Román Vega

Pontificia Universidad Javeriana

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Miguel San Sebastián

Umeå University

Naydú Acosta-Ramírez

Universidad Libre de Colombia

Paola A. Mosquera

Umeå University

Jorge A. Rojas

Pontificia Universidad Javeriana

Patty Fidélis de Almeida

Universidade Federal Fluminense

Daisy Iturrieta

University of Valparaíso

ÓF

Óscar Feo Istúriz

University of Carabobo

Gilberto Jiménez Ríos

Administracion de los Servicios de Salud del Estado

Mario Parada-Lezcano

University of Valparaíso

Jinneth Hernández

Pontificia Universidad Javeriana

Cooperative Institutions

Pontificia Universidad Javeriana

Hospital Santa Marcelina

Umeå University

University of Valparaíso

Asociación Colombiana de Diabetes

Fundación Universitaria Sanitas

Universidad Santiago de Cali

Universidad Nacional de Colombia

Miami Foundation

Escola Nacional de Saúde Pública

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Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota–Colombia: a cross-sectional study

BMC Health Services Research (2013)

Paola A. Mosquera Jinneth Hernández Román Vega Jorge A. Rojas Miguel San Sebastián

The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users. The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required.

Health administration

Cross-sectional study

Health Services Research

10.1186/1472-6963-13-315

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Citations (19)

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

The International Journal of Health Planning and Management (2013)

Paola A. Mosquera Jineth Hernández Román Vega Ronald Labonté David Sanders

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.

Thematic Analysis

Community Health

10.1002/hpm.2228

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Is comprehensive primary health care part of the response to the COVID-19 pandemic in Latin America?

Figshare (2021)

Lígia Giovanella Román Vega Herland Tejerina-Silva Naydú Acosta-Ramírez Mario Parada-Lezcano

Abstract Latin America has become one of the epicenters of the COVID-19 pandemic, with a health and humanitarian crisis. The objective of the article is to analyze the strategies implemented by countries in the Region to face the pandemic and the role of Primary Health Care, considering obstacles and potential. The cases of Bolivia, Brazil, Chile, Colombia, Cuba, Uruguay and Venezuela were analyzed. The seven countries have adopted diverse social distancing strategies with varying degrees of sustainability. The responses emphasized hospital care more than surveillance, case identification, contact tracking, and enabling adequate conditions for isolation. In almost all cases studied, the capacity of primary care services in the territory was underestimated. Even so, primary care initiatives with a territorial and community focus sought to integrate health surveillance with promotion, prevention and care, despite partial implementation. In this context, comprehensive and integrated primary care takes on new meaning and requires new developments in order to contribute to the recovery of the balance between society and the environment. The pandemic showed the need to rethink health care systems and the importance of primary care for comprehensive and integrated health.

Pandemic

2019-20 coronavirus outbreak

10.6084/m9.figshare.14327421

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Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

BMC Family Practice (2012)

Paola A. Mosquera Jinneth Hernández Román Vega Jorge A. Rojas Ronald Labonté

Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables.A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index.The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant.Despite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota's initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.

Ecological study

Longitudinal Study

10.1186/1471-2296-13-84

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Is comprehensive primary health care part of the response to the COVID-19 pandemic in Latin America?/ ¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica?/ A atenção primária à saúde integral é parte da resposta à pandemia de Covid-19 na América Latina?

Lígia Giovanella Román Vega Herland Tejerina-Silva Naydú Acosta-Ramírez Mario Parada-Lezcano

Resumen America Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del articulo es analizar las medidas para enfrentar la pandemia en paises de la Region y el rol de la Atencion Primaria de Salud, discutiendo obstaculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete paises adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El enfasis de las respuestas estuvo mas en la atencion hospitalaria que en la vigilancia de la salud, identificacion de casos y contactos y disposicion de condiciones adecuadas para el confinamiento. En casi todos los paises, se subestimo la capacidad de los servicios de atencion primaria en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promocion, prevencion y cuidado, aunque con alcance parcial. En este contexto la Atencion Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atencion primaria de salud integrada e integral.

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Health Policy in Bogota (2004-2008):An Analysis of the Experience with Primary Health Care

Social medicine (2008)

Román Vega Naydú Acosta-Ramírez Paola Mosquera Mendez Ofelia Restrepo Vélez

This study summarizes the health policy and the Primary Health Care strategies developed by the Bogota municipal government from 2004-2008. The experiences and outcomes during this time period indicate that, despite the market-oriented health policy that exists in Colombia, it was beneficial to implement health policies and strategies at the local level so as to guarantee the right to health and equitable access to health care. National level restrictions, however, impose constraints on the potential implementation of such policies and strategies. This suggests that in order to achieve effective and sustainable changes at the local level, it is necessary to promote substantial reforms within national health care policy.

Health for all

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P2547Economic forecasting of Latin America Telemedicine Network (LATIN)

European Heart Journal (2018)

Sagar Mehta Daniel Rodríguez Roberto Botelho Francisco J. Fernández Mario Torres

10.1093/eurheartj/ehy565.p2547

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Experience of implementing the strategy of primary health care in the locality of Bosa

Paola Mosquera Mendez Jineth Hernández Torres Román Vega Cesar Junca

In order to describe the way in which a strategy APS was implemented at Hospital Pablo VI Bosa (HPVI) and to describe predisposing factors and limitations of such an implementation, a qualitative analysis of documentary material, in-depth interviewing with institutional actors and officials and community workshops was performed. From the triangulation of structured information was drafted a narrative synthesis that describes the experience in the area. Among the main findings is an interesting bet management model that views the APS as a central strategy and complements other strategies proposed by the District for the implementation of its public policy emphasizes the strengthening of community dynamics that although, mainly limited to institutional issues, have been significant in terms of sustainability. Favoring and limiting factors identified are diverse, but all related to how to implement public policy and institutional dynamics.

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The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis

International Journal for Equity in Health (2012)

Paola A. Mosquera Jinneth Hernández Román Vega Jorge A. Rojas Ronald Labonté

Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities. The PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

Health Services Research

Social Inequality

10.1186/1475-9276-11-66

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Citations (29)

¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica?

Trabalho Educação e Saúde (2020)

Lígia Giovanella Román Vega Herland Tejerina-Silva Naydú Acosta-Ramírez Mario Parada-Lezcano

Resumen América Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del artículo es analizar las medidas para enfrentar la pandemia en países de la Región y el rol de la Atención Primaria de Salud, discutiendo obstáculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete países adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El énfasis de las respuestas estuvo más en la atención hospitalaria que en la vigilancia de la salud, identificación de casos y contactos y disposición de condiciones adecuadas para el confinamiento. En casi todos los países, se subestimó la capacidad de los servicios de atención primária en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promoción, prevención y cuidado, aunque con alcance parcial. En este contexto la Atención Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atención primaria de salud integrada e integral.

10.1590/1981-7746-sol00310

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Citations (57)