Towards Effective Coverage of Chagas Disease: A Community Approach in Migrant Populations in Barcelona.


I have been working since 1999 in the Public and Community Health team (eSPiC). The eSPiC was created in 1994 in the Drassanes International Health Unit of the Catalan Health Institute in Barcelona, Catalonia. Since then, we have been working to promote equitable, comprehensive and sustainable healthcare, aimed at addressing health needs at the individual, family and community levels, especially in the field of international health and migration.

Since 2013, my team has been part of the infectious diseases service at Vall d'Hebron University Hospital and the Vall d'Hebron Research Institute (VHIR). The human and professional dimension has been, and continues to be, the backbone of the interdisciplinary team, built up over the years by doctors, nurses, community health workers and administrative staff, as well as occasional collaborations with anthropologists and psychologists, among other professionals.

Accessibility to health services

Why do some people use health services and continue treatment, while others do not? A robust health system ensures that people stay healthy or, when they become ill, can access care appropriate to their needs, complete treatment and feel satisfied with the system. Accessibility is defined as the proportion of the target population that, having a health need, can access an appropriate intervention that resolves their condition.

The Health Service Coverage Assessment model, developed by Tanahashi and adopted by the World Health Organisation (WHO), conceptualises five stages on the path to effective coverage: (i) availability, (ii) accessibility, (iii) acceptability, (iv) contact, and (v) effective coverage.

Our work

Community-based approaches have proven effective in improving early access to diagnosis of Chagas disease (CD). The community actions we describe were carried out at the Consulate General of Bolivia in Barcelona—with which we have maintained close collaboration since 2014—and began with CD awareness-raising activities. Subsequently, eSPiC offered on-site serological screening, as well as diagnostic confirmation, antiparasitic treatment and follow-up at the Drassanes–Vall d'Hebron International Health Unit (USIDVH).

From our working perspective, although detection, diagnosis, treatment and follow-up are often considered separate processes, within a community framework the concept of "comprehensive follow-up" begins with screening and extends throughout life, until parasitological cure or the disappearance of clinical manifestations and their complications is achieved.

In Barcelona, eSPiC has become a benchmark in community actions aimed at populations at risk of CD. These initiatives are developed collaboratively with the communities themselves, promoting prevention and communication strategies that strengthen mutual trust and sociocultural understanding between the health system and the target population. Since 2008, eSPiC and the Association of Friends of People with Chagas Disease in Barcelona (ASAPECHA Barcelona) have implemented various community actions in situ to promote the detection of CD and improve access to diagnosis and treatment.

The work carried out by our team over the years suggests that community-based follow-up strategies are particularly recommended. These strategies facilitate a continuum of comprehensive care, from screening in the territory to adherence to treatment, which is essential to achieve the targets set for Chagas disease in the WHO Roadmap for Neglected Tropical Diseases towards 2030.

Our results demonstrate that tailored community actions, beginning with on-site screening, can improve early detection and promote a more comprehensive continuum of care for chronic parasitic diseases such as CD and strongyloidiasis. Furthermore, the implementation of follow-up strategies adapted to the local context can strengthen treatment adherence and completion.

However, further research is needed to explore the reasons for non-acceptance of screening strategies, as well as treatment and/or follow-up discontinuation, and to design innovative interventions to reduce these barriers. The use of digital tools, such as the Community Health Programme with the Health Survey System (HSUS), can help bridge gaps in communication and patient follow-up.

Conclusion

Although I am aware that achieving the vector-borne disease elimination targets set out in the WHO Action Plan for Neglected Tropical Diseases 2021–2030 is a highly complicated task, in my experience there are three elements that are essential for progress towards achieving them: 

  • Decentralised, community-based screening strategies, developed in trusted and accessible settings (such as consulates), involving community health workers.
  • Improved communication and referral systems between primary care centres and specialised health services.
  • Integrated and territorially coordinated care circuits that ensure continuity of care in the places where people live.

By addressing these elements, health systems can move from partial coverage to effective coverage, as proposed by Tanahashi, ensuring not only access but also completion of the entire process of diagnosis, treatment, and care.