Abstract
Primary health care looks beyond clinical services to health promotion and primary prevention at the population level. In 2011, Colombia adopted a normative approach to primary health care, to advance efforts to set health priorities and transcend a curative, hospital-based system. An intervention was carried out in eight communities in Bogotá and Cundinamarca, Colombia to build community capacity to influence health. Activities included training community leaders to design and implement health improvement initiatives aimed at the most important health problems identified by their organizations. Twenty-eight leaders completed the training. They designed and implemented eight health improvement plans to address the most important health problems in their respective communities: protecting public spaces for children’s physical activities, improving family practices in child nutrition, organizing a health insurance beneficiaries’ health promotion network, organizing a service delivery network for homeless persons, connecting people with cognitive disabilities to treatment services, combatting violence against women, working against child abuse, and integrating health education into school curricula. Lessons were learned about capacity-building in primary care, approaches to strengthening intra- and interinstitutional conditions, and managing processes for community ownership. The intervention enabled development of initiatives for solving various problems by different types of organizations, highlighted participants’ understanding of their role as health agents, and promoted community participation and intersectoral action.
Highlights
Colombia is a culturally and ethnically diverse country with a highly varied demographic and epidemiologic profile, and an increased burden of chronic non-communicable diseases in the past decade without yet having eradicated infectious diseases. [3,4,5] Until recently, Colombia’s health system favored development of a hospital-based, curative health care model, oriented toward highly specialized care under a free-market model that generates inequities in financing and limits access to health care, patient-centered care and community-based health improvements.[6]
This article describes an intervention based on primary health care (PHC) and community-oriented primary care (COPC) principles,[10] aimed at building capacity for community participation to change population health status in Colombian communities
Throughout the training process and during plan implementation, it was observed that, as part of the participatory action research (PAR) process, organizations made a clear conceptual and practical differentiation between disease prevention and health promotion, the latter understood as a collective matter and not the exclusive purview of the health system
Summary
This article describes an intervention based on PHC and community-oriented primary care (COPC) principles,[10] aimed at building capacity for community participation to change population health status in Colombian communities.
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