Stakeholders, Primary Health Care and Dispersed Rurality

Abstract

Abstract Objective To characterize the existing tensions between actors which condition the implementation of the renewed primary healthcare (PHC), in the context of the most recent Colombian post-conflict years, in the territories of high rurality of the Pacific Coast. Methods We performed a qualitative study based on action research methodology with a critical and reflexive analysis of the social and institutional actors in the implementation of the Renewed PHC model in dispersed rural areas (Afro-Colombian and indigenous) the Pacific coast. We analyzed the different interested parties and the concordance between the community and institutional actors. Results The level of implementation of the Renewed PHC in high rurality territories of the Colombian Pacific Coast, intersects with tensions arising from the armed conflict, that affect sustainability and governance of the territory, and the intercultural tensions between the national health model in Colombia and the communities' social representations of their own health and development. Only 25% of the Renewed PHC elements are present, under low or medium conditions. Analysis of actors -Stakeholders-, according to their nature, level of presence, and power in the area indicates the absence of the Colombian government in these territories. Members of the community and their health resources constitute 48% of the Renewed PHC parties. Conclusions Limited understanding of the ethnic logics on health and development stands out as the main tension among actors to advance with the implementation of the Renewed PHC in post-conflict territories with high rurality. The national health model has a low capacity to accurately address health priorities from the Afro-descendant and Indigenous communities occupying such territories, with a differentiated, intercultural offer that would be able to act integrally on the dynamics of the illegal economy (illegal mining and illicit crops), which can seriously compromise their food security. Key messages Only 25% of the components of the renewed PHC are present in the territories with high dispersed rurality. In the post-conflict period, there are still tensions between community actors and stakeholders (Institutions).