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

Authors

  • Paola A. Mosquera,

    Corresponding author
    1. Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
    2. Postgraduate programs in Health Administration and Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
    • Correspondence to: P. A. Mosquera, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University. SE-901 87 Umeå, Sweden. E-mail: paolamosquera@gmail.com

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  • Jineth Hernández,

    1. Postgraduate programs in Health Administration and Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
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  • Román Vega,

    1. Postgraduate programs in Health Administration and Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
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  • Ronald Labonte,

    1. Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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  • David Sanders,

    1. School of Public Health, University of the Western Cape, Bellville, South Africa
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  • Kjerstin Dahlblom,

    1. Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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  • Miguel San Sebastián

    1. Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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SUMMARY

Background

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. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

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