Table 2 Summary of the feedback from the community and study participants

The environmental and geographic characteristics of Pueblo Rico favor the transmission of CL and challenge access to health services

Leishmaniasis is always present in the municipality, so it is important to control it.

Indirect costs of health care: reaching the health posts and the economic loss resulting from antileishmanial treatment

During the time of treatment, there are considerable costs to the families. For example, when a child receives treatment, the mother must travel with the child during the 20 days it lasts, plus the time it takes for the diagnosis. This means that to bring one kid, mothers must leave their other children alone at home, and one has to bear in mind that they [the indigenous] are usually very large families.

A different worldview: traditional medicine and frictions between health programs and the community

For the indigenous population, the bites of the sandflies are normal and that is why measures that are within their reach must be implemented.

For example, previously the indigenous people chewed tobacco, and this was smeared on their skin as a barrier or protection measure against bites (Community leader, Santa Cecilia).

Lack of coordination of government programs, administrative barriers of the health system and the inertia of health institutions

The bureaucratic problems mean that the health worker is hired very late and has very little time to develop their activities, therefore, they end up executing tasks just to fulfill their work, but without the sense of belonging that it takes.

Insufficient health infrastructure to provide treatment to the rural population

The deficiency is mainly in the rural area.

"There is a medical service, but you have to see how many turns [‘vueltas’ a colloquial term to indicate visits or administrative procedures] a person has to make to be treated" (Member of the community, living in Santa Cecilia)

Negative perceptions of the indigenous population about CL treatment negatively affect treatment adherence

The first option, from the cultural perspective, are the Jaibanás [traditional healer]. People do not like injections and are afraid of the adverse reactions.

Treatment characteristics, requirements and unavailability pose additional challenges to patients and healthcare provide

There are few alternatives to treatment.

Participants point out the importance of differential health interventions, and although they recognize that there is a policy for indigenous health, they affirm that it does not work in practice. They propose to adopt differential control measures, to guarantee the attention of infectious diseases in the indigenous population.