Mapping primary health care renewal in South America.

Autor:	Acosta Ramírez N; Department of Public Health, Pontificia Universidad Javeriana, Cali, Colombia, naydu.acosta@javerianacali.edu.co., Giovanella L; Department of Administration and Planning in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil., Vega Romero R; Department of Administration and Planning in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, Public Health Institute, Pontificia Universidad Javeriana, Bogotá, Colombia., Tejerina Silva H; Faculty of Medicine, Universidad Mayor de San Andrés, La Paz, Bolivia., de Almeida PF; Department of Health Planning, Fluminense Federal University, Niterói, Brazil., Ríos G; Faculty of Medicine, Universidad de la República, Montevideo, Uruguay., Goede H; Goede Public Health Cons Bureau, Independent Advisor, Paramaribo, Suriname and., Oliveira S; Faculty of Psychology, Centro ABEU University, Rio de Janeiro, Brazil.
Jazyk:	angličtina
Zdroj:	Family practice [Fam Pract] 2016 Jun; Vol. 33 (3), pp. 261-7. Date of Electronic Publication: 2016 Mar 21.
DOI:	10.1093/fampra/cmw013
Abstrakt:	Background: Primary health care (PHC) renewal processes are currently ongoing in South America (SA), but their characteristics have not been systematically described. Objective: The study aimed to describe and contrast the PHC approaches being implemented in SA to provide knowledge of current conceptions, models and challenges. Methods: This multiple case study used a qualitative approach with technical visits to health ministries in order to apply key-informant interviews of 129 PHC national policy makers and 53 local managers, as well as field observation of 57 selected PHC providers and document analysis, using a common matrix for data collection and analysis. PHC approaches were analysed by triangulating sources using the following categories: PHC philosophy and conception, service provision organization, intersectoral collaboration and social participation. Results: Primary health care models were identified in association with existing health system types and the dynamics of PHC renewal in each country. A neo-selective model was found in three countries where coverage is segmented by private and public regimes; here, individual and collective care are separated. A comprehensive approach similar to the Alma-Ata model was found in seven countries where the public sector predominates and individual, family and community care are coordinated under the responsibility of the same health care team. Conclusions: The process of implementing a renewed PHC approach is affected by how health systems are funded and organized. Both models face many obstacles. In addition, care system organization, intersectoral coordination and social participation are weak in most of the countries. (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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