In several Latin American countries, a selective approach to the delivery of primary health care in the past few decades has skewed access to a limited number of services to specific vulnerable populations. The result: fragmented health systems with numerous problems in the delivery of services, and health inequities. Poor coordination between provincial and municipal health facilities, and lack of professional reward associated with work at the primary-care level, have also impeded the delivery of services.
But changes to health systems are happening in the region. In less than 15 years, the city of Rosario, Argentina, successfully transformed a highly fragmented, under-resourced, hospital-centred system into one organized around primary health care. Research conducted by the Instituto de la Salud Juan Lazarte and supported by Canada's International Development Research Centre identified some of the factors that contributed to the successful reforms.
In their case study, researchers show that this successful shift is the result of a social movement empowering young professionals, public health experts, and politicians both to improve access to health care and to raise the professional reward of work at the primary-care level. A shared vision among health workers has strengthened coordination between primary health centres and health-care providers. Most importantly, health workers’ participation in management helped redefine the municipal health system’s norms and values.
Rosario has become a model for other health systems in Argentina and beyond. It provides important insights into how to strengthen health systems by using a primary health-care strategy.
This case study was part of a larger project on governance patterns and health-policy implementation in Argentina and Bolivia.
Photo (top): IDRC/Natalia Yavich