| dc.description.abstract | Para determinar el grado en el que se lograron satisfacer las metas propuestas con respecto a su estructura y sus actividades, después de varios años de operación, se examinó un programa urbano de atención primaria en salud (APS) en un distrito de muy bajos ingresos en Cali, Colombia, cuyos servicios los prestan trabajadores de salud comunitarios, especialmente a través de visitas domiciliarias. Los elementos
estructurales del programa tales como la colaboración entre las organizaciones públicas, privadas, las características de las voluntarias y los incentivos usados para retenerlas en el programa, se calificaron satisfactoriamente porque las metas propuestas se ajustaron a la realidad. Las actividades del programa se evaluaron satisfactoriamente
en algunos aspectos y no lo fueron tanto en otros. P.e., los servicios
preventivos y educativos que prestaban las voluntarias se ajustaron al diseño y el programa ayudó a promover la equidad social; no obstante, fue muy difícil llegar a los grupos socioeconómicos más bajos. Por otro lado, el sistema de información resultó ser demasiado ambicioso, la supervisión de las voluntarias fue deficiente por el alto número de ellas que se asignó a cada supervisor y la cobertura del programa también fue deficiente. Se hacen algunas recomendaciones para que los programas de atención primaria en Cali y también en otras partes alcancen con más eficacia las
metas propuestas. An urban primary health care
(PHC) program that relies on volunteer
community health workers (CHWs)
for delivery of services, especially
through home visits, in a very low
income district of Cali, Colombia,
was examined after several years of
operation to test the degree of
achievement of important goals for
its structure and activities (process).
Methods of study included interviews
with samples of volunteers and their
supervisors, review of those
volunteers’ records, dscussions in
focus groups and conferences, and
reading of reports on the program.
Some of the goals of the program’s
designers, often bsed on aims for use
of CHWs found in the literature of
primary health care, were well
achieved in reality while the application
of others was only partly successful
or even deficient. Important structural
elements of the program collaboration
between public and private organizations,
characteristics of volunteers,
incentives for volunteers, and
avoidance of diversion of volunteers’
efforts by their paid employment
outside of the program, showed a
satisfactory match between the goals
for them and reality. For example,
there was a close formal collaboration
among the Cali public health agency,
the departamental university and
several private foundations. Over half
of the volunteers had outside
employment, but there was no evidence to show that it interfered
with their efforts in the health
program. Activities had a mixed record.
The services provided by
volunteers matched well the
designers’ emphases on preventive
and educational services. Targeting
the population of a low income district
helped to promote social equity, but
the lowest socioeconomic group there
proved significantly more difficult
than the next-to-lowest to serve
effectively. Examination of the
information system revealed some
useful records, but its deficiencies
indicated an overly-ambitious scheme.
Supervision had deficiencies, probably
due to the large number of volunteers
assigned to some supervisors, who
did not receive any additional
compensation for that work. Volume
of service -families covered, home
visits achieved, and hours worked by
volunteers- also had deficiencies. In
discussing the results of the study the
authors offer some recommendations
for improving the achievement of the
goals established for the Cali program,
which could be relevant also to health
programs elsewhere in the world. | |
