Analysis of the enablers of capacities to produce primary health care-based reforms in Latin America: a multiple case study.

Ernesto Pablo Báscolo,Natalia Yavich,Jean-Louis Denis

doi:10.1093/fampra/cmw038

Abstract

BackgroundPrimary health care (PHC)-based reforms have had different results in Latin America. Little attention has been paid to the enablers of collective action capacities required to produce a comprehensive PHC approach.ObjectiveTo analyse the enablers of collective action capacities to transform health systems towards a comprehensive PHC approach in Latin American PHC-based reforms.MethodsWe conducted a longitudinal, retrospective case study of three municipal PHC-based reforms in Bolivia and Argentina. We used multiple data sources and methodologies: document review; interviews with policymakers, managers and practitioners; and household and services surveys. We used temporal bracketing to analyse how the dynamic of interaction between the institutional reform process and the collective action characteristics enabled or hindered the enablers of collective action capacities required to produce the envisioned changes.ResultsThe institutional structuring dynamics and collective action capacities were different in each case. In Cochabamba, there was an ‘interrupted’ structuring process that achieved the establishment of a primary level with a selective PHC approach. In Vicente López, there was a ‘path-dependency’ structuring process that permitted the consolidation of a ‘primary care’ approach, but with limited influence in hospitals. In Rosario, there was a ‘dialectic’ structuring process that favoured the development of the capacities needed to consolidate a comprehensive PHC approach that permeates the entire system.ConclusionThe institutional change processes achieved the development of a primary health care level with different degrees of consolidation and system-wide influence given how the characteristics of each collective action enabled or hindered the ‘structuring’ processes.

Highlights

Primary health care (PHC)-based reforms have been used to promote changes in health systems and services
We provide a detailed description of the health care and organizational practices promoted by the new institutional structures introduced during each period and the changes in the composition of the collective action, including internal and external relationships and political and technical capacities (Table 3)
The first two stages envisioned an improvement in coverage and access to services for the maternal–child population and the final stage focused on the development of a comprehensive PHC approach based on a multicultural model

Summary

Introduction

Primary health care (PHC)-based reforms have been used to promote changes in health systems and services. While some countries moved towards a comprehensive PHC approach accompanied by radical institutional and organizational changes that resulted in significant health improvements, other countries were able to develop only the primary level of care or introduce programmes to improve maternal and child health and control infectious diseases. These latter processes favoured significant health improvements in specific populations and/or diseases, they were unable to produce the institutional and organizational changes required to reform and improve the health system as a whole [1,2,3].

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Conclusion