Comprehensive Primary Health Care in South America: contexts, achievements and policy implications

Ramírez, Naydú Acosta; Ruiz, Jennifer Pollard; Romero, Román Vega; Labonté, Ronald

doi:10.1590/s0102-311x2011001000002

Cited by 30 publications

(23 citation statements)

References 35 publications

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“…As other countries grapple with identifying optimal forms of governance, community engagement, and levels of centralisation or decentralisation for PHC services, it is useful to reflect on how decision‐makers from a small sample of independent Victorian CHS considered the various pressures on their organisations and chose to tackle this dilemma through a change in their organisational make‐up, challenging aspects their sector's status quo. Experience in Latin America and South Australia suggests that stronger rights‐based approaches and governance that is locally driven and independent of government may be enabling factors to the implementation of more comprehensive forms of PHC, even in a context of increasing neoliberalisation . In light of this, if merging does strengthen these characteristics, as intended according to this study's informants, it could mark a step in the right direction.…”

Section: Discussionmentioning

confidence: 83%

“…Since then, PHC‐oriented systems have been shown to be capable of generating better population health outcomes than overly hospital‐centric systems . Further, there are indications that greater comprehensiveness of PHC may be associated with greater benefits . Yet, nearly 40 years later, comprehensive PHC service models continue to play a mostly marginal role in most health systems across the world .…”

Section: Introductionmentioning

confidence: 99%

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Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia

Roussy

Livingstone

2018

Health Planning & Management

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This study offers insights into decision-making processes geared towards protecting the comprehensiveness of PHC service delivery for disadvantaged communities, ensuring financial viability, and surviving neoliberal economic policy whilst preserving communitarian values. These are relevant to an international audience, within a global context of rising health inequities, increasingly tight fiscal environments, and growing neoliberal influences on health policymaking and funding.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia

Roussy

Livingstone

2018

Health Planning & Management

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“…Es una herramienta útil para ayudar a las organizaciones a fortalecer su capacidad de aprendizaje con miras a asimilar y poner en práctica los conocimientos desarrollados regularmente 20 . Las alianzas inter institucionales e intersectoriales son críticas para Colombia en estos primeros años de la implementación del modelo porque la unión de intereses permite hacer un uso eficiente de los recursos disponibles y enfocarlos a las necesidades prioritarias 21 .…”

Section: Discussionunclassified

Voces de la academia y los tomadores de decisiones del Oriente Colombiano ante la implementación del Modelo Integral de Atención en Salud

Rodríguez

Sánchez

Rivero

et al. 2017

revsal

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RESUMENIntroducción: En Colombia, a partir del año 2011 ha resurgido el interés por la incorporación de la Estrategia de Atención Primaria en Salud (APS) en los servicios de salud y en los debates académicos. A partir de la promulgación del nuevo Modelo Integral de Atención en Salud en el año 2016, este interés es explícito por los distintos actores del Sistema General de Seguridad Social en Salud. En el marco de la Alianza por la Atención Primaria en Salud para Colombia, se promovieron encuentros regionales que permitieran identificar potencialidades y limitaciones para la implementación de la estrategia de APS en el marco de la nueva política de atención. Objetivo: Socializar las reflexiones que tomadores de decisiones y representantes de la academia realizaron frente a la implementación de la nueva política de atención en el oriente del país. Metodología: Se realizaron tres mesas de trabajo con 30 actores de 11 Instituciones de Educación Superior y 17 tomadores de decisiones de cuatro departamentos del oriente del país. Se utilizó la estrategia de investigación de grupos de discusión. Resultados: Tanto la academia como los tomadores de decisiones identificaron desafíos relacionados con la comprensión de los aspectos conceptuales del enfoque poblacional del modelo, así como la necesidad de hacer una mirada crítica a las competencias y currículos de los nuevos profesionales. Conclusión: Los distintos temas que emergieron del debate incluyen aspectos estructurales y de funcionamiento del sistema de seguridad social en Salud que le plantean a la autoridad sanitaria retos que superan la mera instrumentalización del modelo.Palabras clave: Atención Primaria de la Salud; sistemas de salud, gobierno local, reforma de la atención en salud, Colombia. ABSTRACTIntroduction: Since 2011, there has been an increasing interest to re-incorporate primary health care (PHC) strategy in healthcare services and academic debates. After the promulgation of the new healthcare model (MIAS) in 2016, this interest has been made explicit by all actors involved in the health benefits program of the Social Security System (SGSSS). According to the guidelines proposed by the Colombian PHC Alliance, regional meetings have been held to identify potentialities and limitations for implementing the PHC strategy within the framework of the new healthcare policy. Objective: To socialize the analysis carried out by decision-makers and academics related to the implementation of the new healthcare policy in the east of the country. Methodology: Three workshops were held with the participation of 30 representatives of 11 higher-education institutions and 17 decision makers from four departments of the east of the country. Qualitative research methodology based on focus groups was applied. Results: Academics and decision-makers identified challenges related to understanding the conceptual aspects of the Model's population focus and raised awareness about the need of a critical assessment of curricula and professional competencies of health professional...

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“…We selected reforms that took place at the municipal level since the decentralization processes during the 1980s and 1990s in Latin America positioned the municipal level at the core of the implementation of these reforms (5,6). Table 1 provides basic information about each municipality’s socio-economic and health services characteristics.…”

Section: Methodsmentioning

confidence: 99%

Analysis of the enablers of capacities to produce primary health care-based reforms in Latin America: a multiple case study

Báscolo

Yavich

Denis

2016

FAMPRJ

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BackgroundPrimary health care (PHC)-based reforms have had different results in Latin America. Little attention has been paid to the enablers of collective action capacities required to produce a comprehensive PHC approach.ObjectiveTo analyse the enablers of collective action capacities to transform health systems towards a comprehensive PHC approach in Latin American PHC-based reforms.MethodsWe conducted a longitudinal, retrospective case study of three municipal PHC-based reforms in Bolivia and Argentina. We used multiple data sources and methodologies: document review; interviews with policymakers, managers and practitioners; and household and services surveys. We used temporal bracketing to analyse how the dynamic of interaction between the institutional reform process and the collective action characteristics enabled or hindered the enablers of collective action capacities required to produce the envisioned changes.ResultsThe institutional structuring dynamics and collective action capacities were different in each case. In Cochabamba, there was an ‘interrupted’ structuring process that achieved the establishment of a primary level with a selective PHC approach. In Vicente López, there was a ‘path-dependency’ structuring process that permitted the consolidation of a ‘primary care’ approach, but with limited influence in hospitals. In Rosario, there was a ‘dialectic’ structuring process that favoured the development of the capacities needed to consolidate a comprehensive PHC approach that permeates the entire system.ConclusionThe institutional change processes achieved the development of a primary health care level with different degrees of consolidation and system-wide influence given how the characteristics of each collective action enabled or hindered the ‘structuring’ processes.

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Comprehensive Primary Health Care in South America: contexts, achievements and policy implications

Abstract: Abstract

Cited by 30 publications

References 35 publications

Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia

Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia

Voces de la academia y los tomadores de decisiones del Oriente Colombiano ante la implementación del Modelo Integral de Atención en Salud

Analysis of the enablers of capacities to produce primary health care-based reforms in Latin America: a multiple case study

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