Colombia

El objetivo del estudio es contribuir a mejorar la salud en Colombia mediante el desarrollo de un sistema nacional de indicadores de desempeño del sector salud. Para ello se utilizó un análisis descriptivo de datos secundarios de Colombia e Israel que, como Colombia, tiene un modelo de competencia regulada. [from abstract]

This film tells the story of Mirta Nubia Rosero, the only health worker in a remote village in south-western Colombia. After five decades of conflict, unexploded landmines and remnants of war lie hidden in the ground. [from publisher]

Four decades of conflict in southern Colombia have made health care a rare commodity on the Rio Caguan, a remote tributary of the Amazon. In this video, Abdi Ismail explains his work taking mobile health clinics along the river to thousands of villagers who would otherwise be cut off from medical care. [from publisher]

A study was undertaken in Mexico, Colombia, and El Salvador to determine the impact of a management training program on health managers’ job performance. Factors associated with a successful training outcome were training techniques, strengthening of enabling factors, and reinforcement mechanisms. [adapted from abstract]

Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.