Public health in Colombia′s new health sector reform

The Colombian health system is experiencing a major crisis and the Ministry of Health is undertaking a structural reform. The main symptoms of this crisis are the low quality of health care, increased health budget deficit, legal problems of health insurance companies and bankruptcy of providers.

The causes include, among others, lack of governance, a health sector not adapted to the new economic reality, a health system too complex with multiple actors and no clarity of stakeholders function and responsibilities, an unclear benefits package, corruption, etc.

Methods:

An interdisciplinary team analyzed the different health sector reform legislative projects and interviewed different stakeholders. The main goal was to understand the role of public health in the different health sector reform projects.

Results:

Public health has been understood as health promotion and disease prevention in most of the health reforms projects. Health promotion is focused on health determinants; however the role of the health sector and the relationship with other sectors, such as education, is unclear in the proposed reforms.

Disease prevention is presented as the responsibility of the government in a national health system proposal, under the insurance company's responsibility maintaining the actual organization, or by the health providers.

Discussion:

The role of public health in health sector reform is very limited; most of the proposals in the reforms are focused on organization and health sector budget management. Important public health functions such as development of policies and institutional capacity, equitable access and social participation are not in the main agenda.