergency Services, Services Used, Payment, Perception of Quality, Wait Times
Care provided
Antenatal check-up Pap smear Family planning Growth and development of children under the age of 10 Acute diarrhoeal disease Acute respiratory infection Malnutrition
Risk characteristics, treatment process, recommendations received and procedures performed.
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Category Traffic accidents Sexually transmitted diseases HIV/AIDS Back or neck pain High blood pressure Obesity or excess weight Diabetes Injuries caused by physical violence Vaccination according to the EIP Schedule
Variables
Risk characteristics, treatment process and recommendations received
Source: Cendex Calculation- Health Conditions Survey- Users, Cerrejn, 2009
The following are the main results of the survey of out-patient consultations, hospitalization and accident and emergency services. Sixty seven percent (67%) of the total of 322 types of service events analyzed involved out-patient consultations, defined as any type of service received at the IPS on an outpatient basis (consultation of a general practitioner or specialist, preventive and promotional diagnoses that included up to ambulatory surgery). Emergencies accounted for 24%, which included all the consultations that form part of this type of service, particularly at Barrancas Hospital. Last but not least, hospitalizations (discharges) were 9%. Study of the distribution of events by municipality, the largest volumes were from the municipalities of Barrancas and Hatonuevo and the smallest that of Albania (Table 39).
Table 39. Volume of consultation, hospitalization and accident and emergency
services by municipality
Municipality Out-patient Consultations No. Albania Barrancas Hatonuevo Uribia Total 30 79 30 70 216 % 14 37 14 32 100 Hospitalization No. 8 12 9 0 29 % 28 41 31 0 100 Accident and Emergency Services No. 7 43 7 20 77 % 9 56 9 26 100
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The service events included in the analysis for out-patient consultations are listed below: Out-patient consultation General practitioner consultation Specialist consultation Consultation with another professional Dental consultation Preventive oral health consultation Antenatal follow-up consultation Growth and development consultation Laboratory test X-rays or diagnostic imaging Vaccination Educational session Group therapy meeting Meeting other than group therapy Pap smear Family planning consultation Treatment of wounds Ambulatory surgery In events of hospitalization and accident and emergency, the services studied were: Obstetric causes referred by accident and emergency service Elective non-obstetric causes Referrals for care during childbirth or post-partum Elective care during childbirth or post-partum Treatment for non-obstetric emergencies Treatment for obstetric emergencies
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Acute physical illness Long-term physical disease or ailment Mental problem or disease Table 40 shows that, in the aggregate, out-patient consultation events were by more women than men and this is also the case when broken down by type of affiliation. This result matches the NHS findings, which identify women as the larger consumers of out-patient services. People affiliated to the subsidized regime were 78% of the total number of events. The high percentage of the subsidized system is maintained when studying women and men separately. Conversely, the percentage of the contributory system is lower when the population is studied in the aggregate and by type of affiliation.
Table 40. Out-patient consultation according
to type of affiliation declared and gender

Female System No. Contributory Subsidized Non-affiliated Total 7 126 27 160 % 4 79 17 100 No. 4 43 9 56 % 7 77 16 100 No. 11 169 36 216 % 5 78 17 100 Male Total
There is a larger percentage of women in both accident and emergency services and out-patient consultations, but, in this case, the differences are not as marked as in out-patient consultations (Table 41). Again, people in the subsidized system account for the largest number of events.
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Table 41. Treatment by accident and emergency services according
to type of affiliation declared and gender

Variations in treatment with hospitalization are not as clearly differentiated by gender as in the previous two cases. However, slightly more women than men require hospitalization services. Events involving people in the subsidized system represent 83% of all hospitalization services (Table 42). Accident and emergency and hospitalization services differ from ambulatory services in their access and use as they tend to be non-elastic in relation to the price of the services, which means that demand reveals need. Differences in the frequency of hospitalization may represent important differences in the general healthcare access conditions.
Table 42. Care with hospitalization according to type
of affiliation declared and gender

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As in the foregoing cases, demand for out-patient consultation service events is greater for women than for men. As shown in Table 43, people at Sisben level 1 show higher demand, accounting for 88% of events. Demand is lower when it involves individuals from level 3 (1%). This result may be due to the small percentage of individuals at Sisben level 3
Table 43. Care through out-patient consultation
according to Sisben level and gender

Female Sisben No. 1 2 3 Unknown Total 113 8 1 4 126 % 90 6 1 3 100 No. 35 4 0 3 42 % 83 10 0 7 100 No. 148 12 1 7 168 % 88 7 1 4 100 Male Total
According to the level of education, 91% of demand for out-patient consultation services is by the population with basic secondary education or less (Table 44). Twenty four percent (24%) of demand is from persons with no education, 12% with pre-school education, 31% with basic primary and 24% with secondary education. People with technical, university and graduate levels of education represent only 9% of total out-patient consultations. These results are obviously influenced by the concentration of the population in the subsidized system and from low-income levels whose lack of higher education is characteristic.
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Table 44. Educational level of users of out-patient consultations by gender

Female Education No. None and minors Pre-school Basic primary Basic secondary and middle school Technical or technological University without degree University with degree Postgraduate without degree Postgraduate with degree Total 36 9 50 44 17 2 2 0 0 160 % 23 6 31 28 11 1 1 0 0 100 No. 16 16 16 7 1 0 0 0 0 56 % 29 29 29 13 2 0 0 0 0 100 No. 52 25 66 51 18 2 2 0 0 216 % 24 12 31 24 8 1 1 0 0 100 Male Total
In the case of emergency services, like out-patient consultations, the largest demand (94%) is concentrated at levels of education below or equal to basic secondary and middle school (Table 45). Specifically demand is as follows: 34% of people with no education, 3% with pre-school education, 26% elementary education and 31% with secondary education. People with technical, university and graduate levels of education represent only 6% of the total out-patient consultation events.
Table 45. Educational level of users of emergency services by gender
Female Education No. None and minors Pre-school 10 1 % 24 2 No. 16 1 % 44 3 No. 26 2 % 34 3 Male Total
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Female Education No. Basic primary Basic secondary and middle Technical or technological University without degree University with degree Postgraduate without degree Postgraduate with degree Total 12 17 0 1 0 0 0 41 % 29 41 0 2 0 0 0 100 No. 8 7 2 2 0 0 0 36
Male % 22 19 6 6 0 0 0 100 No. 20 24 2 3 0 0 0 77
Total % 26 31 3 4 0 0 0 100
In hospitalization services, the density of secondary and middle levels of education and minors is more pronounced (97%) than in the foregoing services, as shown in Table 46: 38% of demand is of people with no education, 3% pre-school, 28% with elementary and 28% with secondary education. Patients with technical, university and graduate levels of education represent only 3% of total out-patient consultations.
Table 46. Educational level of hospitalization users by gender
Education Female No. None and minors Pre-school Basic primary Basic secondary and middle 5 0 2 7 % 33 0 13 47 No. 6 1 6 1 Male % 43 7 43 7 Overall No. 11 1 8 8 % 38 3 28 28
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Education Technical or technological University without degree University with degree Postgraduate without degree Postgraduate with degree Total 1 0 0 0 0 15
Female No. % 7 0 0 0 0 100 No. 0 0 0 0 0 14
Male % 0 0 0 0 0 100
Overall No. 1 0 0 0 0 29 % 3 0 0 0 0 100
Single people show the highest demand for out-patient consultation services of any civil status, with 47% of the total (Table 47). However, by gender, women living with a partner show the highest demand for services (46%), while single men have the highest demand of their gender (77%). The lowest demand for services is from those who are separated or widowed at 3% each. This low percentage is found in both women (4% and 4%) and men (2% and 4%, respectively).
Table 47. Civil status of out-patient consultation users by gender
Female Marital status No. Married Living with a partner Separated Widowed Single Total 16 74 6 6 58 160 % 10 46 4 4 36 100 No. 5 5 1 2 44 57 % 9 9 2 4 77 100 No. 21 79 7 7 102 216 % 10 37 3 3 47 100 Male Total
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For hospitalization and emergency services, the highest percentage demand overall (47%), women (42%) and men (52%) is by single individuals, followed by 33% persons living with a partner, 39% women and 26% men, respectively. Estimated values are listed in Table 48.
Table 48. Civil status of hospitalization and emergency service users by gender
Female Civil status No. Married Living with partner Separated Widowed Single Total 4 22 5 1 24 56 % 7 39 9 2 43 100 No. 8 13 1 2 26 50 % 16 26 2 4 52 100 No. 12 35 6 3 50 106 % 11 33 6 3 47 100 Male Total
The main reason for out-patient consultations in the aggregate - for men, women and both genders taken together - is preventive care, such as antenatal growth check-ups at 50%, 50%, 48%, respectively. Table 49 shows that rest of the reasons have similar percentages, approximately 10%, in both the group of women and that of men.
Table 49. Reason for out-patient consultation by gender
Female Reason No. Acute physical illness or recent onset of ailment Long term physical illness or ailment Problem or disease of the mouth or teeth Preventive care such as antenatal growth checkups 17 18 22 80 % 11 11 14 50 No. 7 8 8 27 % 13 14 14 48 No. 24 26 30 107 % 11 12 14 50 Male Total
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Female Reason No. Other preventive care such as checkups for healthy individuals Total 23 160 % 14 100 No. 6 56
Male % 11 100 No. 29 216
Total % 13 100
The primary type of care provided in out-patient consultations in the aggregate is general medical consultation at 22%, followed by dental consultation at 21%, antenatal care at 20% and consultation for growth and development at 19%. For women, the primary type of care received is antenatal at 24%, followed by general medical consultation at 22%, dental consultation at 17% and family planning consultation or checkups. In the case of men, checkups and growth are the most frequent type of consultation at 39%, followed by general medical consultation at 24% and dental consultation at 23%. See Table 50.
Table 50. Type of care received by out-patient consultation users by gender
Female Reason No. General medicine consultation Specialized medicine consultation Consultation with other practitioner Dental consultation Preventive oral health consultation Antenatal consultation Growth and development consultation Laboratory tests 39 0 1 31 1 44 18 6 % 22 0 1 17 1 24% 10% 3% No. 15 2 2 14 0 0 24 1 % 24 3 3 23 0 0% 39% 2% No. 54 2 3 45 1 44 42 7 % 22 1 1 21 0 20% 19% 3% Male Total
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Female Reason No. X-rays or diagnostic imaging Vaccination Educational session Group therapy meeting Meeting other than group therapy Pap smear Family planning consultation or treatment Care of wounds, removal of stitches Ambulatory surgery Other Total 0 3 0 0 0 10 26 0 0 2 181 % 0% 2% 0% 0% 0% 6% 14% 0% 0% 1% 100% No. 0 3 0 0 0 0 0 1 0 0 62
Male % 0% 5% 0% 0% 0% 0% 0% 2% 0% 0% 100% No. 0 6 0 0 0 10 26 1 0 2 243
Total % 0% 3% 0% 0% 0% 5% 12% 0% 0% 1% 100%
Of the total number of consultations, 76% are scheduled and 24% are priority, as illustrated in Table 51. The main reason for scheduled consultation is preventive care. In the case of priority care, the main reasons are oral or dental problems or disease, acute physical illness or sudden ailment and other preventive care services, such as checkups of healthy individuals.
Table 51. Reason for out-patient consultation, scheduled or priority
Scheduled Reason No. Acute physical illness or sudden ailment Long term physical illness or ailment 8 % 5 No. 16 % 31 No. 24 % 11 Priority Total
23
14
26
12
220
Scheduled Reason No. Problem or disease of the mouth or teeth Preventive care such as antenatal growth checkups Other preventive care such as checkups for healthy individuals Total 20 % 12
Priority No. 10 % 19 No. 30
Total % 14
92
56
15
29
107
50
21 164
13 100
8 52
15 100
29 216
13 100
The presence of physical or acute illness or a sudden ailment are the main reasons for emergency treatment in women (41%), in men (47%) and in the aggregate (44%). In women, the following reasons for emergency care are birth at 34% and long-term physical illness or ailment at 22%. In men, the reasons for emergency care are accidental injury at 28% and for longterm physical illness or ailment at 25%. It is important to note that, among women, none of the cases of emergency were due to accidental injury, as shown in Table 52.
Table 52. Reason for emergency care, by gender
Reason for emergency care, by gender Acute physical illness or sudden ailment Long term physical illness or ailment Accidental injury Delivery Other Total Female N 17 9 0 14 1 41 % 41 22 0 34 2 100 N 17 9 10 0 0 36 Male % 47 25 28 0 0 100 N 34 18 10 14 1 77 Total % 44 23 13 18 1 100
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The main reasons for hospitalization, in the aggregate and for each of the genders are acute physical illness or sudden ailment at 55% in the aggregate, 40% of women and 71% of men. Table 53 shows that the second reason for hospitalization is long-term physical illness or ailment at 28% in the aggregate, 27% of women and 29% of men.
Table 53. Reason for hospitalization by gender
Female Reason No. Acute physical illness or sudden ailment Long term physical illness or ailment Accidental injury Delivery Other Total 6 4 0 3 2 15 % 40 27 0 20 13 100 No. 10 4 0 0 0 14 % 71 29 0 0 0 100 No. 16 8 0 3 2 29 % 55 28 0 10 7 100 Male Total
Table 54 shows that 57% of the total emergencies and hospitalizations are non-obstetric emergency care and 23% involve hospitalization referrals from accident and emergency for non-obstetric causes. Among women, 46% of events are non-obstetric emergency care, 18% of the hospitalizations are due to non-obstetric causes referred from accident and emergency and 16% are referred from accident and emergency for delivery or post-partum care. In the group of men, 68% of the events involve non-obstetric emergency care, and 28% of the events involve hospitalization for non-obstetric causes referred from accident and emergency.
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Table 54. Hospitalization and accident and emergency service events by gender
Female % 10 No. 18 % 14 Male No. 28 % 24 Total % 23
Events Hospitalization due to accident and emergency referral for non-obstetric causes Referral from accident and emergency for delivery or post-partum care Elective delivery or post-partum care (Caesarean section) Care for non-obstetric emergencies Care for obstetric emergencies Total
16
5 26 6 56
9 46 11 100
0 34 2 50
0 68 4 100
5 60 8 106
5 57 8 100
With regard to the primary payer of out-patient consultation services (Table 55), in the aggregate, 83% are paid by the EPS, ARS or other social security institutions and 17% by the health department or the mayoralty. The composition of these payers varies by type of affiliation. In the contributory system, 91% of the services are paid by the EPS, ARS or other social security institutions and 9% by the health department or mayoralty. In the subsidized system, they are all paid by the EPS, ARS or other social security institutions. As for Patients who are not affiliated, 97% of out-patient consultations are mainly paid for by the health department or the mayoralty and 3% by the patient or a family member.
Table 55. Primary payer of users bills for out-patient
consultation by type of affiliation

CONTRIBUTORY
Primary Payer EPS, ARS or other social security institution
SUBSIDIZED
SPECIAL
NON- AFFILIATED
TOTAL
N 10
% 91
N 169
% 100
N 0
% 0
N 0
% 0
N 179
% 83
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CONTRIBUTORY
Primary Payer Health Department or city hall (affiliated members) The beneficiary or someone from the beneficiary's household Total
SUBSIDIZED
SPECIAL
NON- AFFILIATED
TOTAL
35
97
36
17
11
100
169
100
36
100
216
100
Source Cendex Calculation- Health Conditions Survey- Users, Cerrejn, 2009
Table 56 shows patient distribution by payment by declared type of affiliation. Fifty six percent (56%) of the total out-of-pocket expenses, co-payments or monthly payments are made by individuals in the contributory system and 44% by those in the subsidized system. Non-affiliated individuals incur expenses related exclusively to private consultations. Payments for prepaid medicine vouchers and splints, braces or other elements were not made in any of the cases. Of the total expenses for laboratory or other tests, 78% are paid by individuals in the subsidized system and 22% by persons in the contributory system. All (100%) of expenses for materials required for care are reported in the contributory system and 100% of expenses for therapies and injections are reported in the subsidized system. Finally, 57% of medication expenses are paid by affiliates to the subsidized system, 14% to the contributory system and 29% by non-affiliated Patients
Table 56. Users who incur out-of-pocket expenses for out-patient
consultations, by declared type ofaffiliation

CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Payment No. Co-payment/quota Private consultation Pre-paid medicine voucher 5 0 0 % 56 0 0 No. 4 0 0 % 44 0 0 No. 0 0 0 % 0 0 0 No. 0 1 0 % 0 100 0
TOTAL
9 1 0
224
CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Payment No. Laboratory or other tests Supplies necessary for service Therapies and injections Medications Splints, braces or other items Total 2 1 0 3 0 11 % 22 100 0 14 0 26 No. 7 0 2 12 0 25 % 78 0 100 57 0 58 No. 0 0 0 0 0 0 % 0 0 0 0 0 0 No. 0 0 0 6 0 7 % 0 0 0 29 0 16
TOTAL
9 1 2 21 0 43
Evaluation of the primary payer of emergency services (Table 57) shows that the main payers are the EPS, ARS or other social security institutions at 71%, followed by the health department or mayoralty at 13% and through civil liability for road traffic accidents insurance at 12%. In the contributory system, the primary payers are the EPS, ARS and other social security institutions, which make up 67%, followed by civil liability for traffic accidents insurance at 17% and pre-paid medicine at 17%. In the subsidized system, payments are distributed between the EPS, ARS and other social security institutions (85%) and civil liability for road traffic accidents insurance (13%). Finally, for non-affiliated, Patients, 90% of the payments are made by the health department or mayoralty and the other 10% by Patients or their relatives.
Table 57. Primary payer of accident and emergency
service users bill, by type of affiliation

CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Total
PRIMARY PAYER N EPS, ARS or other social security institution % N % N % N % N %
67
47
85
55
71
225
CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Total
PRIMARY PAYER N % N % N % N % N %
Pre-paid medicine, health insurance or supplementary plan
17
Health department or mayoralty (affiliated members)
90
10
13
Beneficiary or member of beneficiarys household SOAT (civil liability for road traffic accidents) insurance Total
10
17
13
12
12
100
55
100
10
100
77
100
In the case of hospitalization services, in the aggregate, EPS, ARS or other social security institutions are the primary payers in 90% of cases, as shown in Table 58. In the contributory system, 50% is paid by EPS, ARS or other social security institutions, followed by pre-paid medicine and the Health Department at 25% each. In the subsidized system, the primary payers are the EPS, ARS or other social security institutions in all cases. In the case of non-affiliated users, Health Departments or mayoralties are the primary payers.
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Table 58. Primary payer of users hospitalization bills by type of affiliation

CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Total
Primary Payer No. EPS, ARS or other social security institution % No. % No. % No. % No. %
50
24
100
26
90
Pre-paid medicine, health insurance or supplementary plan Health Department or mayoralty (affiliated members) Beneficiary or someone from beneficiary's household
25
25
100
SOAT (civil liability for traffic accidents insurance) Total
100
24
100
100
29
100
Sixty seven percent (67%) of the out-of-pocket expenses for emergency and hospitalization services are paid by persons affiliated to the contributory system and 33% by those in the subsidized system (Table 59). Only non-affiliated persons pay for private consultations. Those affiliated to the contributory system are the only ones who pay pre-paid medicine vouchers and laboratory or other test expenses. Persons with social security (contributory and subsidized) have to pay for materials necessary for treatment, as well as therapies, injections and medicines. Finally, 47% of payments for splints, braces or other elements are paid for by
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the subsidized population, 35% by those in the contributory system and 18% by non-affiliated users.
Table 59. Users who incur out-of-pocket expenses in respect of payment for
hospitalization and emergency treatment by declared type of affiliation

CONTRIBUTORY
SUBSIDIZED
SPECIAL
NON- AFFILIATED
Payment No. Co-payment / quota Private consultation Pre-paid medicine voucher 2 0 1 % 67 0 100 No. 1 0 0 % 33 0 0 No. 0 0 0 % 0 0 0 No. 0 1 0 % 0 100 0
TOTAL
3 1 1
Laboratory or other tests Supplies necessary for service Therapies and injections Medications Splints, braces or other items Total
100
3 1 1 6 15
50 50 33 35 44
3 1 2 8 15
50 50 67 47 44
0 0 0 0 0
0 0 0 0 0
0 0 0 3 4
0 0 0 18 12
6 2 3 17 34
Users Perception of Quality Conditions

For out-patient services, the institution was assigned in 70% of cases and individually chosen in 30% of the cases. Evaluation of this variable showed that this trend also applies according to type of affiliation: the institution was assigned in 82% of the cases for the contributory system and 76% for
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the subsidized system. Non-affiliated individuals were able to choose the institution in a higher percentage of cases (58%). See Table 60.
Table 60. Choice of institution for out-patient consultation
according to declared type of affiliation

Chosen System No. Contributory Subsidized Non-affiliated Total 2 41 21 64 % 18 24 58 30 No. 9 128 15 152 % 82 76 42 70 11 169 36 216 Assigned Total
As in out-patient services, individuals are assigned to an institution in 58% of hospitalizations and emergency treatments (Table 61). In the contributory and subsidized system, institutions are assigned in this type of event for most of the population, at 56% and 66%, respectively. Non-affiliated users choose their institution in all cases.
Table 61. Choice of institution for hospitalization and emergency care according
to declared type ofaffiliation

Chosen System No. Contributory Subsidized Non-affiliated Total 7 27 11 45 % 44 34 100 42 No. 9 52 0 61 % 56 66 0 58 16 79 11 106 Assigned Total
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Table 62 shows that in 92% of the cases, patients were not allowed to choose their preferred professional. According to the study, this ratio is maintained throughout the population according to the type of affiliation declared, at 82% of the people affiliated to the contributory system, 91% of those in the subsidized system and 100% of non- affiliated users.
Table 62. Choice of preferred medical professional by out-patient
consultation users, according to type of affiliation declared

System Contributory Subsidized Non-affiliated Total Yes No. 2 15 0 17 % 18 9 0 8 No. 9 154 36 199 No % 82 91 100 92 Total 11 169 36 216
As in the case of out-patient consultation services, patients cannot choose their preferred medical professional in 94% of hospitalizations and accident and emergency service events, as shown in Table 63. This occurs in 94% of cases in the contributory system and 100% of non-affiliated persons.
Table 63. Choice of preferred medical professional by hospitalization and accident
and emergency service users according to declared type of affiliation

System Contributory Subsidized Special Non-affiliated Total Yes No. 1 5 0 0 6 % 6 6 0 0 6 No. 15 74 0 11 100 No % 94 94 0 100 94 Total 16 79 0 11 106
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Clear Information on Medical Condition and Treatment

Table 64 shows out-patient consultation patients access to clear information on their medical condition. Eighty five percent (85%) of them had access to such information, which is also reflected in the analysis of the population by type of affiliation: 64% contributory, 85% subsidized and 94% non-affiliated.
Table 64. Out-patient consultation patients access to clear information on
medical conditions according to declared type of affiliation

It is clear System No. Contributory Subsidized Non-affiliated Total 7 143 34 184 % 64 85 94 85 No. 1 10 1 12 % 9 6 3 6 No. 3 16 1 20 % 27 9 3 9 11 169 36 216 It is not clear Not Applicable Total
Similar to out-patient consultation, in hospitalization and accident and emergency service cases, a predominant 78% of patients have access to clear information (Table 65). This is supported by a study of the population by affiliation: contributory (88%), subsidized (75%) and non-affiliated (91%).
Table 65. Hospitalization and accident and emergency service patients access to
clear information on medical conditions according to declared type of affiliation

It is clear System No. Contributory Subsidized 14 59 % 88 75 No. 2 20 % 13 25 16 79 It is not clear Total
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It is clear System No. Non-affiliated Total 10 83 % 91 78
It is not clear Total No. 1 23 % 9 22 11 106
In out-patient consultation services, 68% of the Patients had access to clear information on their treatment. Study of this variable by system showed that 36% in the contributory system, 68% in the subsidized system and 75% in the non-affiliated category received clear information. These figures are listed in Table 66.
Table 66. Out-patient consultation users access to clear information
on treatment according to type of affiliation declared

Yes System No. Contributory Subsidized Non-affiliated Total 4 115 27 146 % 36 68 75 68 No. 2 18 5 25 % 18 11 14 12 No. 5 36 4 45 % 45 21 11 21 11 169 36 216 No Not Applicable Total
In hospitalization and accident and emergency services, 73% of the population did have access to clear information, while 27% did not, as shown in the estimates in Table 67. By type of affiliation, there is a marked prevalence of situations where there is access to clear information on treatment: 75% in the contributory and 70% in the subsidized system, and 91% non-affiliated users.
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Table 67. Hospitalization and accident and emergency service users access to
clear information on treatment according to declared type of affiliation

Not clear System No. Contributory Subsidized Non-affiliated Total 12 55 10 77 % 75 70 91 73 No. 4 24 1 29 % 25 30 9 27 16 79 11 106 Not clear Total
Request for Authorization to Carry out a Procedure

In 44% of all out-patient consultation events, patients authorized the procedure and 33% did not. A larger percentage of people in the contributory and subsidized systems did so, at 45% and 46%, respectively. However, 53% of the non-affiliated patients did not authorize treatment. See Table 68.
Table 68. Out-patient consultation users (%) who authorized a procedure
according to type of affiliation declared

With authorization System No. Contributory Subsidized Special Non-affiliated Total 5 77 0 14 96 % 45 46 0 39 44 Without authorization No. 1 52 0 19 72 % 9 31 0 53 33 Not applicable Total No. 5 40 0 3 48 % 45 24 0 8 22 11 169 0 36 216
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62% of hospitalization and accident and emergency service cases authorized their treatment, as shown in Table 69. This trend is maintained in the contributory system (63%) and the subsidized system (66%). In the case of non-affiliated patients, however, the percentage that did not authorize their treatment is greater (64%).
Table 69. Hospitalization and accident and emergency service users (%) who
authorized a procedure, according to declared type of affiliation

With authorization System No. Contributory Subsidized Special Non-affiliated Total 10 52 0 4 66 % 63 66 0 36 62 No. 6 27 0 7 40 % 38 34 0 64 38 16 79 0 11 106 Without authorization Total
Perception of Time between Arrival at the IPS and Service

The average time it takes for users to access out-patient consultation services is 14.4 minutes. There are no major differences according to type of affiliation: in the contributory system it is 15 minutes, 14.4 minutes in the subsidized system and 13.8 minutes for non-affiliated patients. Once they reach the facilities, the average waiting time in this type of service is 14.42 minutes. Considerable differences were found in the study of the population by type of insurance: waiting time in the contributory system was 11.81 minutes, in the subsidized system 15.27 minutes and for non-affiliated patients 16.19 minutes.
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As regards hospitalization and accident and emergency services, there are significant differences in arrival and waiting times when the population is broken down by type of insurance. On average, arrival time is 14.21 minutes, the shortest being 11.5 minutes in the case of patients in the contributory system, followed by 13.21 minutes in the subsidized system; the longest waiting time is 17.91 minutes for non-affiliated patients. As to how long it takes to receive service, the average time is 8.39 minutes, nonaffiliated persons have shorter waiting times of 6.58 minutes and those in the contributory system the longest at 9.62 minutes.
Perception of Service Quality according to Priority Condition

The following are the elements identified as objective and perceptive regarding quality based on the survey. Those relating to the patients opinion of the care process, referred to as either a consultation or hospitalization, or of the treatment received from various human resources, are presented as perceptive. The recommendations and procedures received by patients with special health conditions were analyzed retrospectively. In this case, the observation unit refers not only to the last consultation or hospitalization but rather to how the various processes are remembered.
Antenatal Checkups and Care during Delivery

Analysis of the number of antenatal check-ups variable showed that 24% had between one and two, 45% from three to five and 31% more than five. In most cases, in the contributory and subsidized system, women have from three to five checkups at 48% and 52%, respectively. In the case of nonaffiliated Patients, 40% have from one to two, 40% from three to five and 20% more than five check-ups. Fifty nine percent (59%) of patients were told that they should be accompanied when they attended antenatal check-ups, 95% of the users had a general check up and 100% had a blood test. Analysis of this variable by system
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showed that there are differences only with regard to the recommendation to attend antenatal check-ups accompanied by another person: 100% in the contributory system and 59% in the subsidized system. A VRL blood test was conducted on most patients, i.e. 100% in the contributory system and for non-affiliated patients and 96% in the subsidized system. All patients, regardless of type of affiliation, had an HIV test and were told to take calcium and iron. Pap smears were administered to 93% of users: all contributory and non-affiliated users and 89% of patients in the subsidized system. On average, 95% had an obstetric ultrasound, including 100% of the users affiliated to one of the systems and 87% of the non-affiliated users. 86% of women were vaccinated, 50% of whom were in the contributory system, 96% in the subsidized system and 73% in no system. 80% of women were given orders for dental care: 50% in the contributory system, 93% in the subsidized system and 60% of those not affiliated to any system. 91% of the patients were recommended to avoid alcohol, cigarettes and abuse of prescription drugs. When differentiated by type of affiliation, only 50% of the user population affiliated to the contributory system and 93% of those in the subsidized system or no system were given these recommendations. All childbirth related information was collected in the hospitalization and accident and emergency services module. On average, women were examined during pregnancy 1.9 times, users in the subsidized system 3.14 times, in the contributory system twice and non-affiliated 4 times. At the time of discharge, 89% of the patient population were advised of possible post-partum problems and given advice on birth control methods. 89% of all users wished to follow a birth control method and, on discharge, all patients were advised to return for a check-up in an average of 8 days.
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Upon discharge, 89% were given an explanation as to how to treat lesions caused by childbirth, 100% were told how to breast feed their baby and what they themselves should eat and 94% were told what they should do if they or the baby became ill. 89% of users were provided with civil registration and 79% were given birth certificates. A blood sample was taken from 53% of the babies to identify whether they had congenital hypothyroidism. There were significant differences between the subsidized and contributory systems at 57% and 100%, respectively. In addition, 84% of the cases were advised to bring their baby for a medical check-up. By type of system, this recommendation was given to 85% in the subsidized system, 50% in the contributory system and to 100% of nonaffiliated users. Finally, vaccines were administered to 68% of infants, 71% in the subsidized system, 50% in the contributory system and 75% non-affiliated. All mothers of the vaccinated babies were given a card showing the vaccines administered.
Pap Smear
The user population for Pap smears were women affiliated to the subsidized system and non-affiliated women. Therefore, this section does not refer to the users in the contributory system. On average, this consultation was the first Pap smear for 33% of the users and there are differences in the population by affiliation. In only 40% of the users in the subsidized system was this their first Pap smear and all non-affiliated users had already had this procedure. The test was explained to 92% of the users and 83% were told how important it was. Sixty seven percent (67%) were asked for permission to perform the Pap smear and, finally, only 8% had to buy materials for the test. 50% were told that they should return for the result, which were given to 50% of patients. 100% received an explanation of the results and 83% understood the explanation. One hundred percent (100%) of the results
237
obtained by the examination were normal and 83% were advised to return for a further Pap smear.
Family Planning and Birth Control

As in the foregoing case, there is no user population of this service affiliated to the contributory system. In 92% of cases, the doctor explained existing birth control methods. On average, the most common method is by injection (64%) and the contraceptive pill (23%). There is 68% preference for the injection and 24% for the contraceptive pill. Of non-affiliated users, 100% have the injection. On average, 81% have freely chosen the method they are using. For those who did not, in 60% of the cases it was the husband or partner who decided and in the remaining 40%, it was the respective doctor. In all cases, the women were advised on how to use the method chosen and 96% understood how to use it correctly. 79% were provided with their birth control free of charge, 13% were required to pay and 8% had to pay partially. The same was true for users in the subsidized system at 78% , 13% and 9%, respectively. 100% of non-affiliated users were given their birth control method and 100% of all users were advised to return for a check-up.
Growth and Development of Children under 10

On average, children attended 3.6 years of age and had been come for this type of check-up 3.3 times. There are differences according to type of affiliation: in the contributory system the average age was 5 with 2 checkups, in the subsidized system, the age was 4.5 with 6.5 appointments and the age of non-affiliated users was 1.5 with 1.5 check-ups. 100% of children were examined, weighed and measured. Their head was measured in 98% of the cases and 98% received an explanation of the childs condition. 74% of immunization cards of users who carried it with them were checked, 12% did not have them with them and 14% were not asked for them. In
238
the contributory system, 100% of cards were checked and in the subsidized system 73%. 12% were asked for their cards, but did not have them and 15% were not asked. Finally, 88% of the non-affiliated users were asked for their immunization cards but were not carrying them and 12% were not asked for them. Explanations of vaccines and their importance were given in 83% of cases, how to prevent accidents in 67%, how to play with children to stimulate their development in 57%, how to discipline and educate children in 62%, the importance of giving only breast milk in 100%, how to care for the navel in 67%, daily bathing in 67%, the importance of going out in the sun in 33% and the importance of sleep for children in 33% of cases. In 33% of cases advice was given on how to keep the mouth and teeth clean and how to feed their babies. All users were told how to start their child eating different foods and 67% were advised that babies should not sleep with their parents.
Acute Diarrhoeal Disease - ADD

There are no non-affiliated users for this type of consultation as the entire user population is either in the contributory or subsidized system. All patients were weighed, measured and given rehydration solutions. Laboratory tests were performed in 89% of cases,. Users were taught how to prepare the solution and what fluids they could drink. 89% were told why they were sick and 78% were told of the warning signs that their condition was worsening and they were taught how to prepare food properly in all cases. Medicines were prescribed in 100% of cases and users were told how to have their prescriptions filled. They had to buy the medications and were advised to return for follow up. For hospitalization and accident and emergency service events, there are affiliated users (subsidized and contributory system) and non-affiliated users.
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In 93% of cases, patients were given electrolyte solutions and weighed and the height of 56% was also measured. Laboratory tests were performed in nineteen percent (19%) of the population: 25% in the subsidized system and 0% of the users in the contributory system or non-affiliated population. Warning signs were explained to 56%, with differences according to type of affiliation. For persons in the subsidized system or non-affiliated group, this advice was given to 50% of the population and to the entire population in the contributory system. Medications were prescribed in all cases, 93% were advised on how to use them and 0% had were required to pay for them. Finally, 37% were told they should return for a check-up.
Acute Respiratory Infection - ARI

The population with respiratory infection was from the subsidized system alone. 33% suffered respiratory symptoms for two days, 33% for 4 days and the remaining 33% for 90 days. All cases were examined and a laboratory test or x-ray was ordered in 33% of cases. These users were given explanations of why they had become ill and were prescribed respiratory therapy. None were told of the signs that might indicate that their condition was worsening. 67% were prescribed medications and all of them were told how these were supplied and how to obtain them. Medications were provided in 50% of the cases and the other 50% were required to pay for them. Finally, 67% were advised to return for follow up. Patients in the hospitalization and accident and emergency services were in the contributory system, the subsidized system or were not affiliated to any system. 100% of the patients underwent a general check-up, 94% were weighed, the height of 42% was measured and laboratory tests or x-rays were ordered in 47% of cases. There were no significant differences in insurance coverage. In 52% of cases, patients were told how they had become ill: 55% were in the
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subsidized system, 33% were non-affiliated and 100% of those affiliated to the contributory system received an explanation. 95% were prescribed medications, 100% understood how to take them and 83% were advised on how to obtain them. On average, 17% were required to pay, 67% received them free of cost and the remaining 17% had to make partial payment. Of the users affiliated to the subsidized system, 82% were given the medicine and 18% had to make partial payment. 50% of users in the contributory system received medications free of charge, while the other 50% were required to pay for them. 60% of non-affiliated users had to pay for their medications and 40% received them free of cost. Finally, 52% were advised to return for follow-up.
Out-Patient dental care consultations

21% of out-patient dental care consultations were for initial dental evaluations, 33% in the contributory system, 21% in the subsidized system and 17% non-affiliated. At this consultation, 62% in the contributory system, 68% in the subsidized system and 33 non-affiliated users had fillings. Teeth were cleaned in 32% of the cases, 67% in the contributory system, 29% in the subsidized system and 33% of non-affiliated users. Root canals were required in an average of 11% of the cases. This procedure was not carried out for those in the contributory system or for non-affiliated users, but only in 13% of those in the subsidized system. Fluoride was applied in 36% of cases and sealants 19%. Dentures were or will be provided in 4% of cases. Oral surgery was necessary in 4% of cases. Orthodontic treatment was not provided in any of the cases. Sensitivity was treated in 2% of cases. 79% were advised that they had problems with either their mouth or their teeth. 70% were taught how to brush their teeth and 47% how to floss. Finally, 79% were advised that they should return for follow-up.
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Road traffic accidents

Patients receiving hospitalization and accident and emergency services following road traffic accidents were affiliated to the subsidized and contributory systems. In all cases, users were brought directly to the institution and in 90% of cases in a private vehicle. Once at the institution, the average waiting time was 11.6 minutes. This was 14.2 minutes for users in the subsidized and 5.3 minutes in the contributory system. In all cases, the institution had available all the drugs and materials required for the treatments given. All cases were examined by a general practitioner, 30% had laboratory tests, 70% had x-rays and 33% stitches and treatment for lesions. Surgery was not carried out in any of the cases. 40% were immobilized or had a wear a cast; 40% were prescribed medication and 80% advised to return for follow-up. Finally, an average of 18 days sick leave was prescribed.
Back or Neck Pain

100% of patients with back or neck pain were affiliated to the subsidized system. 64% were diagnosed, 91% were examined, x-rays and diagnostic tests were ordered for 45% and 45% were told how prevent their pain. 9% were advised to exercise, 36% taught how to lift objects correctly, 45% how to reduce stress and none were advised to lose weight. None of the users were referred to a psychologist, but 9% were referred to physiotherapy. Medicine was prescribed and explained in all cases. Finally, 45% were advised to return for follow-up.
High Blood Pressure

Patients with hypertension belonged to the contributory and subsidized systems. 94% of patients were advised not to smoke, 83% try to control their everyday stress, 72% to lose weight, 89% reduce alcohol intake, 56% to exercise and 89% to reduce their intake of salt and fat.
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93% of patients were treated by a general practitioner, 87% by a specialized physician, 6% by a nutritionist and none received treatment from a dietician or exercise training. 100% of the patients are taking high blood pressure medication. 25% were required to pay for their medication, 62% received it free of charge and the remaining 12% made partial payment. A study of the distribution of payment by type of affiliation produced the following results: of patients in he subsidized system 21% were required to pay for their medicines, 71% received them free of charge and 7% made partial payment; of users in the contributory system 50% paid for all their medicines and the other 50% made only partial payment.
Diabetes
All diabetic patients are affiliated to the subsidized system. 100% were advised not to smoke, to learn to control everyday stress, to lose weight, to reduce alcohol intake, to exercise and eat less fat, to have tests to measure blood fat levels, to reduce starch and sugar and to regularly measure blood and urine sugar levels. All cases were attended by a general practitioner and 66% received treatment by a nutritionist. 33% received exercise training, 66% underwent testing for cholesterol and triglycerides and 33% were tested for blood and urine sugar levels. None of the patients use any device to measure their blood sugar level at home, nor do they administer insulin or other medications on their own. All patients were also advised to return for follow-up.
Application of vaccines
Of those requesting the application of vaccines, 40% were in the contributory system, 40% in the subsidized system and 20% nonaffiliated.
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Based on immunization cards, it was found that the entire population had received the following vaccines: BCG, hepatitis for newborn babies, polio, polio 1, polio 2, SPR, pentavalent 1, pentavalent 2, pentavalent 3, hepatitis 1, hepatitis 2, dpt 1, dpt 2, Heamophillus 1 and Heamophillus 2. All users were advised when to return for the next vaccine; on average, appointments were scheduled 4 days later.
CHAPTER VI
Opportunities for children
20
Mauricio A. Crdenas Mauricio Ferro
20
This study is based on Crdenas (2010) and Ferro (2007)
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CHAPTER VI Opportunities for children
POVERTY INDICATOR
In general terms, poverty has to do with peoples capacity to function normally in a contemporary society (Townsend 1993), that is, what a person or group of persons are able to achieve and do in and with their lives. In other words, it is the ability to escape from needs such as malnutrition, disease, ignorance or the inability to find formal employment due to a lack of professional skills and/or attitudes necessary to perform a task, position or job (Sen 1987). The World Bank defines poverty simply as a profound lack of wellbeing (World Bank 2000). The condition is tied to low income and lack of access to a minimum level of consumption and certain goods and services (Saunders 2004). People and families with unsatisfied basic needs (UBN) are considered poor. But what, exactly, are the needs not being met? What is the extent of their objective dimension, regardless of the subjective perspective of the observer who measures or describes the needs? Needs obviously depend from where people live, from their particular moment in time, as well as the capabilities and infrastructure available to human beings. It is not the same situation today, with global telecommunications, Internet, cell phones and facilities for easily transporting people and objects than fifty years ago. Nor is being poor in the temperate, developed north the same as being poor in the tropics.
UBN as poverty indicator in La Guajira

Calculations of unsatisfied basic needs or poverty lines endeavour to identify poor people according to indicators measured from national censuses and household surveys. The goal is to define public policies that, when implemented by national, departmental/regional and local/ municipal bodies, are capable of reducing the number of people who are poor and the conditions of their poverty. The UBN is a multi-dimensional indicator aimed at measuring the poverty level in a specific geographic area. This indicator has been popularized in
248
Latin America by the United Nations and the World Bank because it can be calculated from decennial censuses of the population and housing as well as household surveys21. Poverty is not restricted only to low family income, but rather comprises a series of individual and group characteristics that define a lifestyle full of shortages, disease and malnutrition, as well as behaviours and attitudes that ultimately contribute to marginalization. Low levels of education, precarious and limited participation in productive entities and scant purchasing power are the variables that make up the circle of poverty and serve to measure it (Sen 1984a, Sen 1984b, Altimir 1979). The UBN as an indicator to multi-dimensionally measure poverty, uses variables relating to the following: Inadequate Housing: The physical characteristics of the housing are considered inadequate for human accommodation and incompatible with living with dignity. Critical overcrowding: sa situation in which more than three people live in each room excluding the kitchen, bathroom and garage. Housing with a lack of basic utilities: Primarily related to water and sewage, as access to safe drinking water reduces childhood mortality and morbidity. Economically highly dependent housing: in which there are more than three people per working resident and the head of the household has a maximum of two years of primary education. Housing with school-age children who do not go to school: in which there is one child over 6 and under 12 years of age who is related to the head of the household and does not attend a formal school. Without basic education, it is impossible to escape from the circle of poverty. However one may define poverty, it is a multi-dimensional concept in which each dimension measures only one aspect. Households are ultimately
21 See: http://www.iadb.org/sds/POV/site_19_s.htm http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTPOVERTY/EXTPA/0,,contentMDK:20153855~ menuPK:435040~pagePK:148956~piPK:216618~theSitePK:430367,00.html
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classified as poor if they fall into one of the categories of unsatisfied needs. Households that comply with two or more indicators fall into the category of extreme poverty. It is assumed that the people or family units living in one household considered poor are, ipso facto, poor. In rural areas primarily inhabited by aboriginal ethnic groups, such as the Wayu in Cerrejn area of influence, the indicators do not accurately assess the populations wellbeing, as the indicators relate to urban, alijuna (non-aboriginal) cultural patterns. The typical dwelling in a Wayu native ranchera (hamlet) has a dirt floor, adobe walls and a dry yotojoro roof. The ranchera (hamlet) is a small settlement of dwellings which house an extended, matrilineal Wayu family. The wealth of materials in the region ensures an agreeable temperature during hot days and cool nights. This type of housing - which adheres to ancestral cultural patterns - would be considered poor. Measuring the poverty of a household in terms of the dwellings predominantly physical characteristics, the materials used in its construction, and its access to clearly urban services such as running water, plumbing, telephone, cable television and garbage collection is not appropriate. Prez (2004) names some of the construction features of Wayu dwellings: the hamlets (rancheras) are primitive dwellings with only a palm or canvas roof to protect fishing people from the sun and the wind. By nature, they are mobile, as their construction and location is dependent on pearl grounds and production cycles. They often precede the existence of more stable settlements, which in turn can become the embryo of a prosperous city. EPM (2002) described the construction of Wayu rancheras (hamlets) in upper La Guajira as: the shapes of the old (and current) dwellings and arbours have always been rectangular, but the building materials have changed. The older main houses used to use trupillo trees and yotojoro material for the walls and the roofs. The walls were then plastered with mud. Today, the walls feature panels made of wood, mud, cement or adobe. Although traditional yotojoro roofs are still used, there are also dwellings covered with tin roofs and Eternit tiles.
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Vergara (1987) provides the best description of Wayu dwellings:

The typical Guajira residence consists of a small house known as a piichi in upper Guajira and miichi in Lower Guajira. The house is generally divided into two rooms. Hammocks are hung, as are the woven cotton mochila bags in which all of the familys belongings are kept. Mud vessels with narrow necks, on the floor and along the walls, hold water . Outside, there are poles with forked tops dug into the ground. Hollow gourds are placed on these poles. They are full of seeds which, in time, will be planted. The houses are rectangular, although there are some places in Upper Guajira that feature semi-circular dwellings. Roofs are usually steep or triangular and built out of yotojoro, the dried flesh of the Lemaireocereus griseus cactus, called yos by the aboriginal people. The walls of these houses are covered either with adobe or mortar and yotojoro. Packing boxes of the merchandise that reaches this area are also used. Today, there are much more houses that have tin roofs. The appearance of these residences has been changed by the use of cement and other materials. Near the main house is the arbour or luma. This structure consists of a flat roof that rests on six posts. The arbour is an important place where activities take place during the day. Visitors are entertained, business is negotiated and relatives sleep in hammocks there, as well. Almost all the houses have a separate kitchen. These areas, known as kusiapia, do not have roofs. They are partially closed off by a cactus fence for protection from the wind and sand. Some houses also have a three-walled structure that protects the loom. Women use the loom to weave light and heavy hammocks, saddle girths and wrap-around skirts for men. The houses are usually built on the highest point of the land to avoid flooding during the rainy season. This strategic position also provides some protection from the swarms of mosquitoes that breed in stagnant water..
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Romero (2010) used the 2006-2007 Integrated Household Survey to find that: The aboriginal people who live in Colombias major cities have a 7.9% higher chance of lacking at least one of the UBN components. With respect to the Caribbean region, 28.6% of aboriginal people would be considered poor according to urban UBN and 10.6% would meet the criteria for rural poverty. Romero also commented on the inadequacy of the UBN for evaluating Standard of living among ethnic groups: Field observations indicate that housing materials such as sand for flooring are not considered inadequate by the people residing in structures such as malokas or rancheras. The same is true in the case of critical overcrowding. Aboriginal households with more than two residents per room are the rule rather than the exception. Urrea and Vifara (2007) use unordered multinomial logistic regression models in which they assign weight to the decisive factors leading to poverty or extreme poverty according to UBN (for the 1993 Census and the 2003 SLMS) and poverty and homelessness according to poverty lines (for the 2003 SLMS). The primary objective of their research was to identify factors associated with situations of poverty, extreme poverty, and homelessness, and not why certain ethnic populations were not in these situations. The independent variables used for this study were the type of ethnic household (Afro-Colombian or Aboriginal), the gender and age of the head of the household, its size (number of members), the educational level of the head of the household, the average educational situation within the household, the region of residence (Andes, Pacific, Caribbean/Atlantic, or Orinoqua/ Amazon), the average birth rate within the household, the area of residence (urban and Rural), juvenile dependence, dependence of the elderly and the Departmental GDP per capita for 1993 and 2002. The authors results for the ethnic variable show that belonging to an ethnic minority (especially in the case of aboriginal households) increases the relative probability or risk of being in a situation of poverty or extreme poverty. The authors explain that from afar, aboriginal households appear to exhibit a greater relative risk of being in a situation of poverty or extreme poverty. The rate drops drastically but remains significant for Afro-Colombians.
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Notwithstanding these results, Urrea and Vifara (2007) also emphasize the special care that must be given when analyzing poverty in aboriginal communities. Socio-cultural aspects must be taken into consideration, but an extreme stance of measuring and evaluating poverty exclusively based on the aspirations, needs and levels of satisfaction of aboriginal communities should be avoided. Otherwise, there is the risk that they may be excluded altogether. How aboriginal communities live and their access to certain dimensions of so-called wellbeing are unimportant. If communities are living according to their own traditions, they are not suffering from want. The results of the UBN indicator, although important and entirely necessary to develop social policies, do not provide a complete picture of aboriginal communities economic and cultural realities. Poverty is linked to the possibility of escaping from need and crafting a future which revolves around their own choices, regardless of considerations concerning the possession or lack of material assets. As was previously explained with regard to the education variable, the majority of the aboriginal population have semi-nomadic customs that involve roaming in the area surrounding their livestocks grazing land. Most of these are goats. During dry seasons, the aboriginal communities have to find food for their herds. They often cross the border into Venezuela, as the international boundary has little meaning for them. This trait makes it difficult for children to attend school and therefore skews Standard of living indicators designed for urban residences and populations (Ferro 2007). Ethno-educational schools address this problem by providing adolescents with accelerated courses. These programs allow students to attain the expected level of knowledge and competence in reduced periods of time. Table 70 shows the results of the UBN indicator calculated on the basis of the last census and the Standard of living surveys of 1973, 1985 and 2005. A brief analysis of the table shows a marked improvement in the 20-year period between 1973 and 1993 for all the municipalities except Manaure and Uribia, two primarily Wayu towns. From 1993 to the present, it would appear that the UBN indicators have come to a halt or have even been reversed. In fact,
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between 2005 and 2010, almost all of the municipalities regressed while, at the same time, these have been the years in which there has been a substantial increase in income from royalties (FCFI 2009).
Table 70. UBN by municipality in 1973, 1985, 1993, 2005 and 2010, by area
Total UBN Municipality
1973 1985 61.9 53.6 1993 64.1 57.7 66.9 89.8 67.7 44.3 68.6 52.4 60.2 75.8 46.8 49.6 48.4 91.9 78.0 72.7 57.9 2005 63.4 48.4 60.9 45.3 65.0 44.8 45.4 31.8 37.7 58.4 68.3 2010 65.3 49.1 60.9 54.2 66.5 62.9 56.5 43.4 58.7 66.8 68.4 79.8 44.8 96.1 63.0 47.6 70.0 64.7 76.0 71.9 72.3 60.7 31.8 74.9 60.8 54.8 70.0 34.5 65.5 45.4 1973 68.1 63.0 1985 52.3 41.9 2005 38.8 39.7 30.9 28.8 39.4 30.9 42.7 27.9 32.5 57.8 51.6 52.6 24.6 44.4 36.5 33.0 2010 40.5 40.6 28.0 28.8 39.4 31.0 43.5 27.7 32.4 57.3 51.5 50.6 24.6 43.3 35.8 33.0 80.4 90.6 96.0 74.7 90.2 72.9 83.4 68.5 96.4 82.8 1973 92.6 91.1 1985 77.8 71.8 2005 89.9 85.5 85.3 69.4 69.5 59.9 77.7 54.2 88.5 66.9 95.6 98.8 61.1 2010 91.9 85.5 86.2 79.2 71.0 79.5 94.5 80.9 98.0 89.7 95.9 98.3 73.7 98.4 96.5 96.9
Urban UBN
Rural UBN
La Guajira Riohacha Albania Barrancas Dibulla Distraccin El Molino Fonseca Hatonuevo La Jagua del Pilar Maicao Manaure San Juan del Cesar Uribia Urumita Villanueva
82.5 77.5
69.9 100.0 86.9 78.6 96.4 50.3 95.1 68.5 75.8 56.2 49.3 99.4 59.8 49.6 36.3 96.1 42.9 34.4
97.7 100.0 98.4 81.0 60.2 85.7 76.3
Source: DANE
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A breakdown into urban and rural areas shows that, although urban areas have decreased, there have been no changes in rural areas. If the data in the analysis were to be controlled exclusively by ethnic group membership and not by using only the rural proxy, it would be evident that the reduction in poverty has not affected the hamlets (rancheras) in which the Wayu live22. Based on an analysis of municipal UBN levels, Galvis and Meisel (2009) concluded that there is a very low level of mobility in Colombia due to the high correlation between the UBN levels of the latest censuses and those of 20 years ago. The authors state that this correlation demonstrates the stagnancy of UBN level indices in Colombia. This situation has become critical in peripheral regions (Caribbean and Pacific Coasts and Orinoqua and Amazonia Departments). The authors found that 63% of the poverty trap municipalities in 1993 remained as such in 2005, and they are part of this region. A different approach is needed to measure opportunities and wellbeing. An alternative indicator recently studied by Paes de Barros et al (2008a, 2008b, 2010) was the unequal opportunities indicator, which focuses on the inequalities that determine the probabilities of developing or becoming successful from the very beginning of human life. Neither the place where he/she is born nor the family to which he/she belongs can be chosen by a child. These are arbitrary, external conditions that determine a childs future. As opposed to income inequality, regarding which there is always a major debate as to how to overcome it, or the urban focus of UBN, which does not adequately measure the rural situation, promoting equal opportunities (primarily for children) is, on the contrary, a topic that generates political, economic and social consensus. The likelihood of success in adult life is related to the inequality of opportunities at the beginning of the life cycle, which is expressed by the so-called Human Opportunities Index (HOI), a tool based on two fundamental concepts of Professor Amarthya Sens
22 A question that comes up is whether the indicator has cultural biases that give a typical Wayu residence designed for the climatic conditions of La Guajira a poverty score when maybe it should not.
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theory: the incorporation of the distributive aspect (Sen 1976) and analysis of the Standard of living from an approach based on accomplishments and capacities (Sen 1993). The HOI determines whether the children from a specific place have de facto access to basic opportunities such as drinking water (which has a direct impact on their health), sanitation, electricity (which has an impact on academic performance) and education (which will determine a childs employability and access to knowledge and information and, subsequently, the level of income or type of occupation to which he/she can aspire). It also considers external factors that influence childrens ease of access to these opportunities: gender, ethnicity (especially important for the Wayu), place of residence or parents income. The calculation of this index has major repercussions on the adoption of public policies, as they accurately depict the vulnerability and marginality of certain groups of people within the population. The World Banks first conclusions on human opportunity in Latin America are revealing: Behind inequality, which has always shaped the distribution of a regions development results (income, land access, educational accomplishments, among others), there is an even more alarming inequality in the distribution of the opportunities children have for developing. Not only are the results unequal but so are the possibilities of success. The problem is not only inequality but also inequity. The playing field is uneven from the very beginning (Paes de Barros et al 2010). The World Bank provides the best introduction to the concept of the index in its 2010 document: Imagine a country where your future does not depend on how much your parents earn or the colour of your skin or whether youre a man or a woman or where you were born. Imagine that the personal circumstances over which you have no control or responsibility were irrelevant for your opportunities or those of your children. Now, imagine a statistical tool that could help governments make all this a reality. Welcome to the Human Opportunity Index (HOI).
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The authors make three arguments for focusing on children: It is possible to measure childrens access to the goods and services which play a determining role in their development. Empirical evidence shows that policy interventions implemented among children have more significant results than those which are implemented later in the life cycle. From the beginning of their lives, children cannot be held responsible for family circumstances such as race, gender, where they live or the income or education of their parents. In citing the World Development Report (United Nations 2006), Paes de Barros et al (2008a, 2008b) explain that: On the day of their birth, children cannot be considered responsible for their family conditions, even though these circumstances will create important differences in the lives they lead. The basic opportunities included are related to education and living conditions. There is empirical evidence pointing to the fact that these elements are essential for increasing the possibilities of leading a productive life. The HOI combines: (i) the degree to which the distribution of such opportunities are tied to external circumstances (inequality index, D) and (ii) the level of coverage for basic opportunities such as primary education, healthcare, water, sanitation and electricity. Formally, if we follow Paes de Barros et al (2008a, 2008b) arguments for calculating the index, we obtain: If p is the average rate of access to basic opportunities and D is the inequality of opportunities, the primary objective of public policy should be maximizing the average rate of access and reducing the inequality of opportunities. The argument of Paes de Barros et al (2008a, 2008) indicates that if H is the total number of available opportunities and N is the number of opportunities necessary to guarantee access for everyone, then p=H/N could be defined as the percentage of the total number of entirely available opportunities needed for universal access.
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By adjusting the numerator so that only assigned opportunities are included without considering whether the circumstances are valid and by defining that r denotes the available assigned opportunities according to the principle of equal opportunities, the function for an opportunity index (O) could be expressed as O = r / N . Because the measurement of opportunity inequality (D) is the percentage of opportunities that must be reassigned in order to maintain opportunity equality, (1 D) is the properly assigned proportion. Thus, H (1 D ) is the total number of assigned opportunities according to the principle of equal opportunities for all. One possibility is defining r = H (1 D) . In this case, the general measurement of opportunity (O) is:
O=
r H = (1 D) = p (1 D) where 0 p 1 and 0 D 1 n N
Paes de Barros et al (2008a, 2008b) interpret the HOI as follows: It indicates how many opportunities of all those available are equally assigned. It observes not only the coverage of a specific basic opportunity but also how these opportunities are distributed. If those who manage public policies wish to expand public services without addressing distribution concerns, the index will increase slowly. A the same time, the distribution of resources will not be enough to accelerate the growth of social wellbeing on its own. Only a combination of increased coverage and an equal assignment of opportunities will maximize HOI growth.
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Basic Opportunity Coverage - The p Component

In line with the thesis of the Paes de Barros et al study (2008a, 2008b)23, this investigation considered basic opportunities in education, health and housing, as well as access to healthcare services by using micro-data from the SLMS applied to Cerrejn area of influence24. Basic opportunities are those considered to be essential for children to increase their possibilities of achieving their own goals in the future. Basic opportunities should be available and guaranteed. They should not depend on external circumstances such as family group, membership in an ethnic group or gender. From another perspective, basic opportunities allow people to avoid belonging to disadvantaged groups. The basic opportunities used were: completing sixth grade on time for children between 12 and 16 years old, attending school for children between 10 and 14 years old, and households access to basic services such as water, sanitation (plumbing), and electricity. Healthcare access for children between 0 and 5 years old was also considered basic and fundamental due to the repercussions arising when timely treatment is not available. This variable was not included in the World Banks 2008 study, but it is certainly another decisive, external factor for children. There were two major reasons for including this last variable. On the one hand, Sen (2008) tells us that Health is one of the most important conditions for human life and a fundamental component of the human possibilities to be evaluated. No conception of social justice that accepts the need for equal and efficient distribution of human possibilities can ignore the role that health plays in human life and in the opportunities people have to live a healthy life free of disease, avoidable suffering and early death.
23
24
The World Bank calculations were developed from 33 household or Standard of living surveys in 19 Latin American and Caribbean countries between 1995 and 2005. The responses represent nearly 200 million children between the ages of zero and 16. In Colombia, the Standard of living Surveys administered by DANE in 1997, 2003 and 2008 were used.. The components of the Opportunity Index were calculated empirically from the results of the SLMS. STATA and SPSSS were used to calculate relative frequencies and the econometric estimates of the logit and probit models
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Furthermore, the concepts of health and wellbeing are intimately linked to the Wayu worldview. For the Wayu, wellbeing, health and being well are a dynamic balance between humans and between humans and nature. There are three spheres or relationships: the relationship of the individual with him or herself, the relationship of the individual with other people, and the relationship of the individual with nature (Correa and Mendiola 2002). Regarding education, the timely completion of the sixth grade is used as a proxy for the opportunity a child has to obtain a basic education. The gross school attendance rate, meanwhile, covers attendance in the formal school system. Table 71 shows the coverage rates of these variables in Cerrejns area of influence, compared with those found in Colombia and the Latin American average from Paes de Barros et al study (2008a, 2008b).
Table 71. Timely Completion of Sixth Grade in 1997, 2003 and 2009
Timely Completion of Sixth Grade
1997 (%) 57(1) 63(1) 2003 (%) 68(1) 76(1) 2009 (%) 42.7(2)
School Attendance Rate

1997 (%) 89(1) 89(1) 2003 (%) 93(1) 91(1) 2009 (%) 90.6(2)
Area
Latin American Average* Colombia Cerrejn area of influence
*For the Latin American average, the information is from approximately 1997 and 2003. (1). According to the World Bank, 2008. (2). Standard of living Survey, DANE and Cerrejn, 2009
The percentage of timely completion of the sixth grade among children between the ages of 12 and 16 in the area of influence is 42.7%. This coverage rate is lower than the Colombian average calculated in 1997 and 2003, which reached 63% and 76%, respectively. The figure is also lower than the Latin American average, which was 57% and 68% for the same years. As for the rate of school attendance between the ages of 10 and 14, the result for the area of influence was 90.6%, a percentage which is more or less compatible with the average results for Latin America and Colombia.
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Colombia has made children under the age of 5 a priority in terms of access to health services, striving for 100% of this population to be insured through the General Social Security Health System (SGSSS). The results of the 2008 national SLMS show that coverage among this population reached just 82.7% (table 72). According to the data from the SLMS, coverage within Cerrejn area of influence is even lower. Of boys and girls under the age of 5, 67.7% were affiliated to social security healthcare: 34.4% in the contributory system and 20.7% in the subsidized system.
Table 72. Affiliation to the General Health System in 2008 and 2009
Area Latin American Average* Colombia Cerrejn area of influence 2008 (%) 82.7 (1)
2009 (%) 67.7(2)
(1). Standard of living Survey, DANE, 2008. (2). Standard of living Survey, DANE and Cerrejn, 2009
Adequate housing conditions (water, sanitation and electricity) are also basic as they are tied to the reduction of disease, greater capacity for education and skill development among children. The population of children between 0 and 16 years of age who live in a house with access to these public services was considered for this variable. In terms of access to water, the percentage of children between zero and 16 years of age who live in a household equipped with public, communal or local water service was used. To create a dummy variable, the residences in this situation were given a value of 1. As shown in studies by the Fundacin Cerrejn para el Agua en La Guajira, Universidad del Valle, and Instituto Cinara (2009) and De Lueque, Doria et al (2010), most water supply sources (including public and local water systems) exhibit a high risk of contamination. For this reason, supply from wells, rainwater, rivers, etc. is not considered acceptable.25
25
Neither does the Paes de Barros et al study nor others by the World Bank include water supply from public wells, taps, public taps, water trucks, rain, rivers or ponds
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It is important to note Latin America and Colombias progress. Just 44.5% of children between zero and 16 years old within the area of influence live in houses with running water. This is almost half the national average for 2003 (82%). It is also below the Latin American average (75%) for that same year. The rural location, though, has an impact on these averages. Sanitation in these households cannot be measured by the presence of plumbing systems or garbage collection. More indirect measurements were used, as the coverage of these public services indicates very precarious situations within the rural parts of the area of influence. This was explained in the chapter on SLMS results. Dwellings with toilets connected to plumbing systems or septic tanks were used. Unconnected residences (residences equipped with latrines or without plumbing) cannot be considered. They indicate a very poor Standard of living for children, whose future opportunities for development remain in question. Within the area of influence, 47.7% of the children between 0 and 16 years old live in residences with basic sanitation. In terms of electricity coverage, responses were recorded as to whether residences had electricity or not. Among children between the ages of 0 and 16 in the area of influence, 58.41% have electricity. This percentage is quite low: the national rate in Colombia in 2003 was 90%; levels in Latin America are over 80%.
Table 73. Coverage for Basic Living Conditions for 1997, 2003 and 2009
Area Latin American Average* Colombia Cerrejn area of influence Running Water
1997 70(1) 2003 75(1) 2009 1997 50(1)
Sanitation
2003 54(1) 2009 1997 80(1)
Electricity
2003 84(1) 2009 -
80(1)
82(1)
62(1)
64(1)
91(1)
93(1)
44.5(2)
47.7(2)
58.4(2)
* For the Latin American average, the information is from approximately 1997 and 2003. (1). According to the World Bank, 2008. (2). Standard of living Survey, DANE and Cerrejn, 2009
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Inequality Index
Appendix 2 explains how component D (inequality index) is calculated for the Human Opportunity Index (HOI). Table 74 shows the results of the probit regressions, the estimated probability from equation 2 in appendix 2. For these results, it is important to realize that the probability of having access to the established basic opportunities is more or less determined by whether one belongs to the Wayu ethnic group or not. Individuals who recognize themselves as Wayu have a 28 percentage point lower probability of completing the sixth grade on time, a 2.4 percentage point lower probability of being affiliated to the education system, a 44 percentage point lower probability of having adequate access to water, a 50 percentage point lower probability of having access to adequate sanitation, and a 37.6 percentage point lower probability of having access to electricity. Gender bias can also be seen in the results. Being a woman in the area of influence involves a minor but negative impact for adequate access to water and electricity. The coefficients found for other basic opportunities such as education, health and adequate sanitation were positive. The World Bank (2009) argues that education for girls is the key to sustainable development. The economic justification for investing in education for girls is unquestionable, even in times of financial or employment crisis. The acquisition of female human capital is critical for economic development, growth, and reduced poverty, not only because of the income it generates but also for breaking the vicious cycle of poverty.
Table 74. Econometric estimates according to the Probit Model
Variables
Timely Completion of Sixth Grade School Attendance Healthcare Affiliation Adequate Access to Water Adequate Sanitation
Access to Electricity
Age
13 years old (0.0482) -0.0138 ** (0.0440) -0.1386 ** (0.0449) -0.1176 ** (0.0473) 0.1185*** (0.0317) 0.5177*** (0.0113) -0.0112 (0008) 0.0351** (0.0162) (0.0003) 0.0104 (0.0064) -0.0009** (0.0050) 0.0181*** (0.0129) (0.0215) 0.0338 *** (00787) -0.0007 (0.0005) 0.0368*** (0.0107) 0.0116 0.0049 -0.0207 (0.0178) 0.0540*** (0.0060) -0.0029*** (0.0004) 0.0048 (0.0091) 0.0009 (0.0187) 0.03538*** (0.0067) -0.0006 (0.0005) 0.0686*** (0.0095)
-0.0074
14 years old
15 years old
16 years old
Gender
-0.0035 (0.0130) 0.0466*** (0.0052) -0.0021*** (0.0004) 0.0262*** (0.0065) CHAPTER VI Opportunities for children
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Years of education completed by the head of the household
Years of education completed by the head of the household^2
Logarithm of per capita income
Variables
Timely Completion of Sixth Grade School Attendance Healthcare Affiliation Adequate Access to Water Adequate Sanitation Access to Electricity 0.0461 (0.3356) -0.0341*** (0.0094) -0.1959*** (0.0373) -0.2807*** (0.0359) (0.0189) (0.0317) -0.0243 0.0459 -0.4432*** (0.0181) (0.0185) (0.0275) (0.0173) -0.0411** -0.1688*** -0.4762*** (0.0035) (0.0056) (0.0050) (0.0051) -0.4193*** (0.0184) -0.4999*** (0.0168) 0.0040 0.0083 -0.0005 0.0586 (0.0141) (0.0241) (0.0197) (0.0206) 0.0113 -0.0117 -0.0673*** 0.1078 -0.0715*** (0.0131) -0.0063* (0.0034) -0.4187*** (0.0145) -0.3767*** (0.0155)
Presence of the head of the household and spouse
Number of 0-to-16 year old children in the household
Area (urban or rural)
Ethnicity (Wayu or non-Wayu)
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No. of Obs 0.3497 0.000 0.000 0.0900 0.1033 0.000
1373
1531
1935
5242 0.4651 0.000
5242 0.5118 0.000
5266 0.5488 0.000
Pseudo R2
Prob>chi
Notes: (1) Reported coefficients correspond to marginal changes in the Probit model
(2) Standard error in parentheses
*** Significant to 1%, ** Significant to 5%, * Significant to 10%
Source: Standard of living Survey, DANE and Cerrejn, 2009
The World Bank is adamant about the social benefits of education for women. The report shows, for example, that
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The World Bank is adamant about the social benefits of education for women. The report shows, for example, that:
One year of education for girls reduces infant mortality 5 to 10% in developing countries. The children of mothers with five years of primary education have a 40% higher chance of living past the age of five. A two-fold increase in the percentage of women with secondary education reduces the fertility rate from 5.3 to 3.9 children per woman. Each additional year of education for girls increases their salary 10 to 20%. There is also evidence that more productive agricultural methods can be attributed to higher rates of female education, as can a 43% reduction in malnutrition Educating women has a greater impact on childrens education than educating men does. Young people in rural Ugandan communities who have attended secondary school are three times less likely to carry HIV. In India, women with formal education are more capable of resisting violence. In Bangladesh, educated women are three times more likely to participate in political meetings.
Colombia and La Guajira are no different. The debate about ethnic exclusion and affiliation in healthcare systems has been studied by Crdenas and Bernal (2005). Using the Standard of living Survey (2003), they show that the probability of having health insurance is slightly lower for ethnic groups. A breakdown of minority groups (aboriginal, Afro-Colombian, and others), though, reveals that aboriginal communities have higher healthcare coverage. The authors explain that the fundamental reason for this level of coverage is the transfer payments the national government makes to aboriginal reservations for healthcare. Our estimates confirm Crdenas and Bernals findings: That there is a positive but not significant coefficient for the probability of health system affiliation. Childrens probability of accessing all basic needs drops if they live in rural areas. Residence is a determining factor for a persons level of productivity or employability. This situation will increase income gaps and everyday Standard of living in the future. The head of the households level of education and
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the presence of the head and his or her spouse have a positive and significant relationship with childrens access to basic opportunities. For the head of the households years of education, the coefficient has the expected sign for all basic opportunities. In the presence of the head of the household and his or her spouse, the coefficients for health system affiliation, water access, and access to electricity are negative. Statistical analyses indicate that the number of years of school attended by the head of the household increase childrens probability of completing sixth grade on time by 51.7 percentage points, their probability of attending school by 1.8 percentage points, their probability of having adequate access to healthcare by 3.38 percentage points, their probability of having adequate access to water by 5.4 points, their probability of having access to adequate sanitation by 3.5, and their probability of having access to electricity by 4.6 percentage points. An analysis of the quadratic formula used for the number of years of education completed by the head of the household reveals negative results for all related coefficients. One additional year of school completed by a childs parents translates into better social benefits, but these returns diminish as the educational cycle advances. The results were significant for school attendance, adequate access to water and access to electricity. The per capita income of a household is important for accessing basic needs for children. The coefficients were positive and significant. In the variables for school attendance and access to water were positive but not significant. The estimated logit models were used to calculate the coefficients bk for equation 2 in appendix 2. The results are shown in table 75.
^
Table 75. Econometric Estimates according to the Logistic Model

School Attendance Healthcare Affiliation Adequate Access to Water Adequate Sanitation Access to Electricity
Variables
Age 0.9385 0.5057 0.5271 0.5735 1.7483 1.2515 0.9953 1.1812 1.2257 0.4259 0.4259 0.2886 0.6845 1.2351 0.5255 0.4089 1.0614 1.0414 1.1346 0.9366 1.1460 1.1905 0.9860 0.9971 0.9870 1.0513 0.7292 1.0087 0.1057 0.1248 1.3101 1.1709 1.2704 1.1655 1.0287 0.9147 0.9833 1.1579 0.9979 1.3838 1.0350 1.034 0.1300 0.0857 0.9712 1.3727 0.9855 1.1926 0.6042 0.9538 0.0246 0.0442
13 years old
14 years old
15 years old
16 years old
Gender
Years of education completed by the head of the household
Years of education completed by the head of the household^2
Logarithm of per capita income
Presence of the head of the household and spouse
Number of 0-to-16 year old children in the household
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Area (urban or rural)
Ethnicity (Wayu or non-Wayu)
No. of Obs 0.3489 0.000 0.000 0.0904
1373
1531
1935 0.1034 0.000
5242 0.4687 0.000
5242 0.5151 0.000
5266 0.5521 0.000
Pseudo R
Prob>chi2
Notes: (1) The coefficients reported correspond to the "odds ratios" from the logistic regression.
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The inequality index (D) was ultimately calculated using equation 3 from appendix 2. Paes de Barros et al (2008a, 2008b) explains that the index D results are measures of the variation between the circumstance groups of how existing basic opportunities are distributed according to a childs attributes at birth and his or her family environment. Lower scores correspond to greater equity in the distribution of opportunities. The index comprises values between 0 and 100%. A zero value would represent a situation of perfect equality of opportunities. The following tables show the results from the indexes (D) identified for the area of influence and Paes de Barro et al calculations for Colombia and Latin America (2008a, 2008b, 2010). Table 76 shows that the average index D for analyzing educational opportunity inequality in Latin America dropped from 17% in 1997 to 11% in 2003. In Colombia, it dropped from 20% to 11% during the same timeframe. Both the region and the country have been making major strides in terms of equality of educational opportunities.
Table 76. Inequality of Opportunities (Index D) in Education
1997 2003 2009
School Attendance
1997 2003 2009
Area
17(1) 20(1) -
11(1) 11(1) -
34(2)
4(1) 4(1) -
3(1) 3(1) -
3.3(2)
* For the Latin American average, the information is from approximately 1997 and 2003. (1). According to the World Bank, 2008. (2). Standard of living Survey, DANE and Cerrejn, 2009
In the case of Cerrejn area of influence, the inequality index is at 34%. There is therefore a less equitable distribution of opportunities for finishing sixth grade on time than that observed in Colombia and Latin America. According to the authors of the study, there are two ways to interpret this result: 1) 34% of the opportunities for children to complete sixth grade on
269
time should be reassigned to eliminate the differences that exist between the defined circumstances. 2) In Cerrejn area of influence, the groups that are in better or worse conditions are 34% above or below average in the area of influence for finishing sixth grade on time. The school attendance rates for children aged 10 to 14 in Latin America, Colombia and the area of influence have low levels of inequality of opportunity. This encouraging result reflects the progress that has been made in achieving relatively acceptable rates of coverage. The inequality of opportunities was 12% for water, 26% for sanitation, and 10% for electricity in Latin America in 2003. Colombias results are practically the same as the regional ones, with the exception that electricity is more equitably distributed (table 77).
Table 77. Inequality of Opportunities (Index D) in Health and Housing
Health Area
2009 1997 2003 2009 1997 2003 2009 1997 2003 2009
Water
Sanitation
Electricity
15%(1)
12%(1)
29%(1)
26%(1)
11%(1)
10%(1)
10%(2)
15%(1) -
12%(1) -
39%(2)
26%(1) -
25%(1) -
38%(2)
6%(1) -
5%(1) -
32%(2)
*For the Latin American average, the information is from approximately 1997 and 2003. (1). According to the World Bank, 2008. (2). Standard of living Survey, DANE and Cerrejn, 2009
The inequalities of opportunity for access to water, sanitation and electricity within Cerrejn area of influence were 39%, 38% and 32%, respectively. See table 77. These levels of inequality are much higher than those in Colombia and Latin America as a whole. The inequality of opportunity for health in the area of influence was calculated to be 10%. As health is a relatively newly
270
designated opportunity, it cannot be compared with previous results from Colombia or Latin America. But because it is close to zero, it indicates a more equitable distribution of the opportunity to be affiliated to a healthcare system.
The HOI for the Area of Influence

The authors consider that the HOI is a sensitive distribution measurement: The Human Opportunity Index uses access to basic opportunities and the coverage rate and subtracts from them if the opportunities are distributed unequally. Two forces affect the index: For a given level of D, an increase in the prevalence of opportunities (or, in other words, a higher p ) increases the index, while an improvement in how the opportunities are assigned (a reduced D) will also drive it up. Therefore, the index will go up if the general average access to a given opportunity increases, regardless of how the access is distributed. In this case, someone would be better off and no one would be worse off. Index D, though, gives much more weight to opportunities assigned to a disadvantaged sector of the population than to those allocated to a privileged group. The HOI could also be interpreted as the equitable coverage of basic goods and services. In this case, the HOI would be the number of opportunities that exist in a given society that were assigned on the principle of equal opportunities. It is measured as a percentage of the total needed for universal access. Existing opportunities assigned to groups with specific circumstances that go against the principle of equal opportunities are not counted in the level of opportunity provided by the society. Equality of opportunity is ensuring that basic goods and services are distributed among children without any correlation to circumstances such as gender, parents level of education, or place of residence. The following tables present the HOI results for the area of influence (following equation 1) and those calculated for Colombia and Latin America by the World Bank in 2008 and 2010.
271
For the HOIs for timely completion of the sixth grade and school attendance (table 78) in the area of influence, only 28% of the opportunities needed to guarantee access to education (timely completion of sixth grade) are available and equitably distributed. Compared to the results from Latin America and Colombia in 2009 (68% and 74%, respectively), this level is low. It is an issue that must be substantially improved in Cerrejn area of influence. The HOI for school attendance in the area of influence is 88%, a percentage that is relatively close to the Colombian and Latin American averages. This is good news. The area of influence must maintain and reinforce the efforts that have been made in terms of primary education coverage in recent years.
Table 78. HOI for Education
1997 2003 2009
School Attendance
1997 2003 2009
Area Latin American Average* Colombia Cerrejn area of influence
49(1) 50(1) -
62(1) 67(1) -
68(1) 74(1) 28(2)
86(1) 86(1) -
90(1) 88(1) -
94(1) 94(1) 88(2)
* For the Latin American average, the information is approximate for 1997 and 2003 and estimated for 2010. (1). According to the World Bank, 2008 and 2010. (2). Authors calculations based on the SLMS from Cerrejn area of influence
Table 79 shows the housing conditions index and its growth since 1997 for the three variables considered: water, sanitation, and electricity in Latin America as well as Colombia. In the area of influence, the opportunity index is 27% for water, 30% for sanitation, and 40% for electricity. These values are well below the averages observed in Colombia and Latin America since the end of the nineties.
272
Table 79. HOI for Health and Housing

Health Area
2009 (%) 1997 (%) 2003 (%) 2009 (%) 1997 (%) 2003 (%) 2009 (%) 1997 (%) 2003 (%) 2009 (%)
Water
Sanitation
Electricity
Latin American Average*
61(1)
67(1)
67
38(1)
43(1)
62(1)
72(1)
78(1)
88(1)
Colombia
68(1)
71(1)
71
46(1)
48(1)
69(1)
86(1)
89(1)
71(1)
Cerrejn area of influence
61(2)
27(2)
30(2)
40(2)
The proposed and calculated health HOI for the area of influence is 61%. Compared to the indices found for water, sanitation and electricity, it is the second highest of all the indexes after school attendance. A summary of the HOI, the biases, and the issues that illustrate the major differences between the area of influence and Colombia and Latin America can be seen in graph 72.
273
Graph 72. Human Opportunity Index Summary

Timely Comletion of Sixth Grade 74 68 Electricity 88 71 40 30 27 69 Sanitation 71 Water 28 School Attendance 94
Colombia
Area of Influence
Latin America
Based on the annual HOI growth rates observed in Colombia (1.0% for education opportunities and 1.1% for housing opportunities), many- too many- years would be needed to achieve equal and universal coverage for these basic opportunities in Cerrejns area of influence. The World Bank (2010) assumes an optimistic linear expansion that could only be considered a reference for the situation in terms of implementing basic opportunities in the area. The calculation is very simple if a desired HOI of 100% is assumed: (100-current HOI)/annual growth rate. Table 80 shows the results of simulating the number of years Cerrejns area of influence would need to achieve these objectives. The results suggest enormous challenges for the area of influence. Based on the levels observed in 2009 and the growth rates observed in Colombia, it would take 72 years for the opportunity to complete sixth grade on time to become universal. This is the most challenging variable. The result is consistent with the World Banks findings (2010), especially for Central American countries. The opportunity of school attendance,
274
on the other hand, is the most plausible and could become universal within the next 12 years.
Table 80. HOI and simulated years for coverage and equity
HOI area of influence Simulated years for universal coverage Simulated date on which universal coverage would be achieved 2081 2021 2075 2073 2064 2045
Basic Opportunity
Timely Completion of Sixth Grade School Attendance Water Sanitation Electricity Health
28% 88% 27% 30% 40% 61%
72 12 66 64 55 36
Water and sanitation opportunities would need more than 60 years to become universal; electricity would need 55. Finally, it would take 36 years to achieve universal coverage of the healthcare access opportunity. Paes de Barros et al (2008a, 2008b) also calculate an index summary which is a simple average explained as follows: it assumes that opportunities are perfect substitutes in each dimension, and that each dimension is a perfect substitute of the other. This index summary is presented below26. It first compiles the index categories into just two: education and housing (table 81) and then establishes a summary of the overall HOI (table 82) as a simple average of the two previous ones. For this summary, the results of the Latin American countries from Paes de Barros et al study (2010) are included.
26 The calculation of the summary index does not include the healthcare access opportunity calculated herein
275
Table 81. Opportunity Index for Education and Housing

Education HOI Area Latin American Average* Colombia Cerrejn Area of Influence 1997 (%) 67(1) 68(1) 2003 (%) 76(1) 78(1) 2009 (%) 81(1) 84(1) 58(2) 1997 (%) 58(1) 67(1) Housing HOI 2003 (%) 64(1) 69(1) 2009 (%) 72(1) 76(1) 32(2)
The summary index combines the level of opportunity in Latin America, Colombia and Cerrejn area of influence into one single value. The value of the index for the area of influence indicates that 45% of the opportunities available for access to education and housing are equitably distributed between the different categories of childrens circumstances. Colombias HOI was within the average range for the region. Between 1995 and 2009, the index increased from 67% to 81%. The current level means that 81% of the available opportunities for accessing education, drinking water, sanitation and electricity are distributed equally among the countrys children.
Table 82. Human Opportunity Index Summary
HOI Area 1997 (%) 63(1) 67(1) 2003 (%) 70(1) 74(1) 2009 (%) 77(1) 81(1) 45(2)
276
The dynamics of sustainable development cannot be left to inertia or chance. It is urgent and necessary, on the one hand, to empower the communities themselves to demand results from government institutions and on the other, to provide the required support so that, in the short term, achievable goals are reached which drastically improve opportunities for future generations. Cerrejns CSR and the companys system of foundations also have an important role to play here. We cannot be complacent about the future. The future depends on us and what we make of it.
CHAPTER VII
Conclusions and general recommendations
Fernando Ruiz
279
CHAPTER VII Conclusions and general recommendations
The results show evidence of a traditional rural structure with aboriginal components and an ongoing process of urbanization in La Guajira. The traditional family structure is still dominant in the rural part of the area studied. The urban structure is different, with a percentage of the population in rented accommodation. Access to public services is very limited in the rural areas. Families supply their own non-drinking water from jageyes (water holes) or wells that are severely contaminated. Firewood is commonly used as fuel and there is little use of electrical appliances. From a demographic perspective, just over half of the population consider themselves to be Wayu and more than 50% live in rural areas. There is a high level of family density, with more than 4 people per household. The population pyramid is pre-transitional and has a broad base under the age of 30. School attendance rates and education levels are low in rural areas and there is a high degree of illiteracy. These results show significant differences in housing conditions, access to public services and education between this population and the Colombian average. These results place the people in the area of influence, in particular those in rural areas, among the most socially vulnerable populations in the country. The social security affiliation rate is low, especially in the rural zone. Transportation is an important factor in peoples access to medium care. There are considerable differences in the consultation rate according to affiliation and the type of social security regime. It is to be noted that the population argue that 50% of the reasons given by the them for not attending appointments are the result of peoples behaviour and motivation towards using the health system. These results suggest possible problems in access that have not been addressed by the existing health services. The food security situation is precarious with a low level of animal protein, but a high level of fat, an unbalanced diet which is common among most families.
280
Only a small number of main meals are consumed and the tendency to going without food has the greatest effect on disadvantaged children and this precarious food security situation puts the population at high risk. As to awareness of morbidity, perceived illness is generally low. This perception is combined with a low rate of attendance at medical and dental consultations and the persistence of risks associated with poor oral hygiene, nutrition and disease prevention habits. The low level of perceived illness in the survey responses may be related to a low risk factor detection rate and a low rate of diagnoses, especially of chronic diseases. Finally, the results show major discrepancies in the health services network, with limited response capacity on the part of the services to corrective and preventive requirements. These results correlate to low selection capacity and restricted access to clear and convincing information on health conditions, treatments and authorizations for procedures. These poor results are particularly worrying in the subsidized system, which is almost entirely dependent on the public service network. In general, the results paint a picture of a population in critical poverty conditions, measured by both access to goods and services and by the human opportunity index. From the point of view of health, the results evidence vulnerability of the population and low service coverage, together with limited institutional response. A multi-focus intervention with the population in the area of influence is necessary and should be based on health and wellbeing factors. It should also include intervention mechanisms to overcome poverty and also to mitigate the impact of the social, intermediate and individual factors that are damaging to the health of the population.
GLOSSARY
283
GLOSSARY
CENDEX: Development Projects Centre; an inter-disciplinary academic unit of Pontificia

Universidad Javeriana, which produces and applies knowledge and develops technology of the highest quality in order to contribute to social and institutional development, in accordance with its priorities and external, national and international requirements.
CERREJON: An integrated mining and transport complex in La Guajira Department

in the northernmost corner of Colombia. It includes an open-pit thermal coal mine that produces 32 million tons a year, a 150 km railway and a sea port capable of receiving ships of up to 180,000 tonnes dead weight. Cerrejon is independently operated, but belongs in three equal parts to subsidiaries of BHP Billiton, Anglo American and Xstrata.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A set of

diseases characterized by progressive reduction in pulmonary capacity and severe long term limitation of respiratory function.
DANE:
agency.
NATIONAL DEPARTMENT OF STATISTICS (DEPARTAMENTO
ADMINISTRATIVO NACIONAL DE ESTADSTICA): Official Colombian statistics
EPIDEMIOLOGICAL PROFILE: A type of demographic analysis which includes

the characteristics of the population with their ill health conditions based on frequency indices, such as prevalence or incidence.
INSTALLED CAPACITY: Economic concept that involves the quantity of resources or

the production factors necessary to consolidate services such as healthcare.
IPS:HEALTHCARE
PROVIDERS
(INSTITUCIONES
PRESTADORAS
DE
SERVICIOS DE SALUD): Institutions of varying levels of complexity dedicated to providing healthcare services in Colombia.
NATIONAL HEALTH SURVEY (NHS): National study carried out in 2007 in

accordance with World Health Survey parameters.
POPULATION SEGMENT: An average of five (between 3 and 7) neighbouring rural

housing units or an average of seven (between 5 and 10) neighbouring urban housing units which were selected from within each of the previously selected Primary Sampling Units (PSU).
284
SISBEN: IDENTIFICATION SYSTEM FOR POTENTIAL BENEFICIARIES OF

SOCIAL PROGRAMS (SISTEMA DE IDENTIFICACIN DE POTENCIALES BENEFICIARIOS DE PROGRAMAS SOCIALES,): A system which includes a survey and model for classifying impoverished populations to be incorporated in subsidy systems and social programs provided by the Government. The system is applied at Departmental and municipal levels.
STANDARD OF LIVING MEASUREMENT SURVEY (SLMS): National

survey that measures socio-economic factors and wellbeing conditions of the population according to the World Bank and Interamerican Development Bank methodology.
RELATIVE STANDARD ERROR

of the value of the estimated indicator.
or
COEFFICIENT OF VARIATION:
Indicator of the accuracy of the results obtained from probability sampling as a proportion
SURVEY OF HOUSEHOLDS: A type of transverse survey which studies the

population in households by selecting a sample and establishing its representational quality for extrapolation to the greater population.
APPENDICES27
27
NA identifies cells without observations. Admissible interval values are between 0 and 100.
APPENDIX 1.
ESTIMATED ACCURACY OF SELECTED INDICATORS
Table 1. Percentage of households according to home ownership by area

Urban Rural Total
Home Ownership 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%)
Estimated value (%)
Relative Standard error (%) Relative Standard error (%) 1.3 84.4 88.8 70.7 3.2 49.8 56.4 86.6
Relative Standard error (%) 1.4
95% confidence interval
Owned, completely paid for
53.1
68.7
72.7
Owned, being paid for
1.4
23.5
0.8
2.0
0.2
71.2
0.0
0.5
0.7
22.5
0.4
1.0
Rented or subleased
36.7
4.2
33.7
39.7
4.6
15.1
3.2
6.0
19.9
4.2
18.3
21.5
287
In usufruct
6.0
12.6
4.5
7.5
7.1
14.1
5.1
9.1
6.6
9.6
5.4
7.8
Possession without deed (de facto occupancy) or collective ownership 32.4 0.9 4.1 0.8 74.1 0.0 0.7 0.8
APPENDICES
2.5
31.3
0.3
1.3
1.6
26.3
0.8
2.4
No information
0.3
31.2
0.3
1.3
0.5
31.4
0.2
0.8
Table 2. Percentage of households according to access to public services, by area

Urban Rural Total
Type of public utility 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%)
Estimated value (%)
Relative Standard error (%) Relative Standard error (%) Relative Standard error (%) 1.4 65.0 4.8 34.5 41.7 66.9 97.7 99.5 38.1
Electricity
98.6
0.4
68.8
Natural gas connected to public network 58.1 67.7 5.2 20.9 3.1 7.3 32.7 4.4
62.9
3.9
29.9
35.5
Water
94.2
1.2
92.0
96.4
21.1
8.4
17.6
24.6
55.9
1.9
53.8
58.0
Sewer
82.5
2.3
78.8
86.2
11.8
13.0
8.8
14.8
45.4
2.6
43.0
47.8
288
Garbage collection
91.1
1.4
88.6
93.6
13.2
12.5
10.0
16.4
50.3
2.2
48.1
52.5
Telephone
7.1
11.9
5.4
8.8
0.3
49.8
0.0
0.6
3.5
12.0
2.7
4.3
No public services
0.9
43.5
0.1
1.7
59.6
3.0
56.1
63.1
31.7
3.0
29.8
33.6
Table 3. Percentage of households by source of supply of water for food preparation, by area
Urban Rural Total
Water supply for food preparation 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 45.5 5.7 10.6 18.9 0.2 17.0 1.0 5.4 100.0 0.5 0.8 34.3 31.2 0.0 0.2 0.3 10.6 0.6 0.8 1.3 7.0 0.4 4.6 2.2 4.4 0.5 13.6 8.4 5.1 49.8 14.2 32.5 15.5 21.0 11.5 31.4 2.3 43.4 4.2 8.8 17.0 0.0 5.0 0.1 3.2 1.3 3.4 0.2 11.4 9.9 19.3 35.7 0.3 13.4 0.6 8.0 0.2 16.4 36.4 0.2 13.6 9.8 49.9 0.0 0.6 4.9 32.3 39.1 8.7 16.0 22.6 13.8 7.2 12.6 12.8 8.5 14.3 Relative Standard error (%) Relative Standard error (%)
Estimated value (%) 1.8 35.2 31.2 50.4 NA NA 71.9 31.9 18.6 11.6 74.1 0.0 0.7 6.6 10.4 2.9 6.1 0.3 1.3 0.0 0.5 NA NA NA NA 0.0 0.8 0.4 1.8 0.3 1.9 80.2 86.0
Relative Standard error (%)
Public water supply system
83.1
47.6 7.2 12.4 20.8 0.4 9.0
Communal or local water system
1.1
Well with pump
1.1
Well. pool without pump
0.4
Rainwater
NA
River. stream. spring
NA
289
Public fountain
0.2
0.7 6.0 3.1 5.4 0.8
Tanker truck
0.8
Water vendor
4.5
APPENDICES
Water bottles or bags
8.5
No information
0.3
Table 4. Percentage of households according to type of sanitation service, by area

Urban Rural Total
Type of sanitation service 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 2.9 39.3 14.1 7.6 13.4 41.7
Estimated value (%)
Relative Standard error (%) 2.6 72.3 79.9 10.5
Toilet connected to sewage system
76.1
44.1
Toilet connected to septic tank
13.5
10.2
10.8
16.2
15.8
9.6
12.8
18.8
14.7
7.2
12.6
16.8
Toilet not connected to sewage system 38.2 0.2 1.0 0.6 40.8 0.1 1.1
0.6
0.6
27.8
0.3
0.9
Body of water. latrine
0.2
70.6
0.0
0.5
0.8
29.0
0.3
1.3
0.6
27.3
0.3
0.9
290
No sanitation service
9.2
12.9
6.9
11.5
71.5
2.3
68.3
74.7
41.9
2.2
40.1
43.7
No information
0.3
74.1
0.0
0.7
0.8
31.2
0.3
1.3
0.5
31.4
0.2
0.8
Table 5. Percentage of households according to ownership of goods and services by area

Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 6.7 13.4 13.6 5.4 1.2 0.4 25.9 6.1 5.8 0.1 0.6 19.9 37.8 19.4 17.7 2.0 1.4 6.0 0.3 20.9 26.9 49.4 1.4 2.3 1.2 0.7 0.0 9.0 9.0 1.0 2.0 26.0 44.0 3.0 5.0 3.0 2.0 1.0 31.0 1.0 4.0 56.0 19.8 17.0 5.2 6.5 53.8 36.4 5.1 6.6 5.1 10.3 2.2 3.0 8.0 9.0 46.9 19.0 40.2 2.5 2.1 8.0 10.5 1.6 4.2 4.8 11.0 9.7 1.7 3.1 8.6 8.9 9.4 8.1 15.2 19.0 40.6 2.5 11.0 24.2 3.8 22.0 39.0 38.0 45.0 7.0 3.0 54.0 18.0 15.0 4.0 5.0 52.0 34.0 4.0 5.0 4.0 9.0 2.0 38.0 64.0 64.0 79.0 12.0 6.0 85.0 30.0 25.0 8.0 10.0 85.0 29.0 7.0 8.0 7.0 17.0 3.0 23.0 10.0 12.0 3.5 10.0 2.2 34.0 40.8 3.7 90.0 23.1 7.0 14.0 1.4 27.7 12.0 0.6 38.7 31.0 7.4 11.1 36.0 7.7 10.9 89.0 27.9 5.4 9.0 0.9 29.9 17.0 2.1 22.8 84.0 7.0 11.4 70.0 16.3 8.4 71.0 16.0 8.2 45.0 8.6 11.5 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 4.0 2.6 2.4 1.7 8.1 11.1 1.3 4.4 5.4 11.1 10.3 1.3 4.7 9.3 10.1 9.9 7.9 15.7 Rural Total 95% confidence interval 26.0 43.0 42.0 49.0 9.0 5.0 58.0 21.0 19.0 6.0
Goods and Services
Estimated value (%)
Washing machine
41.4
Refrigerator
67.7
Blender
66.7
Electric or gas stove
81.7
Electric or gas oven
14.6
Microwave oven
7.5
Colour television
86.9
DVD player
33.0
Stereo system
27.7
Computer for family use
10.2
291
Air conditioning
12.0
8.0 56.0 39.0 6.0 8.0 6.0 12.0 3.0
Fan
87.5
Bicycle
31.5
Motorcycle
8.3
Private car
10.0
APPENDICES
House. apartment or second property
8.6
Cable or satellite television
20.1
Internet connection
4.4
Table 6. Percentage of households according to SISBEN survey by area

Rural Total
Urban
SISBEN survey 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 61.5 24.8 13.7 3.7 2.2 1.1 60.1 23.6 12.6 40.1 39.5 20.4 4.9 18.2 22.5 2.5 37.4 41.6 2.6 37.9 42.4
Estimated value (%) 81.1 10.4 7.2 7.7 11.4 82.1
Relative Standard error (%) Relative Standard error (%) Relative Standard error (%)
Yes
81.6
0.3
62.8 25.9 14.8
No
10.9
2.1
Unknown
7.5
1.5
Table 7. Percentage of households according to Sisben classification by area

Rural Total
Urban
292
SISBEN level 95% confidence interval Estimated value (%) 76.6 5.8 0.6 NA 16.9 2.8 NA 7.0 2.8 1.4 74.2 5.5 0.6 NA 14.3
Estimated value (%) 67.3 19.0 6.6 0.1 5.7 5.8 0.1 6.7 20.2 68.5
Relative Standard error (%) Relative Standard error (%)
Estimated value (%) 79.0 6.2 0.7 NA 19.5 70.6 15.3 4.7 0.1 9.3
Relative Standard error (%) 0.5 1.5 0.9 0.9 4.4
One
67.9
0.4
69.8 14.8 4.6 0.1 8.4
71.5 15.7 4.8 0.1 10.2
Two
19.6
1.3
Three
6.6
0.4
Four
0.1
0.4
Unknown
5.8
0.4
Table 8. Percentage of households according to head of household by area

Urban Rural Total
Head of household 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%)
Estimated value (%)
Relative Standard error (%) Relative Standard error (%) Relative Standard error (%) 1.8 58.4 2.6 57.4 63.4 60.6 2.5 57.9 63.9 60.4
Households with male head
60.9
62.8
Households with female head
39.1
4.0
36.1
42.1
39.5
3.9
36.5
42.5
39.3
2.8
37.1
41.5
Households with female head without spouse 3.1 70.7 79.9 76.8 2.6 72.9 80.7
75.3
76.0
2.0
73.0
79.0
Households with female head without spouse with children under the age of 18 5.6 46.8 58.4 60.4 4.2 55.5 65.3 9.4 10.4 15.0 14.7 9.2 12.1 17.3
52.6
56.8
3.5
52.9
60.7
Households with male head without spouse
12.7
13.7
6.9
11.8
15.6
293
Households with male head without spouse with children under the age of 18 34.9 2.6 14.2 12.0 26.6
8.4
5.8
18.2
10.4
21.5
6.0
14.8
APPENDICES
Table 9. Population distribution according to age range and gender by area

Urban Rural Total
Gender 95% confidence interval 95% confidence interval 15.7 16.4 11.9 18.4 9.6 7.5 4.3 4.4 1.9 13.3 3.9 4.2 21.7 3.5 14.0 13.2 20.1 5.9 5.8 2.8 16.0 16.5 15.8 23.3 9.2 11.7 12.4 9.8 5.8 3.9 2.1 14.4 14.2 13.2 22.6 21.7 20.6 14.6 13.4 2.5 2.0 2.2 2.3 3.4 4.4 5.7 2.3 2.2 2.4 1.7 19.8 16.3 2.6 18.5 15.7 2.3 14.9 15.4 12.7 19.7 11.8 9.3 5.4 3.6 1.8 13.8 13.5 12.5 21.8 13.8 14.1 13.3 20.9 14.0 11.1 6.5 2.5 1.8 13.9 12.8 11.6 23.3 23.8 11.9 14.5 13.3 15.2 14.5 14.7 4.3 1.8 2.3 9.8 2.7 5.1 6.6 6.7 5.1 7.4 11.6 8.4 5.0 14.6 10.6 4.6 21.5 20.1 3.9 13.9 13.3 4.8 14.6 18.1 4.4 14.5 17.1 3.9 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%)
Age group
Estimated value (%) 1.1 0.9 1.1 0.7 0.9 0.9 0.9 2.1 0.2 0.9 0.9 0.6 0.5
95% confidence interval 16.4 17.2 14.1 21.5 12.9 10.3
5 years old and younger
14.2
6-11 years old
14.4
12-17 years old
13.6
18-29 years old
21.2
Men
30-39 years old
14.3
40-49 years old
11.3
294
50-59 years old
6.6
6.2 4.3 2.3 15.1 14.8 13.8 23.4
60-69 years old
2.6
70 years old and older
1.8
14.2
Women
13.1
6-11 years old
11.7
12-17 years old
23.5
Urban
Rural
Total
Gender 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 12.8 10.7 5.7 3.7 2.7 15.0 15.2 14.8 22.1 10.5 8.4 6.1 4.6 2.6 5.5 8.0 4.6 4.1 2.1 11.8 10.0 5.9 5.1 3.0 13.3 21.6 12.6 10.3 5.7 3.8 2.4 4.2 4.1 6.6 1.7 1.6 1.6 1.4 1.3 1.9 2.9 3.4 4.4 2.6 10.2 5.2 3.4 2.3 14.5 14.7 12.9 21.0 12.2 9.9 5.4 3.6 2.2 2.1 12.2 11.6 9.9 5.4 4.1 2.8 15.8 16.6 13.9 20.9 11.1 9.2 5.3 4.1 2.8 2.7 19.7 2.9 13.1 2.8 15.6 17.6 3.1 14.8 16.9 12.5 2.1 3.5 7.2 3.5 4.8 8.5 4.4 6.4 5.4 8.8 11.1 4.4 10.5 12.7 Relative Standard error (%) Relative Standard error (%) 13.3 11.3 6.2 4.1 3.1 15.6 15.7 13.7
Age group
Estimated value (%) 0.9 0.6 1.5 1.3 0.9 0.4 0.5 0.6 0.5 0.4 0.6 1.0 1.3 0.4 2.2 2.2 2.9 3.1 6.1 6.4 11.3 11.6 14.0 14.3 22.2 22.7 12.5 12.8 13.5 13.8 14.1 14.3 2.6 2.7 3.2 3.4 5.8 6.1 11.4 11.7 13.7 14.3
30-39 years old
14.0
40-49 years old
11.6
Women
50-59 years old
6.0
60-69 years old
3.3
2.6
14.2
6-11 years old
13.7
12-17 years old
12.6
295
18-29 years old
22.4
22.3 12.9 10.7 6.1 4.1 2.6
Total
30-39 years old
14.1
40-49 years old
11.5
50-59 years old
6.3
APPENDICES
60-69 years old
3.0
2.2
Table 10. Population distribution according to marital status and gender by area
Urban Rural Total
Gender 95% confidence interval 95% confidence interval 1.3 29.3 1.4 0.7 63.0 1.4 29.1 6.3 3.2 54.7 1.4 2.1 5.7 2.6 60.4 9.1 1.0 29.4 4.0 2.1 59.1 32.4 8.1 4.9 57.8 2.0 32.1 5.1 3.1 61.6 2.1 66.3 62.1 5.0 28.8 7.4 3.8 54.9 5.1 29.2 4.9 2.4 58.4 1.5 0.9 2.3 2.3 5.3 10.4 0.7 2.5 1.4 3.1 5.4 0.7 2.3 1.1 2.8 5.1 0.6 32.2 29.7 1.2 1.9 5.1 2.4 4.8 28.9 2.0 0.7 61.2 4.7 28.0 6.9 3.4 54.1 4.8 28.5 4.6 2.1 57.7 8.6 28.2 2.6 0.6 58.9 8.1 26.6 7.5 3.5 53.3 8.4 27.4 5.2 2.1 56.1 56.5 2.2 5.4 4.6 27.8 30.7 8.9 1.7 8.5 53.8 56.3 1.3 3.7 4.1 10.0 7.8 7.2 6.1 27.2 30.7 2.6 8.6 1.8 10.0 59.7 64.7 1.2 0.6 1.1 15.9 2.9 1.8 11.9 28.7 30.8 2.3 9.1 1.6 8.5 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%)
Marital Status
Estimated value (%) 1.4 0.4 2.7 1.6 0.4 1.4 0.5 0.9 0.8 0.2 1.4 0.4 1.0 0.6 0.2
95% confidence interval 5.4 30.4 2.5 1.1 63.0 5.3 29.7 7.9 4.3 55.7 5.3 29.9 5.2 2.7 59.1
Married
8.9
Cohabitation
28.5
Men
Separated
2.7
Widowed
0.6
Single
59.3
Married
8.4
Cohabitation
26.9
296
Women
Separated
7.6
Widowed
3.6
Single
53.5
Married
8.6
Cohabitation
27.6
Total
Separated
5.3
Widowed
2.2
Single
56.3
Table 11. Average years of education according to age groups by area

Urban Rural Total
Wayunaiki literacy 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 1.6 4.7 3.2 2.9 3.3 4.9
Estimated value (%)
Relative Standard error (%) 6.8 7.2 3.1
Under 5 years of age
7.0
1.7
5.1
From 5 to 19 years of age 4.9 5.3 2.7 2.8 2.6 2.8 3.7
5.1
2.1
1.8
3.6
3.8
From 20 to 34 years of age 9.4 10.0 5.0 4.1 4.6 5.4
9.7
1.6
7.3
1.9
7.0
7.6
35 or more
7.3
2.5
6.9
7.7
2.1
6.1
1.8
2.4
4.7
2.8
4.4
5.0
297
APPENDICES
Table 12. Population distribution according to educational level by area

Urban Rural Total
Educational level 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 33.1 0.4 27.5 28.4 4.5 0.7 0.9 0.7 NA 60.1 0.0 1.5 NA 0.3 1.2 3.8 0.1 0.4 2.7 2.7 7.1 16.7 13.7 9.6 50.6 22.8 21.7 3.0 31.2 0.2 26.0 26.9 3.9 0.5 0.8 3.1 0.0 0.2 51.9 0.6 29.4 14.2 2.0 0.1 0.6 1.1 NA 0.1 NA 20.2 24.1 0.3 57.8 0.0 0.2 16.8 1.3 2.6 5.9 12.6 15.9 3.7 27.2 31.5 24.7 0.3 0.8 2.8 49.1 54.8 Relative Standard error (%) Relative Standard error (%)
Estimated value (%) 8.8 0.0 23.3 43.1 6.5 0.9 1.2 5.7 0.0 0.4 1.2 0.3 8.6 2.4 1.8 8.7 47.7 27.1 0.3 12.0
None
10.4
7.8
35.0 0.6 28.9 29.9 5.1 0.9 1.5 4.5 0.1 0.6
Pre-school
0.2
44.4
Basic primary
25.2
3.8
Middle school
45.4
2.6
Technical
7.6
7.2
298
Technological
1.4
17.3
University without degree
1.8
16.4
University with degree
7.1
10.4
Postgraduate without degree
0.2
50.5
Postgraduate with degree
0.8
24.6
Table 13. Net and gross school attendance rate according to level of education by area
Urban Rural Total
Level 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 1.9 123.3 2.8 126.2 140.8 128.1
Attendance rate
Estimated value (%)
Relative Standard error (%) 2.2 114.8 125.2 133.5
Gross
120.0
132.9
Primary 1.4 86.6 91.4 71.5 2.5 68.0 75.0 78.6 1.6 76.1 81.1
Net
89.0
Gross
101.5
3.3
94.9
108.1
40.1
6.1
35.3
44.9
67.4
3.0
63.4
71.4
Secondary 2.7 66.0 73.4 23.4 7.1 20.1 26.7 43.9 3.0 41.3 46.5
Net
69.7
Gross
20.9
8.5
17.4
24.4
6.6
15.4
4.6
8.6
13.4
7.8
11.4
15.4
299
Higher Education 10.6 9.8 15.0 4.7 17.9 3.1 6.3 8.3 9.3 6.8 9.8
Net
12.4
APPENDICES
Table 14. Population distribution according to literacy by area

Urban 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 95% confidence interval 1.0 3.2 74.8 22.2 77.8 25.2 Relative Standard error (%) 95% confidence interval 62.7 42.5 23.7 76.3 37.3 3.3 Rural Total
Literacy
Estimated value (%)
Relative
Literacy 5.8 8.2 39.9
95% confidence interval Relative Standard error (%) 95% confidence interval Estimated value (%)
Estimated value (%)
Illiteracy
7.0
8.6
Table 15. Distribution of the population aged 12 to 65 according to occupational position by area
Urban 95% confidence interval 38.4 9.0 35.8 3.3 1.4 0.9 0.2 0.0 0.2 1.2 2.1 5.3 3.7 0.1 2.8 0.7 5.7 1.3 41.8 71.4 1.9 23.9 29.3 12.2 15.9 99.8 13.2 4.0 16.5 2.7 68.7 0.7 0.3 4.0 2.5 0.0 44.0 13.5 8.5 11.3 Estimated value (%) Relative Standard error (%) 15.7 5.3 74.1 1.9 1.1 6.6 4.9 0.3 95% confidence interval Rural Estimated value (%) 26.8 7.4 55.8 2.9 1.3 3.5 2.3 0.1 Relative Standard error (%) 3.4 8.7 2.0 12.0 15.2 11.2 14.9 58.0 Total 95% confidence interval
Occupational position
Estimated value (%) 3.5 9.7 4.0 13.9 17.5 21.6 33.2 71.7
300
Employee or worker at private company
41.2
25.0 6.1 53.6 2.2 0.9 2.7 1.6 0.0
28.6 8.7 58.0 3.6 1.7 4.3 3.0 0.2
Government employee or worker
11.1
Independent contractor or freelance
38.8
Domestic employee
4.5
Boss or employer
2.1
Unpaid worker
1.5
Laborer
0.7
Other
0.1
Table 16. Autonomy of women (12 - 69 years of age) with a partner to go out alone by age group and area
URBAN 95% Confidence interval 95% Confidence interval 15.6 26.2 22.7 24.7 0.0 17.0 26.4 40.0 55.2 56.5 51.4 80.4 51.5 60.4 0.0 2.8 25.5 33.7 NA 4.0 5.1 12.4 13.6 2.5 1.0 NA 2.9 3.5 72.1 70.6 100.0 78.9 68.8 13.1 8.7 9.8 8.3 NA 5.2 6.7 68.0 81.1 34.3 24.3 68.0 66.6 72.8 70.6 84.4 69.5 70.8 3.8 4.9 4.9 4.4 5.1 7.7 4.9 44.5 22.8 19.6 10.6 18.2 15.0 3.2 7.8 1.9 2.2 2.7 2.3 4.8 1.2 60.4 12.0 14.2 16.3 6.0 7.0 6.4 44.0 25.0 7.7 36.3 22.3 6.2 39.1 28.6 4.6 25.6 19.1 20.6 6.1 14.9 22.5 55.8 63.6 69.1 66.2 79.9 61.8 68.9 0.0 3.5 3.3 2.7 4.4 6.4 4.2 55.3 28.2 18.0 16.5 Estimated value (%) 14.2 24.5 15.6 16.4 11.0 12.1 18.9 74.2 69.9 78.1 77.7 78.7 73.5 75.5 3.0 4.0 3.8 4.1 8.6 11.5 4.7 4.8 12.9 9.3 NA 4.2 4.7 4.0 6.2 4.2 5.8 22.3 4.0 4.0 97.8 76.4 64.6 2.8 76.4 65.2 9.1 80.4 90.7 4.9 79.5 61.0 6.8 80.5 64.3 5.3 71.4 61.6 4.5 82.5 60.6 14.7 19.8 30.4 5.6 13.6 30.8 19.4 12.0 9.3 47.7 18.3 34.3 12.2 18.0 29.5 10.0 25.8 32.6 8.6 22.0 35.4 24.3 Estimated value (%) Est. relative error (%) Est. relative error (%) 95% Confidence interval 39.9 31.6 25.6 29.5 15.0 30.7 26.1 80.2 69.5 76.5 75.1 88.8 77.2 72.7 9.1 6.2 6.5 6.0 5.8 8.9 5.6 RURAL TOTAL
Permission
Age
Estimated value (%) 9.3 1.1 3.2 2.3 1.8 2.5 1.0 2.3 0.5 0.7 0.5 0.5 0.8 0.3 6.5 1.1 1.0 0.7 1.8 2.5 0.3
12-17 years old
18.1
18-29 years old
25.2
30-39 years old
16.8
Asks permission
40-49 years old
17.3
50-59 years old
11.5
60-69 years old
12.8
Total
19.3
12-17 years old
78.4
18-29 years old
70.7
30-39 years old
79.3
Notifies
40-49 years old
78.6
50-59 years old
79.5
60-69 years old
75.0
301
Total
75.9
12-17 years old
3.5
18-29 years old
4.1
30-39 years old
3.9
40-49 years old
4.1
APPENDICES
50-59 years old
9.0
60-69 years old
12.2
Total
4.7
Table 17. Autonomy of women (12 - 69 years of age) with a partner to go out with her children by age group and area
Urban Rural Total
Autonomy 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 11.6 25.4 20.3 22.5 10.7 23.1 21.8 88.1 52.7 53.2 6.9 5.5 63.3 62.4 8.5 3.0 49.6 77.0 50.8 58.1 65.7 69.6 68.5 99.6 75.8 66.7 73.2 64.8 70.9 70.5 83.1 66.8 69.5 6.9 8.6 19.9 12.2 3.7 6.3 2.0 2.4 2.7 2.6 4.4 1.2 5.2 40.8 0.7 22.3 17.1 18.0 5.8 16.5 19.9 62.6 61.8 66.9 66.0 78.2 60.0 67.5 15.3 32.5 29.7 33.5 11.7 31.2 29.9 70.0 59.2 61.4 59.0 88.3 5.8 4.8 11.2 51.9 5.8 25.9 33.9 16.7 19.2 43.1 41.8 0.4 23.0 12.5 23.8 43.1 9.6 23.1 36.3 8.7 26.0 39.0 51.5 0.0 33.5
Age
Estimated value (%) 6.5 2.1 4.2 3.1 1.8 2.5 1.3 2.4 0.7 0.7 0.5 0.5 1.0 0.2 75.0 75.8 69.6 72.9 78.3 80.0 79.0 80.8 77.1 79.6 68.5 70.7 73.5 81.9 14.6 15.5 12.1 13.6 9.5 10.4 12.5 14.4 11.8 14.3 18.5 20.4 5.3 7.2
12-17 years old
6.3
22.4 28.4 23.6 26.9 15.6 29.6
18-29 years old
19.4
30-39 years old
13.1
Asks permission
40-49 years old
13.4
50-59 years old
10.0
60-69 years old
12.8
302
Total
15.0
23.6 83.9 67.9 74.9 74.9 88.0 73.6 71.4
12-17 years old
77.7
18-29 years old
69.6
30-39 years old
78.3
Notifies
40-49 years old
79.9
50-59 years old
79.1
60-69 years old
71.3
Total
75.4
Urban
Rural
Total
Autonomy 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 1.5 5.7 6.8 5.2 5.2 7.2 5.9 21.2 4.3 0.0 1.2 NA NA 1.8 NA 27.5 NA NA 0.6 4.0 1.7 NA NA 2.9 13.8 4.1 1.9 1.8 0.9 2.9 2.8 10.7 18.8 6.0 7.0 6.0 12.2 10.6 27.4 3.7 6.0 7.0 7.9 10.3 4.3 5.1 3.0 4.5 6.1 5.1 9.9 3.1 0.7 1.7 0.8 2.4 2.3 11.6 1.1 NA 6.1 7.7 6.1 NA 5.5 5.9 14.6 2.2 1.2 1.4 NA 97.8 8.2 42.8 0.0 19.4 8.1 13.1 4.1 7.7 12.4 4.0 7.1 NA NA NA 35.5 1.1 11.1 21.7 3.8 11.5 21.0 3.1 9.1 NA NA NA
Age
Estimated value (%) 6.5 1.1 1.0 0.7 1.8 2.5 0.3 12.2 2.4 1.0 0.7 1.8 2.5 1.8 3.6 3.9 6.1 6.9 1.6 1.7 2.1 2.2 2.4 2.5 5.4 6.0 9.0 16.1 5.8 5.9 8.9 9.9 8.9 9.6 4.4 4.6 6.0 6.3 5.2 5.5 3.0 4.0
Relative Standard error (%) Relative Standard error (%) Relative Standard error (%) 1.8 7.0 8.5 7.5 6.0 8.4 6.7 17.7 5.1 3.1 2.0 1.1 3.3 3.4
12-17 years old
3.5
18-29 years old
5.3
30-39 years old
6.2
40-49 years old
4.5
50-59 years old
9.2
60-69 years old
9.4
Total
5.8
12-17 years old
12.5
18-29 years old
5.7
303
30-39 years old
2.4
No children
40-49 years old
2.2
50-59 years old
1.6
APPENDICES
60-69 years old
6.5
Total
3.7
Table 18. Autonomy of women (12 - 69 years of age) with a partner to pay everyday expenses by age group and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 15.6 27.4 23.1 20.2 0.0 22.0 26.4 44.7 52.4 55.0 7.1 6.2 57.0 62.4 10.5 2.9 50.3 74.6 43.2 58.3 34.0 84.4 65.8 70.3 70.1 99.6 70.9 66.6 46.4 20.8 9.4 26.2 22.1 68.9 65.7 72.3 69.6 80.6 64.8 69.6 39.8 20.7 36.6 20.2 7.0 9.6 22.0 10.9 3.5 7.4 2.1 2.2 2.9 2.9 5.1 1.2 40.4 26.7 4.8 55.3 23.3 22.0 11.5 23.8 17.0 16.1 4.6 19.6 20.3 57.2 62.6 68.6 65.0 75.3 57.1 67.7 5.3 20.2 11.7 12.1 8.6 15.1 14.9 70.4 70.6 78.6 76.4 74.7 73.1 75.2 76.1 76.0 76.7 87.1 78.2 60.2 80.8 62.7 5.3 72.0 59.1 4.9 79.4 64.6 13.3 15.8 30.2 5.5 16.9 34.2 15.5 9.4 9.9 48.2 14.0 30.0 14.1 13.8 29.9 9.8 21.3 33.9 8.3 7.2 35.4 24.3 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 6.5 1.1 3.6 3.2 1.8 2.5 1.3 2.6 0.4 0.6 0.5 0.6 0.8 0.3 95% confidence interval 35.1 29.7 23.5 25.3 14.1 32.7 23.9 80.6 68.9 76.0 74.2 86.0 72.5 71.6 Rural Total
Autonomy
Age
Estimated value (%)
12-17 years old
6.3
18-29 years old
20.8
30-39 years old
12.8
Asks permission
40-49 years old
13.1
50-59 years old
9.0
60-69 years old
16.0
Total
15.4
304
12-17 years old
74.9
18-29 years old
71.3
30-39 years old
79.7
Notifies
40-49 years old
77.3
50-59 years old
75.7
60-69 years old
74.6
Total
75.6
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval NA 2.3 3.8 0.0 NA 2.9 3.5 NA 0.0 NA 2.3 97.8 96.0 2.2 24.1 0.0 0.0 1.0 6.8 NA 4.5 NA 8.2 10.0 15.2 3.4 5.2 NA 7.8 6.4 6.5 6.4 1.3 0.2 3.9 2.2 2.6 1.8 9.1 5.8 15.3 6.0 7.0 5.2 14.8 42.5 3.3 14.4 58.9 97.6 13.8 11.0 7.3 9.3 8.3 6.2 9.6 4.8 5.7 3.7 6.7 5.4 5.7 4.2 0.0 0.2 2.6 0.0 0.0 1.2 NA 1.5 11.6 1.1 3.0 6.6 7.0 6.7 13.1 8.9 7.5 11.7 1.0 0.3 2.7 1.5 NA 1.3 1.4 NA 4.7 1.6 3.1 2.8 5.3 24.3 0.3 NA NA 1.0 1.7 72.2 19.0 NA NA 7.7 5.2 14.3 9.9 4.0 12.4 14.3 NA NA 7.0 4.5 44.0 7.4 7.4 20.9 7.3 5.3 24.5 4.0 NA NA Estimated value (%) Estimated value (%) 1.8 7.6 8.9 7.8 8.9 7.4 7.3 8.6 2.6 0.2 5.2 5.3 8.6 2.3 Relative Standard error (%) Relative Standard error (%) 6.5 2.1 1.0 0.7 1.8 2.5 0.7 10.4 1.1 1.0 0.7 1.8 NA 1.5 95% confidence interval
Rural
Total
Autonomy
Age
Estimated value (%)
12-17 years old
3.5
18-29 years old
6.9
30-39 years old
7.2
40-49 years old
6.9
50-59 years old
13.7
60-69 years old
9.4
Total
7.6
12-17 years old
15.4
18-29 years old
1.0
305
30-39 years old
0.3
No expenses
40-49 years old
2.8
50-59 years old
1.6
APPENDICES
60-69 years old
NA
Total
1.4
Table 19. Participation of women (12 - 69 years) with a partner in decisions regarding household expenses by area
URBAN
Estimated value (%) value (%)
RURAL 95% confidence interval

Estimated
TOTAL 95% confidence interval Relative Standard error (%) 6.6 8.5 95% confidence interval
TYPE OF EXPENSE Relative Standard error (%) 1.8 7.5 8.1 12.3 11.2 9.3 15.3 9.9 Relative Standard error (%)
WHO DECIDES
Estimated value (%)
Clothing or shoes 39.2 53.0 0.4 52.5 53.5 51.1 3.5 47.2 54.9 52.1 0.4 38.8 39.6 36.6 4.9 32.8 40.5 38.0 2.2 1.7
Only the father or another man/woman in the household 7.8
11.4
Only the mother
36.1 50.2
39.8 53.9
The mother takes part in the decision 8.2 2.2 7.8 8.6 12.4 10.8 9.5 15.3 10.2
Only the father or another man/woman in the household 41.9 49.9 0.5 49.4 50.4 51.9 3.5 48.0 0.5 41.4 42.3 35.7 4.9 31.9 39.5 55.9
6.3
8.8
11.6
Food
Only the mother
38.9 50.9
2.2 1.7
37.1 49.0
40.7
306
The mother takes part in the decision 10.4 1.3 10.1 10.7 13.4 10.5
52.8
Only the father or another man/woman in the household 36.4 53.2 0.4 52.7 53.7 52.2 0.5 36.1 36.8 34.5 5.2 3.4
10.4
16.4
11.8
5.7
10.3
13.2
Home improvements or purchase of furniture, etc.
Only the mother
30.6 48.3
38.3 56.0
35.5 52.7
2.4 1.6
33.7 50.8
37.3 54.6
The mother takes part in the decision
Table 20. Shared responsibility of the parents in the care of

Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 7.2 56.8 12.0 6.4 56.7 15.2 5.3 55.9 16.1 5.3 6.6 11.6 19.9 69.4 15.8 16.3 5.4 19.2 49.9 21.7 7.9 61.1 9.3 28.7 19.2 72.8 30.8 19.2 67.0 36.9 20.6 77.7 23.3 72.6 20.3 13.6 65.6 20.8 12.6 61.6 25.9 12.6 58.0 29.4 15.6 69.3 15.2 29.7 15.7 74.4 68.7 3.0 13.4 11.7 2.8 7.6 12.6 3.3 7.2 12.6 3.5 6.5 9.4 2.8 10.8 19.8 15.6 9.4 12.4 64.1 11.0 10.1 61.5 17.3 9.0 57.0 21.7 9.1 53.4 25.2 12.3 65.0 11.5 Estimated value (%) 16.6 70.4 8.5 12.8 65.3 18.1 12.2 55.8 24.8 12.3 54.6 25.9 15.7 67.8 12.2 70.4 18.0 33.0 29.3 14.3 60.6 58.4 13.6 12.2 25.5 31.9 23.4 14.1 61.7 64.3 5.9 13.6 12.2 25.5 21.1 22.0 13.8 67.7 64.7 5.5 14.9 13.4 23.3 12.4 20.9 19.0 73.1 65.6 6.0 19.0 13.5 21.1 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 3.0 0.9 8.4 3.4 0.8 3.5 2.3 2.3 5.6 2.3 2.3 5.4 3.0 0.8 5.7 Rural Total 95% confidence interval 18.9 73.2 20.4 17.2 69.7 24.3 16.1 66.1 30.0 16.1 62.6 33.6 18.8 73.5 18.8
children during the first year of life according to type of activity and area
Activity
Frequency
Estimated value (%)
Gets up at night to calm the baby
Always or most of the time
17.8
Sometimes
71.8
Never
10.4
Feeds the baby during the day
13.9
Sometimes
66.5
Never
19.6
Bathes the baby
12.9
Sometimes
58.7
Never
28.4
307
Changes nappies
13.0
Sometimes
57.6
Never
29.5
16.9
APPENDICES
Entertains the baby during the day
Sometimes
69.1
Never
14.0
Table 21. Shared responsibility of mothers in the care of children during the
first year of life according to type of activity and area

Urban Relative Standard error (%) 95% confidence interval Estimated value (%) Estimated value (%) 81.1 14.0 4.9 88.8 9.4 1.8 91.2 8.0 1.1 86.7 7.8 3.3 1.9 14.5 0.3 4.8 84.3 7.9 0.3 14.8 7.5 91.8 15.4 0.4 0.8 86.4 8.9 4.8 87.6 11.4 1.0 8.9 1.0 9.8 8.1 1.0 10.9 22.1 0.9 9.3 10.6 1.0 7.7 2.4 6.9 1.2 79.0 11.8 3.9 86.8 7.3 1.5 89.2 6.0 0.4 84.6 7.0 3.6 85.7 9.4 0.9 82.6 13.4 3.9 89.3 10.7 NA 89.3 10.4 0.3 83.3 11.3 5.4 88.1 11.6 13.8 17.6 1.9 99.1 0.0 79.8 15.9 6.7 1.9 85.4 93.1 14.1 NA NA NA 16.4 6.8 14.6 2.0 85.4 93.2 20.4 2.2 5.7 14.0 9.3 17.6 2.2 78.5 86.7 95% confidence interval 78.8 13.6 5.1 87.5 7.1 3.0 92.2 4.5 1.2 88.6 5.3 3.4 86.3 10.2 1.6 1.6 12.2 88.2 4.7 7.5 90.4 1.2 6.6 94.3 4.3 9.0 89.1 6.5 15.5 80.4 Relative Standard error (%) Relative Standard error (%) 0.5 2.9 5.2 0.4 5.3 8.0 0.5 8.4 0.7 0.4 7.5 7.2 0.5 4.0 0.7 95% confidence interval 83.2 16.2 5.8 90.8 11.4 2.1 93.3 Rural Total
Activity
Frequency
Estimated value (%)
Gets up at night to calm the baby
79.6
Sometimes
14.6
Never
5.8
Feeds the baby during the day
88.3
Sometimes
8.0
Never
3.6
Bathes the baby
93.3
308
Sometimes
5.5
9.9 1.1 88.1 10.7 5.9 89.6 13.4 1.0
Never
1.2
Changes nappies
89.5
Sometimes
6.4
Never
4.1
87.2
Entertains the baby during the day
Sometimes
11.2
Never
1.6
Table 22. Percentage of households according to the opinion of the head or
spouse with regard to their condition of poverty by area

Urban Rural Total
Opinion 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 75.3 24.7 3.7 1.2 83.9 16.1 6.9 13.9 18.3 1.3 81.8 86.0 Relative Standard error (%) Relative Standard error (%) 73.5 22.9
Estimated value (%) 62.7 31.3 37.3 68.7
Consider themselves to be poor
65.7
2.3
77.1 26.5
Do not consider themselves to be poor
34.3
4.5
Table 23. Percentage of households according to present standard of living
(of the household) compared to five years ago by area

Rural 95% confidence interval 44.0 36.1 12.1 15.9 12.1 42.1 56.8 49.8 31.1 4.5 2.5 7.5 Estimated value (%) Relative Standard error (%) 95% confidence interval 28.4 54.0 10.3 33.8 59.6 13.9 Estimated value (%) 38.6 48.4 13.0 Total
Urban
309
Opinion
Estimated value (%)
Relative Standard error (%) 2.7 2.2 5.2
95% confidence interval 36.6 46.3 11.7 40.6 50.5 14.3
Better
46.9
3.2
Same
39.1
3.9
APPENDICES
Worse
14.0
7.1
Table 24. Population distribution according to affiliation by gender and area

Urban Rural Total
Gender 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 66.1 18.0 0.7 15.1 69.0 16.0 0.8 19.0 79.8 4.3 0.2 5.6 14.7 5.8 0.9 18.7 14.2 67.6 17.0 0.8 14.7 13.4 3.3 0.9 1.9 8.5 4.0 0.8 1.8 10.3 3.3 2.0 1.0 64.8 17.2 0.5 14.1 67.7 15.4 0.7 13.0 66.4 16.3 0.6 13.6 76.8 5.9 0.6 16.7 78.6 4.3 0.5 16.7 77.7 5.1 0.6 16.7 27.5 7.0 1.2 75.7 6.6 14.3 26.7 0.2 0.8 9.4 3.4 5.1 1.4 76.2 80.9 5.8 14.6 18.8 30.5 0.2 1.0 6.5 5.1 6.7 1.4 74.6 79.0
System
Estimated value (%) 0.4 0.6 0.3 0.9 0.3 0.4 0.9 0.9 0.3 0.5 0.5 0.7 12.3 12.7 1.0 1.0 29.3 29.9 56.5 57.3 11.4 11.9 1.1 1.1 28.0 28.5 58.6 59.4 13.2 13.7 0.9 0.9 30.8 31.6 54.1 55.0
Subsidized
54.6
67.5 18.8 0.9 16.2 70.3 16.7 0.9 15.4 68.8 17.6 0.9 15.7
Contributory
31.2
Men
Special
0.9
Non affiliated
13.4
Subsidized
59.0
Contributory
28.2
Women
Special
1.1
310
Non affiliated
11.7
Subsidized
56.9
Contributory
29.6
Total
Special
1.0
Non affiliated
12.5
Table 25. Distribution of the population between the ages of 6 and 69 according to out-of-pocket
payments of different costs associated with latest consultation by area

Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 20.2 4.4 1.5 1.6 0.8 0.2 0.1 0.2 1.8 0.2 2.2 2.1 4.0 7.5 5.6 4.2 1.2 1.2 2.8 8.9 2.3 2.6 2.2 4.2 1.3 12.4 12.0 9.6 5.7 30.0 15.9 5.0 14.1 8.3 8.4 7.0 5.3 3.8 1.2 0.8 Estimated value (%) 10.7 9.9 11.7 9.8 7.6 5.4 1.7 1.1 1.1 1.2 35.0 1.7 0.1 3.8 6.3 1.0 35.0 8.0 1.4 19.1 10.1 2.8 18.3 12.8 2.2 13.2 10.7 8.2 19.5 11.9 25.1 8.2 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 2.3 1.6 1.8 0.5 1.1 3.2 0.5 0.5 Rural Total 95% confidence interval 17.8 10.9 9.3 8.0 5.9 4.6 1.2 1.5
Description
Estimated value (%)
Round-trip transportation
11.3
Misc. items such as photocopies
10.3
Required POS quotat per appointment (recovery cost or co-payment)
12.3
Medications
9.9
Private consultation
7.8
Voucher or coupon for pre-paid medicine
5.9
Laboratory tests or x-rays
1.7
311
Food
1.1
Other treatment procedures, such as therapies, injections or educational sessions 9.0 0.3 0.5 NA
0.4
NA
NA
NA
0.3
9.1
0.2
0.3
APPENDICES
Materials or other items necessary for treatment 0.5 0.5 0.0 0.0 0.2 0.3
0.3
NA NA
NA NA
NA NA
NA NA
0.2 0.0
1.3 1.3
0.2 0.0
0.2 0.0
Lodging
0.0
Table 26. Distribution of the population between the ages of 6 and 69 according to out-of-pocket
Urban Rural Total
payments of different costs associated with the most recent hospitalization
Description 95% confidence interval 95% confidence interval 0.0 0.0 0.0 0.0 0.7 0.3 NA NA NA NA NA NA 1.1 2.4 3.5 2.0 1.5 0.6 0.3 26.7 6.4 32.2 10.5 6.8 9.6 1.3 1.3 1.3 1.3 1.3 33.9 14.4 4.0 61.9 15.0 6.3 2.9 7.0 1.4 0.0 2.9 1.6 1.2 0.5 0.3 12.0 15.8 13.3 1.4 4.3 2.4 2.1 0.8 0.5 0.5 NA NA 0.8 NA NA 2.2 NA NA 2.6 0.7 4.4 4.5 1.5 4.4 13.0 4.4 40.0 14.0 3.0 76.8 16.7 9.9 19.1 12.6 21.3 15.1 Estimated value (%) Estimated value (%)
Estimated value (%) 0.2 0.2 0.2 6.3 0.2 0.2 0.2 0.2 0.2
95% confidence interval 27.0 21.7 19.5 14.2 4.1 2.3 1.7 0.7 0.4
Round-trip transportation
12.3
Misc. items such as photocopies
16.3
Required POS quota for hospitalization (recovery cost or co-payment)
13.7
Medications
7.2
Food
4.4
Voucher or coupon for pre-paid medicine
2.5
Hospitalization bill (private)
2.1
312
Laboratory tests or x-rays
0.8
Other treatment procedures such as therapies, injections or educational sessions 0.2 0.2 0.3 0.4 NA NA 0.4 0.4 NA NA NA NA
0.5
Lodging
0.4
NA NA
0.3 0.2
1.3 1.3
0.2 0.2
0.3 0.3
Materials or other items necessary for treatment
0.4
Table 27. Distribution of the population (6-69 years old) according to own
perception of their state of health by system and area

Urban Rural Total
System 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 20.2 67.1 11.5 0.9 0.2 21.1 80.2 6.4 7.9 NA 17.2 71.3 59.7 15.8 0.6 NA 0.0 47.5 15.1 0.8 NA 38.9 95.1 19.0 62.7 16.9 1.4 0.0 29.9 49.3 1.3 3.1 8.9 27.3 2.6 0.9 2.1 1.3 0.0 12.4 9.4 4.1 19.2 73.1 6.8 0.6 0.2 15.0 73.6 10.8 0.7 NA 19.2 4.2 67.0 19.3 8.8 36.5 0.1 0.4 22.7 0.3 0.9 8.0 5.7 8.0 2.0 70.1 76.2 7.3 16.2 22.2 Relative Standard error (%) Relative Standard error (%) 18.5 65.3 10.7 0.8 0.1 18.0 61.5 16.2 1.3 0.0 22.0 39.5
Perception
Estimated value (%) 1.7 0.6 0.5 0.5 0.5 1.2 0.3 0.7 0.3 NA 2.0 1.2 36.1 37.9 35.5 38.6 NA NA 1.5 1.5 17.8 18.3 60.2 61.1 19.3 20.3 0.1 0.1 1.4 1.4 18.0 18.3 57.8 59.4 21.0 22.6
Very good
21.8
22.0 69.0 12.2 1.1 0.3 20.1
Good
58.6
Subsidized
Regular
18.1
Poor
1.4
Very poor
0.1
Very good
19.8
313
Good
60.6
63.8 17.7 1.4 0.0 37.8 59.1
Contributory
Regular
18.1
Poor
1.5
APPENDICES
Very poor
NA
Very good
37.0
Special
Good
37.0
Urban
Rural
Total
System 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 95% confidence interval 19.2 1.5 0.0 18.2 69.1 10.5 2.1 NA 20.9 70.8 6.3 20.7 0.2 36.5 6.3 0.4 0.0 76.1 8.2 1.1 0.3 0.0 19.9 66.5 12.4 1.2 0.1 7.3 2.1 8.2 19.2 0.0 3.1 1.0 2.2 7.1 27.3 0.0 10.6 1.2 0.0 15.4 66.0 8.7 1.3 0.0 18.5 65.1 11.8 1.0 0.1 15.1 13.1 25.4 1.9 0.0 21.1 72.2 12.4 3.0 0.0 21.2 67.9 12.9 1.4 0.2 11.5 NA NA 15.1 75.2 8.0 1.7 NA 18.3 73.4 7.2 0.8 1.7 6.5 15.8 NA NA 43.8 0.1 3.2 17.7 5.0 11.1 3.3 70.0 80.4 15.3 10.2 19.9 NA NA NA NA NA NA 63.2 0.0 26.9 Relative Standard error (%) Relative Standard error (%)
Perception
Estimated value (%) 1.2 1.2 NA 1.0 1.3 4.7 0.8 NA 1.3 0.5 0.6 0.2 0.2 0.1 0.1 1.6 1.6 17.4 17.9 58.6 59.8 20.9 22.0 NA NA 2.7 2.8 12.4 15.2 59.3 62.7 21.9 22.9 NA NA 2.3 2.5 23.0 24.1
Regular
23.6
Special
Poor
2.4
Very poor
NA
Very good
22.4
Good
61.0
Non affiliated
Regular
13.8
Poor
2.8
314
Very poor
NA
Very good
21.4
Good
59.2
Total
Regular
17.7
Poor
1.6
Very poor
0.1
Table 28. Consultation prevalence in the last 30 days in the population between the ages of 6 and 69 by gender and area
Urban Rural Total
Gender 95% confidence interval 95% confidence interval 15.9 68.6 5.2 0.3 0.1 15.1 71.7 6.4 0.3 NA 15.8 1.7 6.3 0.8 0.2 20.7 36.5 70.8 6.3 0.4 0.0 76.8 8.5 0.9 NA 20.9 76.1 8.2 1.1 0.3 20.3 0.9 0.3 19.2 65.2 14.2 1.4 0.0 19.9 66.5 12.4 1.2 0.1 1.9 0.8 8.7 9.3 4.9 24.2 32.0 3.2 1.0 2.1 4.8 1.7 3.1 1.0 2.2 7.1 27.3 75.7 68.6 1.3 22.8 21.0 4.2 19.2 66.7 8.3 0.4 0.1 17.9 63.8 13.5 1.3 0.0 18.5 65.1 11.8 1.0 0.1 22.2 63.9 11.7 0.5 0.1 20.0 55.7 20.5 2.2 0.1 20.9 58.6 17.4 1.6 0.1 0.1 1.6 17.9 7.2 59.8 73.4 22.0 18.3 6.5 0.1 NA NA 2.2 0.6 21.1 21.0 7.4 6.8 57.0 74.2 1.6 21.3 17.7 6.9 0.1 0.5 36.6 0.5 1.1 34.8 12.1 6.9 12.0 65.2 72.1 2.3 23.7 19.4 8.4 Estimated value (%) Estimated value (%)
Perception
Estimated value (%)
95% confidence interval 22.9 70.5 10.2 1.2 0.5 20.5 66.6 14.8
Very good
22.9
1.5
Good
64.6
0.5
Men
Poor
11.9
1.0
Bad
0.5
0.4
Very bad
0.1
0.4
Very good
20.6
1.4
Good
56.3
0.6
Women
Poor
20.8
0.6
315
Bad
2.2
0.2
1.5 0.0 21.2 67.9 12.9 1.4 0.2
Very bad
0.1
0.2
Very good
21.4
1.3
Good
59.2
0.5
APPENDICES
Total
Poor
17.7
0.6
Bad
1.6
0.2
Very bad
0.1
0.2
Table 29. Consultation prevalence in the last 30 days in the population between the ages of 6 and 69 by system and area
Rural Estimated value (%) 95% confidence interval 7.9 9.4 11.5 0.8 7.4 9.1 12.1 2.9 6.2 64.6 34.9 4.6 0.5 0.2 15.3 16.9 0.3 10.0 11.8 0.3 11.1 16.3 25.2 5.2 11.6 Estimated value (%) Standard error (%) 9.0 12.4 38.0 1.8 8.3 0.4 0.5 12.5 1.4 0.5 Standard error (%) 95% confidence interval 12.5 17.5 44.6 7.1 12.6 Total
Urban 95% confidence interval 15.4 17.4 32.3 10.8 16.0 16.4 13.3 34.0 18.0 16.5
System
Estimated value (%)
Standard error (%)
Subsidized
15.9
0.3
Contributory
17.7
0.1
Special
33.1
0.4
Non affiliated
12.0
0.6
Total
16.2
0.1
316
Table 30. Average number of days per week each food is consumed in the household by area
Rural Estimated amount 95% confidence interval 2.9 4.5 3.3 1.7 5.2 1.9 2.7 0.1 3.0 0.0 0.1 2.4 0.2 2.3 2.9 0.1 3.1 2.6 0.3 5.4 5.3 1.8 3.3 0.1 3.2 2.4 0.7 1.9 3.0 3.5 3.9 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 4.8 4.4 0.0 3.2 3.5 0.0 3.5 4.3 3.9 2.9 5.2 1.7 3.3 0.1 3.2 2.3 0.7 Estimated amount 3.1 4.6 3.4 1.8 5.3 2.1 2.8 0.1 3.1 2.5 0.3 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Relative Standard error (%) Relative Standard error (%) Total 95% confidence interval 3.6 4.4 4.0 3.0 5.3 1.9 3.4 0.1 3.3 APPENDICES 2.4 0.7
Urban 95% confidence interval 4.0 4.1 4.4 4.1 5.2 1.5 3.8 0.1 3.4 2.2 1.1 1.1 2.3 3.4 0.1 3.9 1.5 5.3 4.1 4.4 4.2 4.0
Food
Estimated value (%)
Milk and derivatives
4.0
0.0
Cereals and derivatives
4.1
0.0
Vegetables and derivatives
4.4
0.0
Fruits and derivatives
4.1
0.0
Fats and oils
5.2
0.0
Fish and shellfish
1.5
0.0
Meats and derivatives
3.9
0.0
317
Alcoholic beverages
0.1
0.0
Eggs and derivatives
3.4
0.0
Legumes and derivatives
2.2
0.0
Sweets and desserts
1.1
0.0
Table 31. Average number of times per day each food is consumed in the household by area
Urban Rural Total
Food 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 1.3 1.3 1.5 1.2 1.9 1.0 1.2 0.1 1.2 0.9 0.1 0.2 1.3 1.1 0.2 1.3 0.1 1.3 1.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 1.3 1.5 1.2 1.9 1.0 1.3 0.1 1.2 1.0 0.4 1.2 1.4 1.4 0.8 1.8 1.1 1.1 0.1 1.2 1.0 0.2 0.0 0.0 0.1 0.1 0.0 1.1 0.0 1.0 1.1 0.0 1.7 1.8 0.0 0.8 0.8 0.0 1.3 1.4 0.0 1.4 1.5 0.0 1.2 1.3 Relative Standard error (%) Relative Standard error (%)
Estimated value (%) 1.4 1.2 1.6 1.6 2.0 0.9 1.5 0.1 1.3 0.9 0.5 0.5 1.0 1.3 0.1 1.5 0.9 2.0 1.6 1.6 1.2 1.4
Milk and derivatives
1.4
0.0
1.3 1.3 1.5 1.3 1.9 1.0 1.3 0.1 1.3 1.0 0.4
Cereals and derivatives
1.2
0.0
Vegetables and derivatives
1.6
0.0
Fruits and derivatives
1.6
0.0
Fats and oils
2.0
0.0
Fish and shellfish
0.9
0.0
318
Meats and derivatives
1.5
0.0
Alcoholic beverages
0.1
0.0
Eggs and derivatives
1.3
0.0
Legumes and derivatives
1.0
0.0
Sweetsand desserts
0.5
0.0
Table 32. Distribution of households according to compensation mechanisms used to reduce food consumption by area
Urban 95% confidence interval 95% confidence interval 42.6 82.8 87.1 73.0 0.9 48.1 37.2 1.7 35.9 71.6 29.1 54.7 56.7 84.9 1.1 30.0 45.4 2.8 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) Rural Total 95% confidence interval 38.6 74.4
Situation
Estimated value (%) 0.7 0.8
Lack of money to buy food
29.6
Reduced the number of meals (no breakfast, lunch or dinner) due to lack of money 0.6 53.3 54.7 85.2 1.2 83.0 87.4 72.5 0.9
55.7
An adult ate less than he or she wanted due to lack of money 0.8 52.4 54.4 80.9 1.4 78.5 83.4 69.7
54.0
71.1
73.9
An adult went without breakfast, lunch or dinner due to a lack of money 1.3 47.6 50.5 82.1 1.3 79.8 84.5
53.4
1.0
68.1
71.3
An adult ate a smaller main meal because there was not enough food for everyone 1.0 45.0 47.1 75.5 1.8 72.4
49.1
68.6
1.1
67.0
70.2
An adult went hungry due to lack of food 1.1 43.0 45.3 77.9 1.7 74.9
46.0
78.6
63.5
1.5
61.4
65.5
319
An adult went to bed hungry because there was not enough money for food
44.2
80.8
64.1
1.4
62.1
66.1
Less indispensable food was bought for children and young people because there was not enough money 1.1 45.2 47.4 69.5 1.3 32.6 34.6 63.9
APPENDICES
46.3
2.1
66.2
72.7
60.0
1.5
58.0
62.0
A child or young person went without breakfast, lunch or dinner due to a lack of money
33.6
2.4
60.4
67.3
51.5
1.9
49.3
53.7
Urban 95% confidence interval 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%)
Rural
Total
Situation
Estimated value (%)
A child or young people ate a smaller main meal because there was not enough food for everyone 1.3 34.3 36.4 67.0 2.2 63.8 70.2 54.1 1.7 52.1 1.5 34.8 37.1 62.9 2.5 59.4 66.3 51.9 1.9 49.6
35.3
56.1
A child or young person complained of hunger due to a lack of food in the household 1.5 29.7 31.8 61.6 2.6 58.1 65.1 49.0 2.1
35.9
54.1
A child or young person went to bed hungry because there was not enough money for food 1.0 25.5 26.6 43.2 2.8 40.6 45.7 34.4
30.7
46.7
51.3
Less food was bought than usual because there wasn't enough money
26.1
1.8
33.1
35.7
320
Table 33. Distribution of the population between 6 and 69 who failed to keep dental appointments by reasons and area
Urban Rural Total
Reason 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 41.5 13.8 12.1 9.6 7.7 7.1 NA 3.8 NA 3.1 3.1 NA NA NA NA 0.9 0.9 NA NA NA 2.1 2.1 NA NA 2.1 1.8 1.8 1.2 0.6 0.5 0.2 16.0 1.2 11.7 1.2 1.2 1.2 1.2 1.2 1.2 1.2 1.2 6.8 5.3 13.7 1.9 0.0 8.1 0.0 6.0 1.7 1.5 1.5 1.0 0.5 0.5 0.2 38.8 35.0 8.8 NA 5.9 5.8 NA 2.7 NA 1.5 1.5 NA 3.1 1.6 NA NA 3.1 3.5 8.2 39.4 0.0 35.2 NA NA NA 56.6 0.0 71.9 6.4 6.7 63.3 14.1 0.0 100.0
Estimated value (%) 13.8 NA 41.6 39.2 45.8 37.9 61.8 99.4 75.9 105.2 NA 102.4 103.7 0.0 0.9 0.0 2.8 NA NA 0.0 3.0 0.0 7.7 0.0 3.8 0.0 7.8 1.7 14.3 0.4 17.3 3.0 28.9 2.0 26.5 NA NA 30.8 55.6
Neglect
43.2
69.3 25.7 36.5 11.2 19.2 8.3 2.4
Service center is too far away
NA
They do not like to go
14.2
The problem got better on its own
15.9
They were scared, nervous or embarrassed
8.9
They felt a consultation was not necessary
8.0
Too much paperwork for EPS/ ARS/IPS
3.4
321
They have to wait too long to be seen
1.2
2.1 2.1 1.3 0.7 0.6 0.2
They did not have anywhere to go
3.0
They did not know they were entitled to it
0.9
APPENDICES
Poor service
NA
Consultation is too expensive or they did not have enough money
0.9
They went but were not seen
0.3
Table 34. Distribution of the population treated at dental appointments by system and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 95% confidence interval 57.1 23.7 4.2 1.5 2.3 13.4 42.1 51.2 1.3 4.5 4.6 7.9 9.7 36.2 36.7 6.2 16.7 44.2 45.0 9.6 45.5 21.4 16.6 50.8 21.0 14.3 3.2 3.7 9.3 7.8 1.6 4.3 2.1 37.4 29.3 12.5 41.8 16.9 13.7 49.0 19.0 13.6 62.7 29.5 6.0 39.9 32.5 14.4 49.2 25.8 19.4 52.6 23.0 15.0 36.8 39.2 3.3 19.9 31.3 7.3 24.0 29.3 15.4 49.4 30.9 35.4 38.7 7.0 5.1 8.0 49.5 26.6 4.9 46.3 59.9 2.1 Estimated value (%) 76.4 9.3 5.0 39.8 28.2 12.9 51.1 8.2 19.8 56.8 7.8 18.1 18.7 9.0 40.9 58.2 40.2 22.0 9.0 38.2 12.9 40.2 12.2 54.2 33.0 12.3 14.7 11.4 16.1 30.4 40.3 10.1 41.2 27.6 12.6 5.3 5.1 16.5 10.5 44.4 5.2 77.7 41.6 5.1 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 0.4 2.7 1.4 0.7 1.7 2.8 1.3 10.1 2.4 0.5 3.2 0.8 Rural Total
System
Place of service
Estimated value (%)
77.0
Subsidized
Government health post
9.9
5.1
40.5
Contributory
29.3
Private clinic or hospital
13.8
322
52.6
Non affiliated
Government health center
10.5
Private doctor
20.9
57.5
Total
Government health post
8.4
18.4
Table 35. Oral health habits in the population under the age of 10 by system and area
Urban Rural Total
System
Habit
Relative Relative Relative 95% confidence Estimated value 95% confidence Estimated value 95% confidence Estimated value Standard error Standard error Standard error interval interval interval (%) (%) (%) (%) (%) (%) 24.2 1.1 23.6 24.7 22.1 4.7 19.9 24.4 23.0 2.7 21.7 24.3
Brushing teeth with toothpaste 8.4 1.5 8.2 8.7 6.1 10.8 4.7 7.5 7.1
Subsidized
Learning how to keep their mouth clean 7.8 1.7 7.5 8.1 4.0 10.0 3.2 4.9 5.6
5.5
6.3
7.9
Cleaning gums with floss 27.2 0.8 26.8 27.7 26.4 9.9 20.9 32.0
4.4
5.1
6.1
Brushing teeth with toothpaste 10.3 1.8 9.9 10.7 10.4 15.7 6.9
27.1
1.7
26.2
28.1
Contributory
Learning how to keep their mouth clean 8.6 2.0 8.2 9.0 5.1 7.7
13.8
10.3
2.9
9.7
10.9
323
Cleaning gums with floss 20.1 1.3 19.6 20.6 17.7
4.3
6.0
8.1
2.2
7.7
8.4
Brushing teeth with toothpaste 14.9 1.3 14.5 15.3
38.9
3.1
32.3
19.2
12.7
14.0
24.4
APPENDICES
Special
Cleaning gums with floss 13.7 1.3 13.3
17.7
38.9
3.1
32.3
15.9
15.3
10.7
21.1
Checking toothbrush
14.0
8.4
86.5
0.0
23.9
11.8
21.1
6.5
17.1
Urban
Rural
Total
System
Habit
Relative Relative Relative 95% confidence Estimated value 95% confidence Estimated value 95% confidence Estimated value Standard error Standard error Standard error interval interval interval (%) (%) (%) (%) (%) (%) 26.0 2.0 24.9 27.1 19.0 12.5 14.0 24.1 22.1 6.1 19.3 25.0
Brushing teeth with toothpaste
Non affiliated
Cleaning gums with floss 13.3 3.6 12.3 14.4 4.9 21.7 2.7 7.2 8.6
7.5
7.3
10.0
Learning how to keep their mouth clean 10.5 2.9 9.8 11.1 5.9 22.2 3.1 8.7 7.9 25.3 0.8 24.8 25.7 21.9 4.0 20.0 23.7 23.6
9.6
6.3
9.5
Brushing teeth with toothpaste
1.9
22.6
24.5
324
Total 9.2 1.3 8.9 9.4 6.4 8.6
Learning how to keep their mouth clean 5.3 8.8 1.8 8.4 9.1 4.3 7.8 3.6
7.6
7.8
3.6
7.2
8.4
Cleaning gums with floss
5.0
6.6
2.9
6.2
7.0
Table 36. Adult population distribution according to oral health habits by enrollment system and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 4.3 5.7 11.7 2.5 11.1 Estimated amount 20.9 21.7 5.0 6.7 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 0.8 Rural Total 95% confidence interval 12.3
System
Oral care
Estimated value (%) 21.3
Dental floss (6-69 years old) 26.5 1.5 25.7 27.4 23.1 5.9 20.2 26.0 24.4 3.6
Subsidized
Fluoride applications or rinses (6-19 years old) 21.5 47.9 0.8 47.1 48.7 29.9 8.4 24.5 35.3 1.8 20.7 22.3 25.0 6.9 21.3 28.7 23.7 45.1
22.5
26.3
4.6 1.3
21.4 43.8
26.0 46.4
Dental floss (6-69 years old) 31.5 0.8 31.0 32.1 32.2 15.6 21.5
Contributory
Fluoride applications or rinses (6-19 years old) 24.5 39.1 1.8 37.6 40.6 27.3 37.9 0.8 24.1 24.9 26.5 17.3 16.7 5.3
42.9
31.6
2.7
29.8
33.4
36.3 49.3
24.8 34.8
3.0 12.0
23.2 26.0
26.4 43.7
325
Dental floss (6-69 years old) 21.1 49.3 0.0 42.3 43.1
Special
Fluoride applications or rinses (6-19 years old) 12.5 55.4 0.0 26.6
44.6
2.2
84.1
29.8
25.9
13.4
46.2
APPENDICES
85.7
9.8
67.7
100.0
32.0
33.3
9.1
54.8
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 95% confidence interval 14.8 18.2 4.1 7.8 16.5 4.7 Estimated amount 29.2 31.5 5.9 14.8 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 1.8
Rural
Total
System
Oral care
Dental floss (6-69 years old) 17.9 3.6 16.5 19.3 11.0 19.8 6.3 15.6 13.7 9.7 10.8
Non affiliated
Fluoride applications or rinses (6-19 years old) 17.4 30.4 0.5 30.1 30.7 6.6 4.9 5.9 7.3 18.3 1.1 17.0 17.8 9.3 21.4 5.0 13.5 12.3 10.3 1.7
16.5
9.6 17.6
15.0 18.9
Dental floss (6-69 years old) 26.7 1.0 26.2 27.3 21.8 5.3 19.4 24.3
Total
Fluoride applications or rinses (6-19 years old) 21.7 0.9 21.3 22.2 22.9 6.2 19.9 25.9
24.0
2.8
22.6
25.4
326
22.4
3.6
20.7
24.1
Table 37. Distribution of the population according to knowledge of causes of caries by system and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 60.5 29.2 7.3 62.2 8.6 2.9 88.1 11.1 0.0 52.1 30.4 19.0 1.9 31.5 9.3 3.8 8.3 4.7 60.6 28.9 7.7 10.9 97.2 77.3 23.9 65.1 42.8 11.1 65.6 34.0 10.9 16.9 26.2 11.7 89.6 35.3 19.2 69.6 25.7 15.9 73.3 20.2 17.1 79.6 84.2 10.7 14.6 3.6 0.9 1.8 4.4 1.2 17.5 12.8 2.5 6.7 5.9 0.9 3.3 2.5 34.6 23.0 3.6 65.8 71.0 1.1 69.3 21.2 13.5 82.7 25.2 10.6 87.3 22.2 14.0 65.8 22.0 13.9 72.0 18.8 16.2 80.7 10.3 21.4 86.2 27.9 11.5 87.6 29.6 24.3 82.7 11.7 24.8 82.8 8.8 24.3 9.4 25.3 84.1 27.2 7.9 63.1 12.1 36.6 84.1 58.6 5.2 8.0 25.7 8.4 86.5 31.2 44.2 35.3 88.3 92.6 2.3 13.6 6.9 27.5 29.3 12.7 15.4 87.0 70.9 5.8 23.3 9.0 8.8 11.2 31.9 4.0 82.6 63.1 2.0 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 0.6 2.0 2.0 0.2 1.1 3.9 0.2 1.3 1.3 0.4 0.9 2.2 0.3 1.4 1.0 Rural Total 95% confidence interval 72.7 24.7 15.8 85.7 27.1 12.8 91.9 48.4
System
Reason
Estimated value (%)
Poor or no brushing
81.7
Subsidized
Unknown
10.7
Consumption of sweets
22.4
Poor or no brushing
86.6
Contributory
28.6
Poor diet
12.6
Poor or no brushing
87.9
Special
30.4
327
Infection
25.0
24.3 73.3 29.3 17.9 74.7 21.6 18.0
Poor or no brushing
83.4
Non affiliated
Unknown
11.9
26.0
APPENDICES
Poor or no brushing
83.5
Total
Unknown
9.1
24.8
Table 38. Distribution of the population according to knowledge about the causes of
gum bleeding or swelling by system and area

Urban Relative Standard error (%) 95% confidence interval 95% confidence interval Estimated amount Estimated amount 50.4 35.8 17.2 14.4 63.5 29.6 28.1 31.5 32.4 26.8 35.4 46.5 10.6 0.3 87.7 77.6 74.8 36.2 21.3 16.0 63.1 45.7 44.9 17.7 3.4 3.3 1.1 1.6 2.7 4.3 7.2 9.1 11.8 16.8 2.6 1.7 48.6 33.9 15.9 13.4 62.0 28.6 20.0 14.6 53.5 36.9 33.6 11.4 43.4 45.8 11.3 11.8 60.0 11.0 21.7 23.1 60.1 52.2 42.7 18.2 23.0 21.7 17.2 14.6 13.9 15.3 10.7 8.5 13.4 6.6 51.6 68.3 6.8 10.1 13.5 7.7 9.5 13.2 3.2 42.7 48.8 3.1 40.5 46.3 Relative Standard error (%) Relative Standard error (%) 0.5 1.0 1.5 1.2 0.7 1.1 2.0 1.9 1.3 1.7 1.5 1.3 16.9 17.9 44.6 47.5 40.6 43.7 63.0 66.5 14.2 15.3 20.3 22.1 32.2 33.8 63.3 65.0 17.5 18.5 24.4 26.0 21.8 22.7 59.2 60.5 Rural Total 95% confidence interval
System
Reason
Estimated amount
Poor or no brushing
59.9
52.2 37.8 18.4 15.4 65.0 30.6 22.5 17.5 72.7 54.6 56.1 24.0
Subsidized
Unknown
22.3
Gum weakness
25.2
Infection
18.0
Poor or no brushing
64.1
328
Contributory
Gum weakness
33.0
Infection
21.2
Unknown
14.7
Poor or no brushing
64.7
Special
Infection
42.2
Gum weakness
46.0
Unknown
17.4
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval Estimated amount Estimated amount 45.9 38.8 18.2 13.3 52.3 32.5 19.8 14.3 15.8 7.2 7.8 1.3 2.2 2.4 2.5 4.3 35.2 15.4 11.1 50.8 30.9 18.8 15.0 3.2 42.8 33.0 54.2 12.9 11.9 42.9 45.6 11.8 12.7 6.0 11.1 7.1 10.0 13.5 2.9 42.8 48.3 2.8 40.3 45.5 15.0 8.1 15.7 17.4 8.2 17.7 4.6 48.9 59.5 6.9 28.1 37.8 Relative Standard error (%) Relative Standard error (%) 49.0 42.3 21.0 15.6 53.7 34.0 20.8 16.7 0.8 1.8 3.2 5.3 0.4 0.9 0.5 1.3 18.4 19.5 27.5 28.1 19.2 20.0 60.9 62.0 13.4 16.8 23.1 26.4 18.6 20.1 61.1 63.2 95% confidence interval
Rural
Total
System
Reason
Estimated amount
Poor or no brushing
62.2
Non affiliated
Unknown
19.3
Gum weakness
24.8
Infection
15.1
Poor or no brushing
61.5
Total
Unknown
19.6
Gum weakness
27.8
Infection
18.9
329
APPENDICES
Table 39. Consultation prevalence in the last 30 days in the population between the ages of 6 and 69 by system and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 0.5 0.5 0.4 0.0 0.3 1.3 1.3 0.1 0.1 0.0 1.2 16.7 26.4 0.3 0.6 47.8 26.7 1.2 0.4 0.0 0.3 2.7 1.2 0.1 0.8 2.5 2.5 1.3 0.6 0.9 2.7 1.7 1.4 4.0 3.5 1.8 0.6 1.4 3.6 3.0 1.6 0.5 1.4 1.8 0.5 2.3 1.1 22.0 48.8 12.4 4.1 4.7 6.9 3.1 6.3 4.3 5.1 7.0 12.8 5.7 2.7 1.9 14.0 2.7 2.4 10.8 1.9 1.3 0.6 0.0 1.0 3.7 3.1 1.6 0.5 1.2 3.2 2.7 1.4 0.4 1.3 Estimated value (%) 3.3 2.2 0.8 0.1 1.8 5.8 4.7 2.9 1.0 2.3 5.1 4.0 2.3 0.7 2.2 2.2 0.8 2.4 0.9 4.2 1.9 5.3 1.9 16.7 2.4 0.4 42.1 1.1 0.1 3.5 3.0 0.6 39.5 4.9 2.0 16.3 6.0 2.0 16.3 1.8 1.0 33.2 0.1 0.8 55.0 0.8 1.3 33.9 2.2 1.6 32.2 3.3 1.6 32.2 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 0.4 0.4 0.4 0.4 0.4 1.1 1.3 1.0 2.8 0.1 0.8 1.1 0.9 2.7 0.1 95% confidence interval 3.0 2.4 1.6 1.0 1.8 4.4 3.8 2.1 0.6 1.6 3.9 3.3 1.9 0.7 1.6 Rural Total
Gender
High blood pressure
Estimated value (%) 3.3 2.2 0.8 0.1 1.8 5.9 4.8 2.9 1.0 2.4 5.2 4.1 2.3 0.8 2.2
Diagnosis at 2 or more appointments
Medications for control
Men
Attended a nutrition consultation
Attended a psychology consultation
Taught exercises
Women
330
Taught exercises
Total
Taught exercises
Table 40. Prevalence of diabetes and related controls among people between the ages of 18 and 69 by gender and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 0.7 0.0 0.1 0.0 0.7 0.1 0.2 0.0 0.9 0.2 0.3 42.8 0.0 1.3 0.9 2.1 1.2 1.2 0.8 1.4 2.3 2.1 1.5 1.1 0.7 2.0 1.4 1.0 0.7 0.9 0.7 1.5 0.9 22.3 22.7 8.6 9.5 11.3 15.0 6.8 8.2 10.2 12.6 1.4 1.1 16.6 2.7 1.9 13.4 1.4 0.7 0.4 0.4 1.7 1.2 0.8 0.5 1.8 1.1 0.8 0.5 1.9 1.3 0.5 0.9 2.6 2.1 1.4 0.9 2.4 1.9 1.2 0.9 1.1 0.4 1.4 0.7 27.7 2.1 0.7 31.6 2.6 1.5 18.2 0.9 0.4 47.1 1.4 0.7 35.9 2.1 0.8 39.6 2.7 1.5 25.7 1.6 0.3 99.1 1.3 0.8 40.9 2.0 0.7 49.2 2.6 1.7 28.4 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 8.0 10.9 20.0 14.6 1.0 0.1 0.1 0.1 2.0 2.4 3.9 5.1 Rural Total 95% confidence interval 2.5 1.5 1.3 1.1 2.5 1.8 1.3 0.9 2.3 1.6 1.2 0.9 APPENDICES
Gender
Diabetes
Estimated value (%)
Diagnosis
2.2
1.7
Men
0.9
Taught exercises
1.2
Diagnosis
2.6
2.1
Women
1.4
Taught exercises
0.9
Diagnosis
2.5
331
2.0
Total
1.3
Taught exercises
1.0
Table 41. Prevalence of back or neck pain among people between the ages of 18 and 69 by gender and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 6.8 1.0 7.1 11.0 7.2 1.5 6.8 11.8 7.7 1.7 7.5 12.4 10.2 3.0 10.6 15.6 15.7 10.5 3.1 4.2 11.3 19.8 13.2 3.9 11.2 19.2 10.0 13.8 18.1 17.7 5.3 2.4 4.7 3.7 2.3 2.3 4.5 3.3 2.1 12.7 10.9 6.6 3.7 3.1 10.8 2.4 9.4 15.7 13.1 3.8 10.5 18.9 12.6 3.5 10.4 18.3 12.8 11.8 6.4 10.2 13.3 3.5 11.2 19.8 18.3 5.6 13.5 24.9 17.1 5.1 13.0 23.7 24.5 14.0 5.4 13.6 9.0 8.0 5.6 2.3 13.9 17.5 8.9 6.6 25.7 13.8 6.6 14.1 8.6 10.1 6.3 2.3 16.0 18.9 8.6 7.7 22.2 14.6 11.6 12.7 9.9 13.5 4.2 2.4 26.2 14.5 9.8 14.4 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 13.4 3.8 12.4 19.7 14.6 4.7 12.2 20.8 13.9 4.3 12.0 20.1 2.1 3.9 3.0 2.7 0.8 2.7 1.0 0.7 0.5 2.1 1.2 0.9 95% confidence interval Rural Total
Gender
In the past week
Estimated value (%)
Have had back pain
13.9
Pain radiates to legs
3.8
Men
Have had neck pain
12.0
Have had back or neck pain
21.0
Have had back pain
18.6
5.9
Women
Have had neck pain
13.8
25.3
Have had back pain
17.3
332
5.4
Total
Have had neck pain
13.3
24.1
Table 42. Distribution of the population aged 18 to 69 according to their opinion of: If other children insult or hit your child,
would you tell him or her to insult them and hit back, not to give in by gender and area
Urban Rural Total
Degree of agreement 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 10.4 10.0 10.1 12.9 10.9 21.3 73.4 72.3 70.9 78.1 75.6 11.5 76.7 79.2 78.4 3.6 3.2 8.6 5.4 4.4 1.4 0.9 0.7 5.7 9.1 9.2 9.4 10.6 9.6 10.4 74.4 77.7 77.2 9.8 6.5 7.5 21.1 18.4 19.2 69.0 75.2 73.3 1.5 1.8 3.0 64.7 5.1 17.2 6.4 15.9 20.8 9.9 16.7 25.6 8.3 6.2 8.8 10.9 5.0 7.9 11.5 7.4 12.2 Relative Standard error (%) Relative Standard error (%)
Gender
Estimated value (%) 10.5 12.7 12.2 3.8 3.8 3.9 84.5 82.1 82.8 83.9 83.4 85.4 4.3 4.4 4.4 13.0 13.6 11.3
Men
10.9
1.7
11.6 10.8 10.8 15.3 12.1 12.5
Agree
Women
13.2
1.7
Total
12.6
1.5
Men
4.1
3.5
Uncertain
Women
4.1
3.3
Total
4.1
2.5
333
Men
85.0
0.3
79.0 80.6 79.6
Disagree
Women
82.7
0.4
Total
83.4
0.3
APPENDICES
Table 43. Distribution of the population aged 18 to 69 according to their opinion of: Corporal punishment is sometimes necessary to discipline children by gender and area
Urban 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 12.1 12.6 12.4 12.4 11.8 12.0 72.8 75.1 68.5 73.4 75.5 75.6 75.6 3.1 8.8 5.2 4.6 1.4 0.9 0.8 3.2 5.9 10.6 11.7 11.6 10.1 10.5 10.8 73.2 74.1 74.3 11.6 8.6 9.5 19.8 19.4 19.5 68.6 72.0 71.0 1.6 2.0 68.9 2.9 64.4 5.6 17.2 21.8 6.3 16.8 22.0 10.5 15.4 24.2 6.9 8.1 10.9 8.6 7.0 10.2 10.8 8.9 14.2 Relative Standard error (%) Relative Standard error (%) Rural Total 95% confidence interval
Degree of agreement
Gender
Estimated value (%) 4.8 1.9 2.5 5.5 2.9 1.7 0.8 0.4 0.4 79.2 80.7 78.2 79.6 81.5 84.2 4.7 5.0 4.6 5.3 4.0 5.0 14.4 16.0 15.5 16.8 11.4 14.0
Men
12.7
13.6 13.4 13.2 14.7 13.1
Agree
Women
16.2
Total
15.2
Men
4.5
Uncertain
Women
5.0
334
Total
4.8
13.2 77.7 77.1 76.9
Men
82.8
Disagree
Women
78.9
Total
80.0
Table 44. Distribution of the population aged 18 to 69 according to their opinion of:
Physical aggression is necessary to earn others respect by gender and area

Degree of agreement
Gender
Estimated value (%) 3.5 1.0 1.2 0.5 3.3 2.0 0.2 0.1 0.1 92.1 92.6 92.8 93.2 90.2 91.1 2.4 2.6 2.0 2.3 3.5 3.6 5.0 5.3 4.8 5.0 5.4 6.2
Men
5.8
5.5 4.3 4.5 14.6 11.3 11.9
Agree
Women
4.9
Total
5.1
Men
3.6
Uncertain
Women
2.1
Total
2.5
335
Men
90.6
85.4 87.4 86.5
Disagree
Women
93.0
Total
92.3
APPENDICES
Table 45. Distribution of the population aged 18 to 69 according to their opinion of: Physical aggression is sometimes necessary to resolve problems by gender and area
Urban Rural Total
Gender
Estimated value (%) 1.5 3.3 2.3 2.0 3.2 2.8 0.1 0.2 0.1 92.8 93.3 93.4 94.1 91.1 91.3 2.7 3.1 2.5 2.8 3.3 3.6 3.9 4.3 3.3 3.8 5.2 5.6
Men
5.4
5.4 3.3 3.8 14.7 11.1
Agree
Women
3.6
Total
4.1
Men
3.4
Uncertain
Women
2.7
336
Total
2.9
11.7 85.4 88.4 87.1
Men
91.2
Disagree
Women
93.8
Total
93.1
If a man hits a woman, its probably because she gave him a reason to by gender and area
Urban Rural Total
Gender
Estimated value (%) 4.6 1.7 2.0 3.5 2.0 1.9 0.7 0.3 0.1 81.6 82.0 83.0 84.2 75.9 78.2 7.3 7.9 7.0 7.6 7.9 9.2 10.1 11.0 8.8 9.4 13.0 15.8
Men
14.4
11.6 6.9 8.1 17.7 14.1 14.7
Agree
Women
9.1
Total
10.6
Men
8.6
Uncertain
Women
7.3
Total
7.6
337
Men
77.0
76.7 82.2 80.1
Disagree
Women
83.6
Total
81.8
APPENDICES
Table 47. Distribution of the population aged 18 to 69 according to their opinion of: There are situations that justify a man slapping his wife or partners face by gender and area
Urban Rural Total
Gender
Estimated value (%) 0.9 1.0 0.7 13.2 3.1 4.7 0.7 0.1 0.1 89.2 89.8 91.1 91.6 83.5 86.0 3.2 3.9 2.9 3.3 3.4 6.1 6.8 7.0 5.5 5.7 10.3 10.7
Men
10.5
8.6 4.5 5.5 16.2 12.0
Agree
Women
5.6
Total
6.9
Men
4.8
Uncertain
Women
3.1
338
Total
3.5
12.8 81.1 86.6 84.5
Men
84.8
Disagree
Women
91.3
Total
89.5
Physical aggression between members of the same family is a private matter by gender and area
Urban Rural Total
Gender
Estimated value (%) 4.1 2.0 2.1 3.4 4.4 3.8 0.9 0.3 0.3 78.8 79.9 79.4 80.5 76.2 79.3 3.6 4.3 3.5 4.3 3.8 4.3 16.0 17.5 15.5 16.9 16.6 19.8
Men
18.2
16.0 12.9 13.5 15.7 13.1 13.4
Agree
Women
16.2
Total
16.7
Men
4.1
Uncertain
Women
3.9
Total
3.9
339
Men
77.7
75.0 77.5 76.3
Disagree
Women
79.9
Total
79.3
APPENDICES
Table 49. Distribution of the population aged 18 to 69 according to their opinion of: Physical aggression should
only be a considered a crime if someone who is not a member of the family is the victim by gender and area
Urban Rural Total
Gender
Estimated value (%) 7.7 2.8 4.3 3.3 8.5 6.8 0.7 0.6 0.6 87.6 90.0 87.5 89.9 87.8 90.3 3.6 4.8 3.8 5.5 2.9 3.4 6.4 7.6 6.3 7.1 6.6 9.1
Men
7.8
7.6 6.0 6.3 14.5 12.5
Agree
Women
6.7
Total
7.0
Men
3.1
Uncertain
Women
4.6
340
Total
4.2
12.7 83.6 84.8 84.1
Men
89.0
Disagree
Women
88.7
Total
88.8
Table 50. Distribution of the population aged 18 to 69 according to their of about:
Not responding to physical aggression means you are a coward by gender and area
Urban Rural Total
Gender
Estimated value (%) 9.6 2.6 1.5 0.5 1.3 1.0 0.7 0.2 0.1 91.2 91.5 91.6 92.2 88.7 91.2 3.1 3.2 2.9 3.0 3.7 3.7 5.3 5.7 4.9 5.4 5.1 7.7
Men
6.4
6.9 4.5 5.0 14.2 11.5 11.9
Agree
Women
5.1
Total
5.5
Men
3.7
Uncertain
Women
2.9
Total
3.2
341
Men
89.9
84.7 87.0 85.9
Disagree
Women
91.9
Total
91.4
APPENDICES
Physical violence is caused by drinking by gender and area

Urban Rural Total
Gender
Estimated value (%) 6.0 2.1 3.3 1.2 1.5 1.1 0.7 0.2 0.3 83.0 84.1 84.1 84.7 80.2 82.6 7.3 7.7 6.8 7.3 8.4 8.8 8.3 9.6 8.2 8.9 8.7 11.2
Men
10.0
8.9 6.6 7.2 17.4 14.0
Agree
Women
8.6
Total
8.9
Men
8.6
Uncertain
Women
7.1
342
Total
7.5
14.6 79.3 82.5 81.2
Men
81.4
Disagree
Women
84.4
Total
83.6
People who are physically violent have more power than other people by gender and area
Degree of agreement
Gender
Estimated value (%) 2.1 2.5 2.1 0.5 2.1 1.6 0.1 0.1 0.1 92.4 92.8 92.6 93.1 91.7 92.2 3.1 3.3 3.1 3.4 3.0 3.1 4.1 4.4 3.7 4.2 4.8 5.2
Men
5.0
4.9 3.9 4.0 14.9 12.0 12.5
Agree
Women
3.9
Total
4.2
Men
3.1
Uncertain
Women
3.2
Total
3.2
343
Men
91.9
85.9 87.1 86.4
Disagree
Women
92.8
Total
92.6
APPENDICES
Table 53. Distribution of the population aged 18 to 69 according to their opinion:
Physical violence only occurs among the poorest people by gender and area
Urban Rural Total
Gender
Estimated value (%) 3.2 5.9 4.4 0.5 3.9 2.9 0.2 0.6 0.4 87.9 89.6 87.1 89.5 89.4 90.2 4.0 4.5 4.0 4.7 3.9 4.0 6.4 7.7 6.4 8.2 5.8 6.7
Men
6.3
6.5 6.5 6.3 14.8 12.8
Agree
Women
7.3
Total
7.0
Men
3.9
Uncertain
Women
4.4
344
Total
4.3
13.0 84.2 84.3 83.9
Men
89.8
Disagree
Women
88.3
Total
88.7
People who are physically aggressive to other people are sick by gender and area
Urban Rural Total
Gender
Estimated value (%) 3.8 4.6 3.6 0.5 3.6 2.5 0.3 0.4 0.3 84.0 84.9 84.0 85.4 83.1 84.3 6.4 7.1 5.5 6.4 8.9 9.1 8.1 9.5 8.5 10.3 6.7 7.9
Men
7.3
7.4 7.8 7.5 18.4 13.9 14.8
Agree
Women
9.4
Total
8.8
Men
9.0
Uncertain
Women
5.9
Total
6.8
345
Men
83.7
79.7 81.7 80.7
Disagree
Women
84.7
Total
84.4
APPENDICES
Table 55. Distribution of the population between the ages of 18 and 69 according
to their history of physical violence in the household by gender and area

Urban Rural Total
History of aggression 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 36.3 28.0 30.4 12.0 11.2 11.4 2.3 2.0 5.3 3.8 3.3 3.1 34.0 26.6 29.1 10.6 10.3 10.6 34.4 21.9 25.8 12.9 8.5 9.9 7.3 8.4 9.5 6.8 10.2 11.4 9.5 10.3 15.5 4.7 23.2 28.4 5.7 19.2 24.5 6.0 30.0 38.8 Relative Standard error (%) Relative Standard error (%)
Gender
Estimated value (%) 1.5 0.6 0.6 0.9 1.8 1.3 12.5 13.2 13.1 14.2 10.7 11.1 34.3 35.3 33.1 33.8 37.1 39.5
Men
38.3
38.7 29.3 31.7 13.3 12.1
Corporal punishment in the household under the age of 18
Women
33.4
Total
34.8
Men
10.9
History of physical violence between parents
Women
13.6
346
Total
12.9
12.2
Table 56. Prevalence of coughing in the population between ages 18 and 69 by gender and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 3.6 9.8 6.2 11.0 4.7 Estimated value (%) 3.5 7.7 6.7 21.5 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 17.9 Rural Total 95% confidence interval 7.6
Gender
Symptoms of Respiratory Problems
Estimated value (%)
Do you usually have a cough?
5.6
Do you usually cough more than 4-6 times per day 4 or more days per week? 12.6 0.0 100.0 87.6 7.5 4.6 100.0 79.7
69.5
3.6
43.1
100.0
Men 22.8 0.0 100.0 56.4 16.2 0.0 100.0
Do you usually cough like this most days for 3 consecutive months or more during the year? 27.5 16.0 5.6 11.4 8.5 16.8 5.5 0.0 20.7 2.7 31.0 0.0 13.4 11.5
41.2
49.7
6.7
7.4
92.1
For how many years have you had a cough?
4.6
3.5 8.5
4.4 5.7
1.6 7.5
5.5 9.5
Do you usually have a cough?
8.5
347
Do you usually cough more than 4-6 times per day 4 or more days per week? 9.4 0.0 100.0 79.5 6.5
65.2
14.1
100.0
72.0
2.8
46.7
97.3
Women 19.6 0.0 100.0 56.4
Do you usually cough like this most days for 3 consecutive months or more throughout the year? 22.0 0.0 8.4 3.2
41.6
10.6
0.0
100.0
48.6
4.2
22.6
74.6
APPENDICES
For how many years have you had a cough?
2.2
20.2
0.0
11.4
2.7
8.3
0.0
5.5
Table 57. Prevalence of phlegm in the population between ages 18 and 69 by gender and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 2.8 8.1 6.2 8.2 5.1 Estimated value (%) 4.3 9.7 5.5 23.0 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 18.2 95% confidence interval 7.3 Rural Total
Gender
Symptoms of phlegm
Do you usually cough up phlegm from your chest? 63.0 11.9 47.7 78.3 48.0 3.7 44.3 51.6 56.1 9.4
Men 30.6 19.1 18.6 42.5 45.0 11.0 34.8 55.1 37.1
Do you usually cough up phlegm twice a day 4 or more days per week? 15.1
45.4
66.9
Have you had phlegm for three or more consecutive months during the year? 8.0 8.1 14.4 5.6 10.6 4.4 19.3 2.6 6.3 0.2 4.8 11.2 3.4 0.1 2.8 4.1 5.9 6.4
25.6
48.6
For how many years have you had phlegm?
0.2 4.7
3.3 5.7
8.5 7.0
Do you usually cough up phlegm from your chest? 42.3 12.7 31.3 53.4 63.9 16.9 41.8
348
Women 18.7 29.9 7.2 30.1 34.6 10.6
Do you usually cough up phlegm twice a day 4 or more days per week?
86.0
49.4
10.1
39.2
59.7
Have you had phlegm for three or more consecutive months during the year? 3.9 0.2 2.6 5.3 2.6
27.1
42.1
23.9
17.9
15.1
32.7
For how many years have you had phlegm?
0.1
2.0
3.3
3.5
0.1
2.5
4.5
Table 58. Prevalence of wheezing in the population between ages 18 and 69 by gender and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 1.6 6.4 5.9 7.8 4.9 Estimated value (%) 5.2 10.7 4.0 27.9 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 16.4 Rural Total 95% confidence interval 6.9
Gender
Wheezing symptoms
Do you wheeze when you have a cold? 1.4 36.1 0.3 2.5 1.2 50.0 0.0 2.4 1.3 18.4
Men 2.6 2.5 7.1 1.6 1.9 2.7 5.5 0.8 4.7 3.5 20.9 1.1 2.8 0.2 70.7 31.1 24.1 0.8 2.4 0.4 51.4 0.0 0.0 0.0 14.1 4.9 9.2 4.5 20.0 2.6 4.3 1.1 3.8 2.2 34.8 0.0 11.9 6.4 0.9 0.6 17.2 26.7 1.1 4.1 1.4 46.0 0.0 2.7 2.0 2.4 5.8 1.0 1.1 2.8
Do you sometimes have wheezing when you do not have a cold?
0.8
1.8
Do you have wheezing most days or at nights?
12.6 1.5 5.3 9.5 7.1 0.0
1.5 2.0 5.2 0.8 1.0 2.4
2.5 2.9 6.5 1.2
For how many years have you had wheezing?
Do you wheeze when you have a cold?
Women
Do you have wheezing when you do not have a cold?
349
Do you have wheezing nost days or at nights?
1.3 3.3
For how many years have you had wheezing?
APPENDICES
Table 59. Prevalence of dyspnoea in the population between ages 18 and 69 by area
Urban 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 9.6 3.1 8.9 6.1 13.4 4.4 7.8 Relative Standard error (%) Relative Standard error (%) 10.2 95% confidence interval Rural Total
Symptoms of Respiratory Problems
Estimated value (%) 8.6 10.5 15.2
Have you experienced shortness of breath or been breathless? 5.3 19.2 30.6 28.3 7.0 19.8 36.8 25.8 1.1 24.5
12.9
How old were you when you had your first episode of breathlessness? 9.9 7.4 11.3 4.5 15.2 3.1 6.0 7.0 4.2
24.9
27.1
Have you had 2 or more episodes of breathlessness? 11.0 3.6 5.7 1.5 25.0 0.7 2.3 3.1
9.4
6.4
7.6
Have you needed medications or treatment for episodes of breathlessness? 9.7 10.2 15.5 6.2 14.9 4.2 8.1 9.6
4.6
5.1
2.8
3.4
Have you experienced shortness of breath when running or walking uphill?
12.8
3.0
9.0
10.2
350
Have you had to walk more slowly than other people your age when walking on flat terrain due to shortness of breath? 12.5 4.9 8.4 3.3 16.8 2.1
6.7
4.5
5.0
4.6
4.5
5.5
Have you needed to stop to catch your breath when walking on flat terrain? 13.2 3.7 6.6 2.4 20.5 13.4 3.6 6.5 2.4 20.1
5.1
1.3
3.4
3.8
5.7
3.3
4.2
After walking for a few minutes on flat terrain, have you needed to stop to catch your breath? 19.4 1.4 3.2 1.1
5.1
1.4
3.4
3.8
5.8
3.3
4.2
Have you had breathing problems when dressing or undressing?
2.3
30.1
0.4
1.8
1.7
10.7
1.3
2.1
Table 60. Distribution of the population between the ages of 12 and 69 according to their
risk for alcohol dependency by gender, age range, and area

Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 0.0 1.2 1.8 NA 4.8 5.8 2.0 NA 0.6 NA NA NA NA 0.2 47.5 22.5 0.6 NA 2.3 7.6 4.4 5.0 1.2 4.9 NA 8.5 24.5 13.0 0.0 0.9 0.5 NA 1.9 2.4 0.8 NA 0.8 NA NA NA NA 0.2 0.8 2.4 0.7 NA 2.7 7.6 1.5 3.9 18.3 8.6 8.8 14.2 4.9 0.1 1.6 3.3 0.7 1.5 1.5 1.6 0.5 2.7 3.7 2.4 3.8 6.0 2.7 NA 7.0 2.7 5.0 4.2 5.6 6.6 14.0 5.1 3.1 9.7 4.9 3.2 4.7 5.5 4.9 20.5 8.0 3.4 3.0 3.9 11.6 3.6 5.9 5.2 11.5 1.7 0.9 23.0 0.4 4.0 4.6 6.2 7.6 10.0 4.4 0.1 1.3 2.9 0.7 1.3 1.3 1.4 0.3 2.3 3.5 2.3 3.5 4.5 2.5 0.9 7.0 7.0 13.5 1.0 16.5 6.9 0.2 1.9 5.6 1.4 2.6 2.9 2.6 0.6 3.4 6.0 4.5 5.0 7.0 4.0 5.2 4.6 6.7 4.3 1.6 0.6 0.4 3.2 0.2 3.5 3.2 NA NA 2.7 NA NA 1.4 NA NA 6.5 NA NA 3.1 0.7 5.2 0.2 NA NA 7.0 3.0 15.3 20.0 12.0 24.5 20.6 6.7 13.5 14.1 NA NA 7.4 2.3 9.4 7.5 3.6 30.6 1.0 0.8 47.4 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 1.1 1.6 1.6 0.9 44.5 4.5 0.3 0.6 11.7 3.7 0.3 1.3 2.1 4.9 0.6 5.7 2.6 0.4 0.9 2.0 2.2 Rural Total 95% confidence interval 1.3 6.5 5.5 7.8 10.0 18.4 5.4 0.1 1.9 3.6 0.8
Gender
Age
Estimated value (%)
12-17 years old
0.9
18-29 years old
7.3
30-39 years old
7.2
Men
40-49 years old
13.8
50-59 years old
10.8
60-69 years old
18.2
12-69 years old
7.0
12-17 years old
0.2
18-29 years old
2.5
30-39 years old
6.1
Women
40-49 years old
1.4
351
50-59 years old
2.7
1.6 1.7 1.7 0.7 3.2 4.0 2.6 4.1 7.5 2.9
60-69 years old
3.0
12-69 years old
2.9
12-17 years old
0.6
18-29 years old
3.9
30-39 years old
6.4
APPENDICES
Total
40-49 years old
4.6
50-59 years old
5.1
60-69 years old
7.3
12-69 years old
4.2
Table 61. Prevalence of adolescent smokers and former smokers by gender and area
Urban Rural Total
Gender Relative Standard error (%) 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 3.1 3.1 NA NA 0.1 NA 0.1 2.2 2.2 0.2 0.1 NA NA 0.1 0.1 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.2 NA NA 0.3 1.1 1.1 NA NA 0.6 0.6 0.2 0.2 NA 0.3 0.3 NA NA NA NA NA NA NA 0.3 0.3 NA 0.5 0.6 NA
Classification
Estimated value (%)
Smoker
0.5
0.3 0.2 NA NA 0.1 0.1
Men
Ex-smoker
0.3
Smoker
NA
Women
Ex-smoker
NA
Smoker
0.3
352
Total
Ex-smoker
0.2
Table 62. Prevalence of adult smokers and ex-smokers among people between the ages of 18 and 69 by gender and area
Urban Rural Total
Gender 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 6.3 3.8 2.1 2.0 3.3 2.5 4.3 6.7 5.7 5.6 8.6 9.5 5.1 3.1 1.9 1.7 2.9 2.2 5.7 2.7 0.9 1.1 2.4 1.6 16.2 1.0 2.1 15.5 1.6 3.2 25.0 0.5 1.6 18.8 0.6 1.3 21.8 1.4 3.9 19.8 3.3 8.1
Classification
Estimated value (%) 3.7 4.7 1.0 3.1 1.6 3.7 3.2 3.7 4.0 4.3 2.7 3.1 3.0 3.2 4.4 5.4 6.4 7.5
Smoker
7.0
7.6 4.4 2.3 2.3 3.7 2.8
Men
Ex-smoker
4.9
Smoker
3.1
Women
Ex-smoker
2.9
Smoker
4.2
Total
Ex-smoker
3.5
353
APPENDICES
Table 63. Distribution of the population aged 12 to 69 according to the practice of light exercise by gender and area
Urban Rural Total
Gender 95% confidence interval 95% confidence interval Estimated value (%) Estimated value (%) 72.9 5.0 13.2 8.9 87.0 2.4 5.9 2.8 86.0 2.4 8.5 3.0 12.2 5.0 2.2 89.0 4.4 7.2 3.8 7.3 3.4 82.3 3.3 9.2 5.2 4.2 5.0 0.4 6.8 3.1 6.0 0.4 7.0 2.8 3.7 10.2 1.1 71.2 4.0 12.0 7.9 86.3 2.1 6.8 2.9 81.5 2.8 8.7 4.8 80.8 5.9 8.2 5.0 91.0 2.1 5.0 1.9 87.5 3.4 6.1 0.8 13.4 21.2 1.1 9.0 4.0 16.0 1.4 2.8 0.8 89.5 92.5 15.8 3.3 6.7 12.2 6.1 10.4 16.8 3.8 8.0 1.8 77.7 84.0 Relative Standard error (%) Relative Standard error (%)
Pattern
Estimated value (%) 0.7 0.3 1.5 1.7 0.1 0.2 1.4 1.8 0.2 0.1 0.7 1.7 7.1 7.6 12.1 12.5 3.2 3.2 76.8 77.5 4.5 4.9 9.1 9.7 2.7 2.7 82.9 83.4 12.5 13.5 17.9 19.0 4.1 4.1 63.5 65.3
Never
64.4
74.6 6.1 14.3 9.8 87.7 2.8 7.7 3.8 83.0 3.8 9.8 5.6
Inactive
4.1
Men
Irregular
18.4
Regular
13.0
Never
83.1
Inactive
2.7
354
Women
Irregular
9.4
Regular
4.7
Never
77.2
Inactive
3.2
Total
Irregular
12.3
Regular
7.4
Urban Rural Total
Pattern
Estimated value (%) 0.6 1.1 1.3 2.9 0.8 0.6 1.5 21.5 0.5 0.7 0.7 5.4 3.3 4.1 27.2 28.0 5.3 5.4 62.7 64.0 0.5 1.5 24.9 26.5 4.4 4.5 67.6 69.9 5.9 6.6 28.6 30.2 6.0 6.3 57.5 58.9
Never
58.2
72.4 5.8 24.2 4.1 78.1 5.7 21.4 1.0 74.5 5.5 22.1 2.4
Inactive
6.2
Men
Irregular
29.4
Regular
6.3
Never
68.8
Inactive
4.5
Women
Irregular
25.7
355
Regular
1.0
Never
63.3
Inactive
5.3
Total
APPENDICES
Irregular
27.6
Regular
3.7
Urban Rural Total
Pattern
Estimated value (%) 0.8 0.4 2.5 2.2 0.1 0.1 1.7 1.8 0.2 0.1 1.3 1.8 7.9 8.5 8.7 9.2 2.7 2.7 79.9 80.5 5.1 5.5 6.7 7.3 2.5 2.5 85.1 85.4 15.1 16.5 13.2 14.7 3.3 3.3 65.9 68.1
Never
67.0
76.2 6.5 10.9 12.4 89.7 2.4 5.6 4.3 85.3 3.5 6.9 6.5
Inactive
3.3
Men
Irregular
14.0
Regular
15.8
Never
85.3
Inactive
2.5
Women
Irregular
7.0
356
Regular
5.3
Never
80.2
Inactive
2.7
Total
Irregular
8.9
Regular
8.2
Table 66. Distribution of the population aged 12 to 69 according to the practice of vigorous exercise by gender and area
Urban Rural Total
Pattern
Estimated value (%) 0.4 0.3 1.7 1.6 0.3 0.2 2.6 1.4 0.3 0.1 1.7 0.6 8.6 8.8 11.2 12.1 4.2 4.2 75.0 75.8 6.2 6.6 7.6 8.5 3.1 3.2 81.9 82.8 13.2 14.2 18.6 20.0 6.4 6.4 60.2 61.1
Never
60.6
71.6 7.2 15.7 10.4 87.1 3.2 6.5 5.4 81.6 4.4 9.4 6.8
Inactive
6.4
Men
Irregular
19.3
Regular
13.7
Never
82.4
Inactive
3.1
Women
Irregular
8.1
357
Regular
6.4
Never
75.4
Inactive
4.2
Total
APPENDICES
Irregular
11.7
Regular
8.7
Urban Rural Total
Pattern
Estimated value (%) 1.0 1.1 1.8 3.1 1.0 0.6 1.7 21.5 0.9 0.7 1.6 4.8 3.9 4.8 31.6 33.9 6.2 6.4 55.4 57.7 0.5 1.5 29.3 31.4 5.6 5.7 61.6 64.3 7.1 8.0 33.7 36.3 6.8 7.1 49.4 51.7
Never
50.5
65.0 6.3 30.1 5.9 75.3 6.3
Inactive
7.0
Men
Irregular
35.0
Regular
7.5
Never
63.0
Inactive
5.6
Women 23.9 1.4 69.5 6.1 26.3 3.4
358
Irregular
30.4
Regular
1.0
Never
56.6
Inactive
6.3
Total
Irregular
32.7
Regular
4.4
Urban Rural Total
Pattern
Estimated value (%) 0.3 0.4 2.3 1.8 0.2 0.1 4.6 1.3 0.2 0.1 2.1 0.4 9.6 9.8 6.7 7.3 3.7 3.7 79.3 79.9 7.0 7.4 4.3 5.3 2.8 2.8 84.8 85.6 15.6 16.8 12.2 13.5 6.1 6.2 64.4 65.2
Never
64.8
75.0 7.8 10.4 12.7 89.5 2.8 3.6 6.2 84.9 4.2 5.4 7.8
Inactive
6.2
Men
Irregular
12.8
Regular
16.2
Never
85.2
Inactive
2.8
Women
Irregular
4.8
Regular
7.2
359
Never
79.6
Inactive
3.7
Total
Irregular
7.0
APPENDICES
Regular
9.7
Table 69. Distribution of the population aged 12 to 69 according to the practice of general exercise by gender and area
Urban Rural Total
Pattern
Estimated value (%) 0.8 0.3 1.6 1.1 0.1 0.2 0.8 1.1 0.3 0.1 0.9 1.1 10.7 11.2 13.1 13.6 3.9 3.9 71.5 72.3 7.7 8.1 9.7 10.1 3.1 3.2 78.8 79.2 16.9 17.7 19.9 21.3 5.3 5.4 55.8 57.7
Never
56.7
68.1 7.0 17.3 12.9 84.2 3.3 8.3 6.4 78.6 4.4 11.1 8.4
Inactive
5.4
Men
Irregular
20.6
Regular
17.3
Never
79.0
Inactive
3.2
360
Women
Irregular
9.9
Regular
7.9
Never
71.9
Inactive
3.9
Total
Irregular
13.3
Regular
10.9
Urban Rural Total
Pattern
Estimated value (%) 1.1 1.1 1.5 2.9 1.0 0.6 1.4 21.5 0.9 0.7 1.2 4.4 4.4 5.3 35.4 37.3 6.4 6.6 51.3 53.3 0.5 1.5 33.1 35.1 5.9 6.1 57.6 60.2 7.9 8.9 37.3 39.8 6.8 7.1 45.0 47.1
Never
46.1
61.8 6.1 33.3 6.3 70.3 6.5 28.6 1.4 65.3 6.1 30.2 3.6
Inactive
7.0
Men
Irregular
38.5
Regular
8.4
Never
58.9
Inactive
6.0
Women
Irregular
34.1
361
Regular
1.0
Never
52.3
Inactive
6.5
Total
APPENDICES
Irregular
36.4
Regular
4.8
Urban Rural Total
Pattern
Estimated value (%) 0.9 0.4 2.3 1.4 0.1 0.1 1.8 1.1 0.2 0.1 0.8 1.2 11.9 12.6 8.1 8.4 3.3 3.3 75.9 76.5 8.7 9.1 6.1 6.6 2.7 2.7 81.9 82.2 20.3 21.6 12.6 13.9 4.7 4.8 60.0 62.2
Never
61.1
71.4 7.6 11.3 16.0 87.0 2.9 4.9 7.4 82.1 4.1 6.6 9.7
Inactive
4.7
Men
Irregular
13.2
Regular
20.9
Never
82.0
Inactive
2.7
362
Women
Irregular
6.3
Regular
8.9
Never
76.2
Inactive
3.3
Total
Irregular
8.2
Regular
12.2
Table 72. Distribution of the population aged 12 to 69 according to BMI by age range and area
Urban Relative Standard error (%) 95% confidence interval 95% confidence interval 3.4 19.8 8.8 1.5 54.8 4.2 25.5 9.4 2.2 50.0 4.1 3.5 5.8 2.7 55.0 9.5 2.2 24.4 9.7 2.2 52.4 30.2 12.7 3.5 56.0 5.7 28.3 12.4 3.3 57.6 6.3 62.8 45.5 5.2 32.9 15.1 6.4 40.3 5.2 31.5 15.3 6.0 42.0 3.5 5.0 13.2 15.5 3.6 5.1 2.3 4.8 1.7 2.7 3.0 1.9 3.6 1.5 2.2 2.6 1.6 27.0 28.8 3.1 5.2 5.2 4.7 4.7 26.9 14.4 4.5 43.3 4.7 31.7 14.3 6.0 38.7 4.8 30.5 14.6 5.6 40.6 Estimated value (%) 5.9 33.7 19.6 7.5 30.4 5.1 37.3 18.7 9.5 27.8 5.4 36.4 19.2 8.9 28.8 29.6 9.4 19.8 11.0 36.8 26.3 5.6 4.9 7.6 28.8 53.0 2.7 10.1 2.8 10.9 19.4 11.0 7.0 38.0 27.9 4.0 5.4 5.2 9.7 32.1 58.8 3.2 8.0 2.5 18.7 21.2 11.0 9.4 35.2 23.4 7.2 6.4 4.3 10.4 Estimated value (%) Relative Standard error (%) Relative Standard error (%) 1.8 1.0 1.9 1.5 1.3 1.4 0.4 0.9 1.2 0.8 1.0 0.2 0.7 1.1 0.6 95% confidence interval 5.7 30.7 16.7 5.6 47.7 5.8 34.1 16.0 6.8 Rural Total
Gender
BMI
Estimated value (%)
Underweight
6.1
Healthy
34.5
Men
Overweight
20.4
Obese or morbidly obese
7.8
No response
31.2
Underweight
5.2
Healthy
37.7
Women
Overweight
19.0
9.8
363
No response
28.3
42.0 5.6 32.5 16.0 6.3 43.5
Underweight
5.5
Healthy
36.6
Total
Overweight
19.5
APPENDICES
9.2
No response
29.2
Urban 95% confidence interval 95% confidence interval 7.0 12.2 1.2 0.2 64.8 6.2 19.8 1.9 0.0 58.1 7.3 17.3 2.0 54.2 3.0 0.0 62.5 0.8 68.7 11.4 23.8 4.2 0.5 71.0 4.6 28.1 12.0 12.4 26.0 5.2 1.5 55.0 12.7 23.6 4.8 1.2 57.7 76.3 60.6 0.3 0.9 4.9 2.5 6.9 4.3 7.5 9.7 2.8 4.5 3.6 5.9 6.7 2.1 4.6 4.4 9.6 21.1 21.1 5.3 18.7 3.5 0.8 57.4 10.6 23.6 4.4 1.2 51.7 11.5 21.8 4.2 1.0 55.2 12.3 13.0 5.3 11.5 15.9 25.2 5.7 1.5 49.2 15.4 28.0 7.3 2.9 42.8 15.9 26.7 6.5 2.2 46.7 47.6 66.8 2.5 0.2 7.2 3.1 16.4 27.5 20.6 7.4 17.2 9.4 10.1 45.2 63.4 3.9 3.3 0.2 99.8 8.3 3.2 20.0 29.1 24.0 8.2 17.8 9.1 15.0 51.0 70.6 3.8 1.8 0.2 6.5 6.3 2.9 27.7 26.3 16.6 12.7 17.1 9.6 13.1 Estimated value (%) Estimated value (%) Relative Standard error (%) Relative Standard error (%) 14.5 23.5 5.3 1.0 63.9 14.2 28.3 6.1 95% confidence interval Rural Total
Gender
BMI
Estimated value (%) 1.8 1.0 2.3 4.2 0.9 3.4 0.9 3.2 2.5 1.3 1.9 0.6 2.3 3.0 0.5
Underweight
16.5
Healthy
25.8
Men
Overweight
6.0
1.6
No response
50.1
Underweight
16.6
Healthy
28.5
Women
Overweight
7.8
364
3.1
1.8 58.3 13.9 25.4 5.4 1.4 60.3
No response
44.0
Underweight
16.6
Healthy
27.1
Total
Overweight
6.9
2.3
No response
47.1
Urban Rural TOTAL
Gender 95% confidence interval 95% confidence interval 1.4 21.5 11.3 2.0 49.3 3.3 26.1 10.8 2.6 47.7 2.9 25.7 5.9 9.7 51.8 2.5 11.5 2.7 49.1 31.3 14.6 4.2 53.9 4.5 30.1 14.8 4.1 54.5 5.6 58.7 39.3 4.0 34.1 16.9 7.3 37.7 3.4 33.5 17.8 7.1 38.2 4.9 6.7 17.2 20.1 3.9 5.5 3.1 6.6 1.7 2.7 3.0 2.0 5.8 1.5 2.2 2.7 1.7 30.8 31.9 3.6 2.9 2.0 9.3 1.6 29.5 18.4 5.9 36.7 3.4 32.9 15.9 6.8 36.1 3.0 32.4 17.0 6.7 36.8 1.7 37.2 25.1 9.9 22.2 3.4 38.6 20.3 10.5 25.5 2.9 38.5 21.9 10.4 24.8 25.7 10.9 3.4 22.6 13.2 39.0 27.9 3.7 3.2 3.7 10.7 26.4 50.8 2.9 11.1 3.4 10.9 21.1 12.7 7.1 39.4 28.7 4.3 3.8 4.4 12.3 24.7 54.0 4.1 10.6 3.4 19.5 27.6 14.3 9.9 38.9 26.2 8.4 2.0 2.1 16.7 Estimated value (%) Estimated value (%)
BMI
Estimated value (%) 3.7 1.0 2.2 1.6 2.5 2.6 0.5 0.9 1.3 0.8 2.2 0.3 0.8 1.2 0.8
95% confidence interval 2.4 34.3 21.8 7.5 41.9 4.5 35.4 17.9 7.8 39.3 3.8 34.5 18.7 7.5 39.6
Underweight
1.9
Healthy
38.1
Men
Overweight
26.3
10.3
No response
23.5
Underweight
3.6
Healthy
39.0
Women
Overweight
20.7
10.8
365
No response
25.9
Underweight
3.1
Healthy
38.7
Total
Overweight
22.3
APPENDICES
10.7
No response
25.3
367
APPENDICES
APPENDIX 2. CALCULATING THE INEQUALITY INDEX (D)

Inequality of Opportunities for Children. The D Component Coverage (P component) only measures average access to the selected basic opportunities. It does not provide information on whether children live in urban or rural areas, whether they belong to the Wayu ethnicity, whether they have a specific family structure or whether they have different rates of access to opportunities. Paes de Barros et al. (2008a, 2008b) argue that different access rates for children whose circumstances are different would mean that the average rates hide major inequality in access to these basic opportunities. It is therefore necessary to develop a dissimilarity index (D-index) which measures rates of access to basic opportunities in groups of children based on external circumstances such as place of residence, gender, educational level of parents, family income per capita, number of siblings, presence of two parents in the household and ethnicity. This index would then be compared with the general rate of access to the same service for the entire child population.
Taken from the World Banks 2008 study -shows an example of the probability gaps for calculating the D-index.
Inequality Index (D)
Probability of completing the sixth grade on time (%)
70 65 60 55 50 45 40 35 30 25 20 15 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Per capita income (USS (PPA)/day) Inequality of opportunities
authors' illustration Note: PPP = Purchasing power parity
Source: Graph from Paes de Barros et al. (2008a, 2008b)
368
The horizontal line represents the average probability for a child to complete the sixth grade at the right age. The curved line shows the same result, but in terms of per capita income. The left part shows groups of low-income children who have a below-average probability of finishing sixth grade. To the right are children from higher income families who have a better than average chance of completing sixth grade. Gaps in probabilities of access represent the absolute differences in specific groups rates of access (pi) and the average general rate of access p. According to Paes de Barros et al. (2008a, 2008b), determining factors are divided into two groups for an individual result of general interest (such as education - completing sixth grade on time- or access to a basic public utility): one group of causes that are beyond individuals control and another that are under such control. An x denotes a vector with all of these causing factors, referred to as circumstances. Another group is made up of factors under the individuals control. This group, represented by vector e, designates choices or efforts. Where Y would be the function that relates the result to its causing factors, Y= Y(x,e). The analysis revolves around finding an inequality of opportunity index by emphasizing external causes in the circumstantial vector x, as vector e (choices and efforts) does not apply directly apply to children at individual level. As it is not possible for all circumstances to be observed and some are more likely to be affected by public policy, the analysis focuses on a set of observed circumstances represented by vector x. The interpretation associated with this circumstantial vector is that its components are not endogenous to people. Rather, these results arise from the differences in how people are treated socially. Differences relate to family traits, gender or membership of an ethnic group and different access to public services. Therefore, it is assumed that U=l(x)+e and a dichotomous indicator, d=1 is defined Y > h If d=0 y < h. Because the observed variables are the indicator d and the socially determined circumstances are vector x, one can calculate a regression function E(d/x).
369
APPENDICES
This type of index is common in sociology and demography and is known as a dissimilarity index. The analysis of indices of dissimilarity is based on a situation in which the circumstances have a discreet distribution and {x1...., xm} which denotes the set of all possible values. Conceptually, the calculation procedure is creating a model about whether a child j has access to an opportunity or not, given as a function of exogenous circumstances. A demonstration of the index and its properties can be found in Paes de Barros et al. (2008a, 2008b). The model takes the following shape:
Ln = S 1-P(I=1/x ,...,x )
1 m
( )
P(I=1/x1,...,xm)
k=1
hk(Xk)
(1)
where Xk is the variable vector representing circumstances, or X=(X1,...,Xm). The model includes a logistic function to obtain the estimated probability of access to each opportunity being considered. The following is calculated for each individual (i):
( ^ p i= ^+ 1+Exp ( b
0
^+ S x b ^ Exp b 0 ki k
m k=1 m k=1
) ^) x b
ki k
(2)
Also, the following is calculated:
p=
and
S w p^
n 1
1 D= 2p
S
i=1
wi | pi - p|
(3)
Where wi = 1/n or some expansion factor for the sample.
370
Two types of models were run for the study. Probit models were used to analyze the probability of a child in the area of influence accessing the basic opportunities defined as a function of exogenous circumstances. Meanwhile, logistic models were used to calculate the dissimilarity index (D) proposed by the World Bank with equation 3. Exogenous circumstances considered by Paes de Barros et al. (2008a, 2008b) include the parents education, family income per capita, number of siblings, whether a single parent runs the household and the area of residence (urban vs. rural). For education, age was also a variable used to predict the probability of completing each grade. As for the family income per capita variable, no explicit calculation is found in the World Banks document. For this particular case, the variable was calculated based on the workforce module of the QLS that was administered. A cluster of components was established that used both monetary and nonmonetary income, as there was evidence of unpaid work and a significant percentage of informal employment. The cluster was based on the responses to the following questions in the QLS: How much did you earn last month in this job? (include tips and commissions but exclude per diems and in-kind payments). State the monthly value. In addition to your monetary salary, did you receive any food in the last month as payment for your work? State the monthly value. In addition to your monetary salary, did you receive any housing in the last month as payment for your work? State the monthly value. In addition to your monetary salary, did you receive other in-kind income for your work in the past month (appliances, clothing, items other than food or Sodexho-like coupons, etc.)? In the past month, did you receive a cash subsidy for food? In the past month, did you receive cash transportation assistance?
371
APPENDICES
In the past month, did you receive a cash family subsidy? In the past 12 months, did you receive: a service bonus, a Christmas bonus, a vacation bonus, a performance bonus, payments or compensation for on-the-job accidents? In the past 12 months, did you receive pension or retirement bonuses or bonuses for pension substitution, disability or old age? In the past 12 months, did you receive any income in the form of cash assistance from other households or institutions? (parents, children, family members, friends) In the past 12 months, did you receive any income from the sale of property? (houses, buildings, lots, machinery, vehicles, appliances, etc.) In the past 12 months, did you receive any other income? (severance packages, interest on severance packages, interest from loans or from fixed-term CDs, raffles, etc). Paes de Barros study also includes variables, such as race and ethnicity, which are extremely important when analyzing access to goods and basic services. But the authors do not include them in their analysis because they are not included in the national surveys available in the region. In Cerrejns 2009 QLS, though, it is possible to establish the ethnic variable, so it is included as another of the external factors affecting children in Cerrejn area of influence. The function {hk} (from equation 2) is selected - as the authors propose by the needs of each circumstance: quadratic for education, logarithmic for income and non-parametric (dummy) for age and other dimensions. In all cases, the functions of all the hk(xk)=xkbk. The following table shows the external circumstances considered and the functional specification used.
372
External Circumstances and Functional Specification

External circumstances Gender Parents' education Number of siblings Parents' presence Place of residence (urban vs. rural) Membership in the Wayu ethnicity Per capita income Specification Dummy Quadratic Linear Dummy Dummy Dummy Logarithm
Source: Calculation based on Paes de Barros et al. (2008a, 2008b)
The years of education variable often uses a quadratic specification to analyze whether there are different returns as grades are passed. This avoids the assumption that each additional year of study will have the same returns, regardless of educational level or whether or not the individuals finished an educational cycle.
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Standard of living and health:

An Assessment of Cerrejn Area of Influence

Printed and made in Colombia - All rights reserved

Standard of living and health:

Fernando Ruiz Mauricio Ferro

MAURICIO A. CRDENAS MAURICIO FERRO

METHODS AND PROCEDURES

MAURICIO FERRO MAURICIO A. CRDENAS JEANNETTE LILIANA AMAYA

JEANNETTE LILIANA AMAYA FERNANDO RUIZ

AVAILABLE PROVISION AND QUALITY OF SERVICES

OPPORTUNITIES FOR CHILDREN

CONCLUSIONS AND GENERAL RECOMMENDATIONS

Standard of living and health:

Participants in the Study:

CERREJN MAURICIO FERRO President, Tecnocerrejn

MAURICIO A. CRDENAS Coordinator, Research and Information Centre

Participants in the field operation

Participating DANE Officials

Area of influence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 DEFINITION OF THE AREA OF INFLUENCE. . . . . . . . . . . 41

Methods and procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 METHODS AND PROCEDURES. . . . . . . . . . . . . . . . . . . . 47

Standard of living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 HOUSEHOLDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

Health conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 HEALTH AND SOCIAL SECURITY. . . . . . . . . . . . . . . . . . . 109

PERCEPTION OF HEALTH AND SERVICE USE. . . . . . . . . . 121 FOOD CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

PERCEIVED MORBIDITY. . . . . . . . . . . . . . . . . . . . . . . . . . 135

USER PERCEPTION OF HEALTH SERVICES . . . . . . . . . . . 207

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

166 167 168

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

3 http://www.cerrejon.com/secciones/CERWEB/HOME/MENUPRINCIPAL/NUESTRACOMUNIDAD/ COMITEIND/seccin HTML.jsp

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER I Area of influence

DEFINITION OF THE AREA OF INFLUENCE

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER I Area of influence

Table 1. Hamlets attached to the municipalities within the area of influence

Source: DANE Census Mapping

Map 1. Demarcation of the study area of influence

RIOHACHA ALBANIA HATO NUEVO

BARRANCAS DISTRACCIN FONSECA SAN JUAN DEL CESAR

CHAPTER II Methods and procedures

METHODS AND PROCEDURES

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER II Methods and procedures

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER II Methods and procedures

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER II Methods and procedures

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

Study Population and Sample Size

CHAPTER II Methods and procedures

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER II Methods and procedures

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

CHAPTER III Standard of living

Source: DANE Calculation - Standard of living Survey, Cerrejn, 2009

STANDARD OF LIVING AND HEALTH: An Assessment of Cerrejn Area of Influence

Source: DANE Calculation - Standard of living Survey, Cerrejn, 2009

Predominant material of floors and walls

CHAPTER III Standard of living