Molina MG, Rodríguez TC. Caracterización de la descentralización del sector salud en tres municipios: Itaguí, La Ceja y Balboa. [Decentralization of the healthcare sector in three municipalities: Itaguí, La Ceja, and Balboa.] Revista Facultad Nacional de Salud Pública [Journal of the National Faculty of Public Health.] ( Medellín , Colombia ) 2002 July-December; 20(2): 7-21.

Objectives: To analyze characteristics of institutional development and community participation as key elements of decentralization in three municipalities of Colombia (Itaguí, La Ceja, and Balboa).

Methodology: Case study using observation systematic interviews, and focus groups.

Results: The decentralization of the healthcare sector implies fiscal, political, social, and administrative changes. Municipalities assume competencies transferred to them by the central and regional governments and become responsible for the population’s health. While Itaguí, La Ceja, and Balboa have attained very different levels of socioeconomic development, they have made similar progress in implementing decentralization. They have faced obstacles such as: (a) the mayors’ lack of political will to support the process; (b) lack of technical ability among the staff members of local healthcare administrative centers; and (c) a high rate of turnover among these staff members, resulting from political patronage and complexity of legislation. Performance of the administrative units has been limited; coordination among them has proven deficient or nonexistent. Healthcare information systems have registered low indices of quality and effectiveness in decision-making. This study shows that activities and power of the private insurance companies have increased considerably in recent years. Numerous community organizations in the three municipalities have exerted little influence on decisions that affect healthcare.

Conclusions: Although certain achievements have occurred in the three municipalities, integrated decentralization has remained incomplete. The three municipalities have shown certain commonalities: (a) a struggle for power among institutions, with healthcare insurers exercising great power; (b) lack of planning; (c) low level of technological development; (d) lack of technical capabilities, (e) high staff turnover in the local health administrative centers; and, (f) weak development of community participation.

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