Encuentros y desencuentros entre salud comunitaria y sistema sanitario español. Informe SESPAS 2018

Abstract

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources.

Crisis, work and nursing: an ethnographic narrative of the coronavirus pandemic in Primary Care in Spain

“…In the case of the Brazilian reality, a Community Health Worker (CHW) can decisively contribute to the work of monitoring and popular education in the territory. But, given the accelerated dismantling of the Unified Health System (SUS -Sistema Único de Saúde) in the last 5 years, with a high loss of professionals in teams (42,44) , community guidance in Primary Care would be in the background as observed in the Spanish context (45)(46) . Nevertheless, the pandemic reveals the importance of the territory and community guidance in the organization of the work process in Primary Care, especially for professional performance in the health crisis.…”

Self-Efficacy of the Community Health Agent, Importance of Motivation and Empowerment

“…11,12 The economic crisis and the weakening of the state make the need arise to promote processes that develop and pro mote health promotion actions at a local level. 13,14 In this area, the community health agent is a social representative who strongly links with the community. 4 The development of community agents is important for responding to social problems since they have greater knowledge of the reality in which they operate, and they have the most significant access to the community.…”

Creating a Collaborative Platform for the Development of Community Interventions to Prevent Non-Communicable Diseases

“…In Spain, the situation of NCD prevention is characterized by being very fragmented and even though there are a lot of good initiatives and programs [17] real coordination between institutions at different levels and territories has not been achieved. Research shows that in other parts of the world there has also been difficulties in consolidating collaborative platforms and partnerships, showing as the most important barriers to budget management, lack of political and institutional support, dealing with the complexity and variability of scenarios and approaches [18] depending on the political situation or sustaining the collaboration in time [19].…”