Saturday, January 28, 2023

Former Deputy Minister: “There is a need for a truly integrated network of health services”

The pandemic exposed several shortcomings in the health sector. In this regard, Dr. José Carlos del Carmen Sara points out that, in order to solve them, it is imperative to address the problem of fragmentation of the health services provided.

by Elena Beletich. January 16, 2023. Published in El Tiempo’s Semana supplement on January 15, 2023.

José del Carmen, Neurologist, Doctor in Public Health and Professor at the Faculty of Human Medicine of the University of Piura, reports that, at present, the healthcare system has structural factors that weaken its response capacity and generate gaps in situations Access and quality of services provided. One of these factors, he says, is the “fragmentation” of the provision of all these services, provided by different institutions in the country.

The former deputy minister of health and former national superintendent of health indicates: “This fragmentation leads to the inability and inequity to address the health problems affecting our population in a timely and effective manner.”

Has inequality in the health sector increased or decreased in recent years?
Over the past five years, two elements have been added that have exacerbated the sector’s vulnerabilities: severe political instability and the COVID 19 pandemic, which, added to budgetary limitations that typically affect the health sector, have weakened the area further. it.

Nevertheless, the invaluable contribution of health professionals and workers is noteworthy, who knew how to face this grave crisis and maintain from their base and jobs the main activities and interventions necessary to protect the lives of the population.

The areas with the greatest shortfalls, in terms of attention, prevention and health care, are rural areas, the poorest cities, how to close the existing gap with other cities?
The existence of large social and economic gaps in living conditions, access to formal work, housing and basic services, among others, conditions our country at greater or lesser risk of death for significant segments of our population during the pandemic. Never at this difficult stage, does it need to be recognized that the so-called “social determinants of health” actually define a person’s likelihood of living or dying; And it is related to poverty, living conditions etc.

In this context, it is necessary to prioritize an effective and sustained approach to the “fight against poverty”, of an interregional and intergovernmental nature, involving regional governments and all actors that can contribute to generating growth poles in the regions Huh. The greatest deficiencies and needs, such as those in the south of the country and, in general, the poorest and most marginalized regions.

What does this imply?
Establish a “state policy” that transcends each term of government or the political revenue that can be provided to the party it represents. It must seek to generate structural change in each of the priority sectors to create conditions to promote human development, which does not involve simply the distribution of vouchers or food aid, but with the building of productive capacity, access to Should be For education, health services, decent housing and work.

It is a task that cannot be postponed, must be accomplished at the earliest and must be supported by a social fabric that ensures its responsible execution and combats any act of corruption.

What are the urgent measures adopted for more equitable access to health in the country?
The initial objective should be to aim at the integration of the various segments of our healthcare system, and not just to embody the implementation of an “integrated network of these services” constituted by public establishments in charge of MINSA or regional governments. EsSalud, instead, integrates services provided by the armed and police forces, municipalities, church or religious congregations, and the private sector, within the framework of a regional approach.

For this, a unique governance mechanism has to be established in each region and this implies creating political agreements between national, regional and local governments and all the actors involved, to use or improve existing mechanisms, The purchase or payment of services by the funding institutions of each provider’s health insurance to different providers. Thus, every citizen will be able to access the service they need, whether the state, Social Security or a private insurer is responsible for paying for said service.

This requires a legal framework…
Certainly, it is necessary to establish a clear regulatory framework that guarantees the correct implementation of the said actions, supported by a solid and reliable information system, necessary to guarantee the continuity and flow of health care to each resident. information allows. Resources required for optimum and timely provision provided by various health establishments.

In the short term, how can health care, promotion and prevention be improved?
Although we have pointed out that there are structural weaknesses and shortcomings that need to be addressed, the contribution of technical and conscientious management by the officials who are responsible for the operation and maintenance of health services in each area or region can generate significant improvements. , not only in the quality of care, but also in the approach to address the health problems of the population under their care, which makes it possible to identify their root cause, so that they can be faced together (civil and religious authorities, private sector, organized community, among others). This means exercising transformational leadership that stems from the bedrock of our health systems and societies.

Do big budgets are needed to solve problems?
Generally, this is attributed to the lack of resources devoted to health, the many shortcomings affecting our services, and the inadequate results achieved; However, if we examine the “Friendly Consultations” portal of the Ministry of Economy and Finance, we can appreciate that the percentage of the budget allocated to health in relation to the general budget of the republic has increased over the past 20 years. More than doubling, meaning an increase in absolute figures of more than 10 times, in a period when inflation had almost no effect on the value of the currency.

You would then wonder why we have not seen this disproportionate improvement in hospital infrastructure, its equipment, the numbers and conditions of our health human resource etc. Undoubtedly, technical and conscientious management, at all levels of government and management of health institutions, could have contributed to explain the effect of this increased funding.

Who is responsible for the effectiveness and efficiency of health management?
It is the primary responsibility of political officials at each level of government to appoint appropriate professionals to handle the leadership and management of health institutions. They should avoid viewing the region as a congenial place for proselytizing activities or for giving free rein to political clientelism.

In this context, moreover, citizens should choose their rulers responsibly and avoid falling under the influence of “relativism” that tries to justify their motivations in expressions such as “steals, but works”.

Similarly, universities should include in the training curriculum for health professionals content that allows them to develop basic management skills and competencies; and, strengthening specialization programs in the field of public health and health management, coupled with a solid ethical training that guides their actions.

Finally, professionals and officials in the field themselves need to be aware of the great responsibility that lies in assuming the management of health care of a population or the management of a health service; This should motivate them to seek ways to strengthen their abilities; And, at the same time, to be able to refuse to take a position for which they are not ready.

Nation World News Desk
Nation World News Desk
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