Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia
Article first published online: 19 NOV 2013
© 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
The International Journal of Health Planning and Management
How to Cite
Mosquera, P. A., Hernández, J., Vega, R., Labonte, R., Sanders, D., Dahlblom, K. and San Sebastián, M. (2013), Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia. Int. J. Health Plann. Mgmt.. doi: 10.1002/hpm.2228
- Article first published online: 19 NOV 2013
- Manuscript Accepted: 7 OCT 2013
- Manuscript Received: 1 AUG 2013
- the Swedish Council for Working Life and Social Research. Grant Number: 2006-1512
- primary health care;
- barriers and enablers;
- qualitative study;
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.
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.
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.
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.