Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota–Colombia: a cross-sectional study

Abstract

BackgroundThe 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.MethodsThe 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.ResultsThe 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.ConclusionsThe 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.

Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

“…They found that the global performance index was rated as good for all interviewees. The weakest dimensions were the family focus and community orientation; the distribution of financial resources; and, accessibility [51]. …”

Promoting healthy eating in primary health care from the perspective of health professionals: a qualitative comparative study in the context of South America

“…Being a particular case, Bogotá provides PHC services from the public sphere. It combines promoting, preventive, curative and rehabilitative actions in its comprehensive approach [32]. Thus, themes related to disease treatment in the logic of the groups studied corresponded to other service levels or they are explicit objectives of the private market.…”

“…Colombia, although already having isolated PHC experiences in its various regions, has recently experienced a national consolidation of policies to strengthen the health system through PHC and emphasizes health promotion in the 10-year public health plan [30]. Bogotá, the capital city, has been a reference point: its renovation started in 2004 and the implementation of the Collective Intervention Plan (Spanish acronym: PIC) acts through a structure that combines management, surveillance, and operation of actions in real life scenarios within the public health field [32]. These, in turn, relate to the environments where people live, grow, and interact: family, school, community, workplace, and the institutions that provide health care.…”

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

“…19,20,21 Even in developed countries, patients are more dissatisfied with healthcare within systems where fragmentation is greater. 22 To address fragmentation, there needs to be greater service integration of essential MCWH care.…”