Tuberculosis control and managed competition in Colombia

Abstract

Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals.

Rectoría de la vigilancia en salud pública en el sistema de seguridad social en salud de Colombia: estudio de casos

“…Circunstancias análogas fueron descritas para el control de la tuberculosis en el país, donde se reportó disminución en los recursos humanos y en la planeación, inspección, vigilancia y control, tanto en el ámbito departamental como en el local (8,9).…”

Incidencia y factores asociados al abandono del tratamiento antituberculoso

“…Una explicación podría ser que el problema ha aumentado, producto de los cambios ocurridos en la dinámica del programa como consecuencia de la reforma del sector salud en el país, que pasó de ser administrado por el Estado para ser delegado a empresas contratistas (26). Este nuevo esquema afectó la visión colectiva de las actividades del control de la tuberculosis (27).…”

Organizational elements of health service related to a reduction in maternal mortality: The cases of Chile and Colombia

“…This complicated the implementation of the multiple strategy approach of public health (research, information, education and communication, early prenatal care, opportune risk identification and follow-up of the pregnant woman) which is necessary for fostering demand for preventive care services, as there is not a clear health need on the part of the user. This situation has been identified by other authors as a weakness of the SGSSS [22,[30][31][32].…”

“…The Ministry was working beyond its capacity in its attempts to foster coordination, communication and liaison mechanisms between the various actors and public health interventions, such as education, surveillance and maternal health. This fact has been identified by various researchers as an element that not only negatively influenced the management of policy for maternal-child care, but that also had an impact on the management of other public health problems [22,30,31].…”