Decentralization and health system reform: what is their impact on malaria incidence in Colombian municipalities?

Abstract

Colombia is one of the Latin-American countries with higher malaria incidence and its control is the responsibility of the departments and municipalities. To assess the effect of decentralization within the context of the Social Security Health System on the incidence of malaria in Colombian municipalities. An ecological trend study was carried out in municipalities which reported at least five cases of malaria in 5 of the 7 years between 1998 and 2004. Information on indicators of decentralization of the municipalities, population with health insurance in either the subsidized or contributive regimes as well as incidence of malaria was requested from the health authorities of the departments and municipalities. Socioeconomic and demographic variables were also collected. The behavior of the malaria rates was assessed in relation to the decentralization status of the municipalities. A repeated measure analysis was performed using the generalized estimating equation. The decentralization status of the municipality (IRR=2.36; 95%CI: 1.57-3.56), its proportion of unmet basic needs (IRR=9.35; 95%CI: 3.66-23.89) and of population younger than 40 years of age (IRR=1.8; 95%CI: 1.13-1.23) were associated with malaria incidence in Colombian municipalities. Decentralization status as well as socioeconomic and demographic factors are associated with increased malaria risk in Colombian municipalities.