Suchergebnisse

Objective: As part of the evaluation of the obligations which the health sector acquired within the national policy for eradication of child labor, it is necessary to analyze their pertinence in relation to the context, the goals of the system and, overall, the needs felt by children of both sexes, young workers and their families.Methods: For this evaluation the systemic approach is used where one side the commitments are compared with the social, political and economic context in which they were formulated and, on the other side, all those involved in the subject are called. From this a comparative strategy or triangulation is generated in order to obtain the coincident aspects as well as the conflicting ones, analyzing the different positions.Results: Difficulties become evident in the sector regarding decision taking, as well as the ignorance of children and youths as social subjects of rights. Conclusions: In the health sector limitations are present for the understanding of the phenomenon of child labor, as well as of the role of the health sector in the solution of the problem ad the structural barriers created by the Law 100 of 1993. ; Objetivo: Evaluar los compromisos que el sector salud asumió en la política nacional para la erradicación del trabajo infantil se examina la pertinencia delo formulado por dicho sector en relación con el contexto, los alcances del sistema y sobre todo, las necesidades sentidas de los niños, niñas, jóvenes trabajadores y sus familias. Metodología: Para realizar esta evaluación se utiliza el enfoque sistémico desde, por una parte, se comparan los compromisos con el contexto social, económico, político del momento en el cual el sector salud definió sus compromisos. Por otra parte, se llama a todos los involucrados alrededor del tema. A partir de ellos se genera una estrategia de comparación o triangulación de discursos para obtener los aspectos en los cuales coinciden y en los que hay conflicto, analizando las diversas posturas. Resultados: Se evidencian dificultades en el sector en cuanto a la toma de decisiones, así como el desconocimiento de la infancia y la juventud en cuanto sujetos sociales de derecho. Conclusiones: En el sector de salud se presentan limitaciones para comprender el fenómeno del trabajo infantil así como el papel del sector en la solución del problema y las barreras estructurales establecidas desde la Ley100 de 1993

Abstract Background The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. Methods The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. Results The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users. Conclusions The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required.

BACKGROUND: Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. METHODS: The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. RESULTS: The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. CONCLUSION: Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.