Governance and Primary Health Care

1
Governance and Primary Health Care
Ernesto Báscolo ebascolo_at_gmail.com WFPHA World
Congress on Public Health 2009 (supported by
IDRC)
2
Primary Health Care models limitations
Taxonomic Model
Evolution Model
Essential health care services
Primary level Health care .
Primary level health services
Community health services.
Strategy to coordinate the health services system
Actions and policies with influence on the social
health determinants.
3
Change processes analysis?
Taxonomic Model
Evolutive Model
Servicios esenciales
Servicios médicos de primer nivel
Servicios de salud de primer nivel
Servicios comunitarios de salud
Acciones y políticas que influencian los
deterninantes de la salud
4
Governance and health care policies
implementation.
context

• Governance
• 1.Actors interaction
• 2. Norms
• (meta norms, organizational,
• management)
• y nodal point
• 3. Process

Results Health care access
Services organization
System resources
5
Primary Health care Governance in local
scenarios.

• Participative evaluative research
• 1 pilot case study Rosario (Arg)
• 5 multi-centric studies 3 Argentina y 2 Bolivia

6
PHC models change factors

• Which are the critical factors that explain the
  wished changes in the PHC models?
• Which are the key actors (and their
  relationships) that lead, promote or manage
  change processes?
• Which are the key social norms (meta norms,
  organizational, and health care norms) to
  achieve effectiveness in PHC change models?

7
Hasta 1990
1990-1994
1994 - 2000
Hospital
Hospital
Hospital
Hospital
Centro de Salud
Centro de Salud
Centro de Salud Vecinal
Centro de Salud
Dir. APS
Dir. APS
Centro de Salud
Posta sanitaria
Centro de Salud Vecinal
Centro de Salud Vecinal
Centro de Salud
Posta sanitaria
Posta sanitaria
Social Organization
Social Organization
Posta sanitaria
8
2004-2007
2008-
2000-2004
Hospital
Hospital
Hospital
Centro de especialidades ambulatorio
Centro de especialidades ambulatorio
Centro de especialidades ambulatorio
CSV
Distrito sanitario
Distrito APS
Dir. APS
Distrito APS
Dir. APS
CS
CS
CS
Distrito APS
Dir. APS
Distrito APS
CS
CS
C.O
CSV
C.O
9
(No Transcript)
10
Performance results
Population Survey n 450 lt 11 years old children
resident in 6 HCs areas of influence
stratification of 42 HC
3 HC A strata n 227
3 HC B strata n 223

• Stratification dimensions
• HC resources
• HC attention
• mechanisms and rules
• HC organizational
• mechanisms
• Source of information
• Organizational survey
• Secondary data

Reference HC utilization 68,3
Reference HC utilization 30,9
Regular source of care in the reference HC 55,9
Regular source of care in the HC of
reference 27,8
A Strata 13 HC
B Strata 29 HC
11
Performance results
12
Some preliminary conclusions

• The change process is long (20 years) and no
  lineal.
• While in the first time, community was a key
  actors in order to expand the social protection
  with new health centres, its influence decrease
  in the last eight years. Specially, when the main
  challenge is the integration between the primary
  health care level with the other ones.
• The introduction of new professional (doctor,
  social workers and psychologies) were a
  fundamental support to create health worker team,
  to develop primary health care values and to
  conform a key political actor in the health care
  system, with the power to influence the direction
  of the health care reform.
• While the autonomy of the health care centres was
  functional to the participative management and
  decentralized planning, the heterogeneous local
  innovation process have serious consequences to
  guaranty the equity of the population access.

13
Thank you!