# Challenges facing primary health care: a perspective from Colombia’s Caribbean region

## TL;DR

This study explores challenges in primary health care for vulnerable families in Colombia's Caribbean region and highlights the need for a more comprehensive approach.

## Contribution

The paper provides a theoretical-reflective analysis of PHC challenges and proposes a family and community-centered approach for vulnerable populations.

## Key findings

- 57% of families show some degree of dysfunction according to the Family APGAR.
- Only 33% of individuals participate in health promotion programs appropriate to their life stage.
- A comprehensive PHC model addressing social and emotional determinants is needed for vulnerable families.

## Abstract

Primary Health Care (PHC) has been a central focus in health policy debates, nationally and internationally. In this context, efforts aim to achieve an effective integration between PHC and the broader health system to ensure equitable, accessible, and needs-based care aligned with the real needs of the population.

To describe the characteristics of the families participating in the study and to conduct a theoretical-reflective analysis of the challenges faced by PHC, as well as the responses required from service providers and local health authorities. The approach emphasizes family and community health to better meet the needs of vulnerable families in the Colombian context.

A cross-sectional descriptive study was conducted. The study included 417 families, totaling 1,923 individuals. Instruments used included the Family Health Diagnosis form and the Family APGAR. A descriptive analysis of frequency and percentage was performed for qualitative variables. Bivariate analysis was used to explore associations between family functionality (functional vs. dysfunctional) and a range of sociodemographic, economic, and life-event variables. Prevalence ratios (PR) with 95% confidence intervals (CI) were calculated, and chi-square tests (χ2) were applied to determine statistical significance (p < 0.05).

Adults accounted for one-third of the population, followed by youth (15%) and children (16%), together comprising 67%. Smaller proportions were observed in early childhood and older adults. Most individuals (72%) are covered under the subsidized health regime, in keeping with the study’s focus on vulnerable populations. According to the Family APGAR, 57% of families exhibit some degree of dysfunction. Only one-third of individuals participate in health promotion and maintenance programs appropriate to their life stage. Less than 1% use mental health services (psychology or psychiatry), and 27% are unaware of or do not attend any such programs.

The findings underscore the urgent need to strengthen PHC as the coordinating axis of family care, moving beyond a model centered exclusively on clinical and individual attention. A comprehensive perspective that addresses social and emotional determinants of health is essential to respond effectively to the needs of vulnerable families.