Sarduy Sánchez C, Alfonso A. Revelando contradicciones en la gestión local de salud. [Disclosing contradictions in the local management of health.] Boletín SaluCo [Bulletin of Collective Health] (Havana,Cuba) 2002; 1: 7-15.

Objectives:To analyze the contradictions in Latin America, particularly in Cuba, of decentralization policies to reform health systems.

Methodology:Analytical and interpretive.

Results:The authors describe the reasons behind policies to reform health systems in Latin America and question privatization as a solution to the problems that led to these reforms (inequity, inefficiency, ineffectiveness, and lack of quality). The authors focus on decentralization and consider different options to implement it, the need to include a gender-based perspective in local management, and the difficulties in accomplishing these goals.

In assessing the Cuban situation, the authors point out the contradictions that emerge from decentralization, such as the centralization of management, an image of the social equality between men and women, and an image of equality of opportunity. These conditions exist in theory but not in practice. The idea of equality has restrained inclusion of the gender perspective in the formulation of public policies in the health field. The Maternal and Child Program, one of the principal programs of the Cuban Health System, reinforces this situation. Although this program has produced outstanding achievements, as evidenced in the indicators of maternal and child mortality, the program has led to a relative weakness in the program of Women’s Integrated Healthcare.

Conclusions:Recognizing the local dynamics in decentralization would foster the incorporation of health as an axis of local development. The perspective of gender also deserves more attention in the analysis of health situations and in local policy making.

Copyright 2007 University of New Mexico