Challenges of implementing a primary health care strategy in a context of a market‐oriented health care system: the experience of Bogota, Colombia

Abstract

SUMMARYBackground Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. Methods The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. Results The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Conclusion Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Barriers and facilitators for implementation of family medicine–oriented model of primary care in Bosnia and Herzegovina: A qualitative study

“…The centralized policy model, lack of stakeholders' interest in reform, resistance from professional associations, and the lack of financial investment were identified as the main hindering factors to implementation, while the main facilitators were perceived to be the collaborative design, a strong financial plan with multifarious apportionment and payment approaches and strong, decentralized, locally adapted decision-making processes. 24,25 The current study corroborates the previous findings that the lack of coordination between primary and secondary health care represents a barrier to supporting the implementation function. 26,27 According to a statement of the European Working Party on Quality in Family Practice, developing a positive working cooperative relationship requires guidelines which would include a process combining the patient's perspective and a description of task distribution between FPs and hospitalists.…”

“…Other authors have stated that primary health reform varies regarding the sphere and the policy instruments used to implement the change. The centralized policy model, lack of stakeholders' interest in reform, resistance from professional associations, and the lack of financial investment were identified as the main hindering factors to implementation, while the main facilitators were perceived to be the collaborative design, a strong financial plan with multifarious apportionment and payment approaches and strong, decentralized, locally adapted decision‐making processes …”

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

“…It is quite unexpected that only one project acknowledged this issue, given that many studies in low‐ and middle‐income countries have reported poor health literacy, patients’ misconceptions and financial constraints as key barriers to the delivery of EBHC (Iravani et al., ; Ritchie et al., ). Even though implementation studies tend to focus on organizational and health provider factors and less so on consumers and least of all on policymakers, the literature supports a multilevel analysis in which implementation planning equally involves examining those who receive health care (i.e., consumers and community; Ritchie et al., ; Vogel et al., ) as well as the government system responsible for regulating health policies and reforms (Mosquera et al., ; Ritchie et al., ). Docherty et al.…”

Situación de la enfermería en el desarrollo de la atención primaria en salud en Antioquia (Colombia): aproximación desde la perspectiva de los profesionales

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