Abstract
BackgroundSocial and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector. These policies contribute not only to overcoming inequity in the provision of this type of services but also to a reduction in social inequalities as a whole. Through a comparative analysis, this study aimed to explain the conditions through which ethnic-rural territories of the Colombian Pacific coast participate in health to contribute to the generation of policies and programs in territories with similar conditions.MethodsThe work was developed through the use of multiple techniques and strategies for information collection and analysis. These include several semi-structured interviews, multiple observation exercises and analysis based on a set theory, i.e., qualitative comparative analysis (QCA). The latter aims to develop a model that provides a count of the main causal combinations that allow high community participation in health.ResultsKey findings include how the trajectory of social mobilization and existence of a robust community social fabric became two critical conditions for community participation in the context of social exclusion. The presence of variables such as the implementation of PHC, guarantee of social rights, and trust in institutions, is underestimated as sufficient causal conditions for obtaining this result. Therefore, it is essential to recognize the existence, validity, and importance of processes, experiences, and resourcefulness of political natures, which aim at transforming the daily reality of the inhabitants of these communities. These also set a potential space and scenario for managing the communities’ main problems, including health, in the absence of institutionality that guarantees access to their social rights.ConclusionThis study points out the importance of understanding community participation as a political activity, expanding exchange dynamics and dialogs between institutions, rulers, and communities to provide social responses in health and well-being to communities and to understand local realities and their own community dynamics.
Highlights
Social and community participation is a fundamental component of the development of renewed primary healthcare (PHC)
Small municipalities located in the Pacific Coast of Colombia have low coverage of healthcare services, since the IPS are located in the main cities, far from rural and scattered areas [16]
Study setting This study was conducted in the Buenaventura District in Colombia, a tropical country in South America, and the only port in the Colombian Pacific located in the west of the Valle del Cauca Department with an extension of 6078 km2
Summary
Social and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector These public policies contribute to overcoming inequity, provided healthcare service, and to the reduction in social inequalities [1]. These policies contribute to overcoming inequity in the provision of this type of services and to a reduction in social inequalities as a whole. Colombian healthcare system The current healthcare system in Colombia is a public service with private and public providers It began in 1993 with the implementation of Law 100 and the goal of achieving universal coverage from 17.4% in 1990 to 9.6% in 2018 [15]. Small municipalities located in the Pacific Coast of Colombia have low coverage of healthcare services, since the IPS are located in the main cities, far from rural and scattered areas (i.e. the Buenaventura District has on only one public hospital in Puerto Merizalde called ESE San Agustin [ESE-Empresa Social del Estado]) [16]
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