Estudio multicéntrico en atención primaria en salud: modelos asistenciales, integración al sistema de salud e intersectorialidad en contextos urbanos en Argentina, Brasil, Paraguay y Uruguay. , (08/2008 - 12/2010 )
Multicentre study in Primary Health Care Uruguay
The results of the study conducted in Uruguay will be presented below. Information from key stakeholder interviews, triangulated with the literature review and documentary and statistical analysis, and organised by analytical dimensions, is analysed. The categories of key informant interviewed were: managers, experts, professional associations and civil society organisations. In general terms it was decided to interview people who hold managerial positions in the various different organisations, although interviewees in the expert category were selected for their individual expertise. In all, 33 interviews were conducted, of 17 health managers, 8 experts, and 4 representatives of organised civil society and 4 of professional associations. Information from the interviews was subjected to content analysis using forms organised according to the various dimensions and variables of the study matrix, which is common to all the countries.
1. PH
C STEWARDSHIP CAPABILITY
Uruguay is engaged in the process of Health System Reform, which began during the last term of government when, in 2007, an integrated national health system (Sistema Nacional Integrado de Salud, SNIS) was set up. The proposed reform aims in three fundamental directions: to change the model of care, the model of management and the model of financing.
As regards changing the model of care, PHC is conceived as a strategy for reorganising the health system. This is embodied in Chapter IV of the law instituting the SNIS, under the heading Health Care Network (Red de Atención en Salud), article 34 et seqq., which define how the health care system is to be organised: it is to be organised in networks by levels of care according to users' needs and the complexity of procedures. Its strategy will be primary health care and it will prioritise the first level of care.
The interviewees also understood PHC as a political strategy that orients and leads all health care in the country. Nonetheless, certain tensions can be identified between the different stakeholders' conceptions. Shades of opinion ranged across a wide scale, the extremes of which could be described as, at one extreme, stakeholders who place the emphasis on health promotion and prevention over and above other aspects and expressly leave aside the care dimension, while at the other extreme are stakeholders who argue the need for PHC to be approached from the starting point of proper clinical resolution of health-illness problems, which would enable promotion and prevention to be addressed with greater legitimacy.
As regards the relationship between PHC and the first level of care, some interviewees report that there is difficulty in understanding the concept. Some of their conceptions equate PHC with the first level of care and mention: In Uruguay today nobody regards PHC as the same as the first level of care any longer, at least in academic and decision-making circles. I am sure that there is still a long way to go from the policy in this respect".
As regards the proposed change in management model, the health reform that brought in the SNIS emphasises the health authorities' stewardship capability and, as part of that, their management capability. This is understood as the ability of the stewardship body (the ministry of public health; Ministerio de Salud Publica, MSP) to formulate, organise and direct execution of national health policy. In this connection, the legislative has sanctioned a series of laws that give
8 horas semanales
Red de Investigación en Sistemas y Servicios de Salud del Cono Sur , Unidad Docente de Administración de Servicios de Salud
Investigación
Coordinador o Responsable
Concluido
Equipo:
NOGUEIRA, E , BERTERRETCHE, ROSARIO
Palabras clave:
Atención Primaria de Salud
Organización de Servicios de Salud
Areas de conocimiento:
Ciencias Médicas y de la Salud / Ciencias de la Salud /
Politicas y Servicios de Salud /
Administración de Servicios de Salud