"Misión barrio adentro": medicina social, movimientos sociales de los pobres y nuevas coaliciones en Venezuela

Abstract

RESUMEN En Venezuela, los gobiernos locales junto con el gobierno nacional, crearon un sistema nacional de salud paralelo, Misión Barrio Adentro (MBA), ubicando a unos 33.000 profesionales de la salud, inicialmente cubanos, en vecindarios de bajos ingresos. A través de la etnografía y entrevistas, se concluye que MBA proporcionó acceso a la atención médica y logró obtener apoyo popular a consecuencia de: movimientos sociales de los pobres; cooperación entre trabajadores comunitarios, residentes, profesionales de salud y funcionarios públicos; la integración de la atención médica con programas sociales y económicos; la ubicación de médicos como residentes en barrios pobres; interacciones positivas y equitativas médico-paciente; el papel clave de los Comités de Salud; y el impacto de la hostilidad de la prensa, un segmento grande de los médicos venezolanos y la oposición en transformar a la salud en un tema político esencial. Todo esto nos sugiere que el Estado puede confrontar las inequidades de salud cuando se unen perspectivas teóricas de la medicina social y la epidemiología crítica con los saberes populares dentro de las comunidades afectadas. Estructuras institucionales flexibles, no burocráticas y creativas aumentan la efectividad de las intervenciones.

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

“…Under this constitutional framework, the comprehensive primary health care program, called Barrio Adentro, grew rapidly in neighborhoods that had up until then been excluded from traditional health care coverage. Initially, health needs and demands under this program were identified informally until the creation of Comités de Salud (health committees) 38 . Health policies were also created in response to a focus on social justice and social inclusion as the right to health became part of the social exclusion discourse used to demand access to health services 28 .…”

“…These changes in primary health care were part of a general surge of progressive social, economic and political reforms that provided further leverage for community autonomy, organization and participation, and led to increasing popular demands for government accountability. Brazil and Venezuela provide rich examples of bottom-up approaches with strong community participation and empowerment 18,34,38,40,41 that had a concrete effect on the formulation, implementation and evaluation of health policies and programs.…”

“…The importance of qualified health workers in creating a more equitable distribution of health resources and ensuring that previously excluded groups have access was demonstrated, notably by the Barrio Adentro program in Venezuela 34,59 . This program's success relied in large part on the availability of capable health care professionals willing to work and live in poor communities 38 . In another example, a family medicine training program, organized by the Ministry of Health in Paraguay, played a critical role in strengthening primary health care 60 .…”

“…The manner in which these tensions are resolved has implications for medical training, health care worker training, health team structure and communication and capacity to incorporate cultural differences and act on the social determinants of health 18,21,26,28,34,35,38 .…”

“…• Research on the characterization of health and living conditions, belief and value systems, and disease prevalence and incidence was conducive to services that focused on equity and social determinants of health 15,25,38,54,62 . Although research on health equity and disparities outcomes is developing, few rigorous studies of this type were found 34,55,69,70 .…”