Abstract
BackgroundColombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.MethodsAn ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007.ResultsIn both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities.ConclusionThe PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.
Highlights
Colombia is one of the countries with the widest levels of socioeconomic and health inequalities
There are other variables or factors that account for this unexplained part of the inequality as well as other factors that could be part of the explanation of the reductions in the effect of the inequality, but the data for those variables were not included due to the unavailability of the information at the locality level in the period observed. To our knowledge, this is the first study in Colombia and Latin America that has addressed the question about the contribution of the Primary Health Care (PHC) strategy to reducing health inequalities using both the concentration index and decomposition analysis
The analysis of changes in the distribution of child health outcomes measured by concentration curves and concentration indices showed a reduction in inequality after the implementation of the PHC strategy in Bogotá
Summary
Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. As a result of this increase, reduction of inequalities is a growing concern for national governments, international organizations and civil society organizations In this regard, the World Health Organization has stated that primary health care (PHC) is an effective way for the health sector to contribute to the reduction of social and health inequalities. The best available evidence shows that PHC values and principles –health equity, people-centered care and a central role for communities in health action– can respond to the expectations and challenges of modern societies. Based on these principles, PHC searches for strategies to achieve a more equitable and comprehensive health system and better population health [4,5]. The Commission on Social Determinants of Health has suggested that health care services with universal coverage and a focus on PHC could help to generate locally appropriate interventions across the range of social determinants by promoting community participation and intersectoral actions, leading to a reduction in the social causes of health inequalities [6]
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