Multidimensional Comprehensive Framework: Health Descentralization



This paper presents a comprehensive multidimensional model, in order to improve relations and interactions that generates as a result the health service provided to the user under a scenario of decentralization of health, where not only plays pronounced relevance the main players in the upper echelons of the state, but also the different local agents that make use of resources based on population needs. Decentralization of health becomes important to rectify the created situations by the failures of the competitive forces in the private market, making the system operate effectively to serve citizens. According this, where used key concepts such as decision space by Bossert and Chernichovsky as the articulator concept among the different actors that make up the model, functions and means (like two sides of the same coin) by Chernichovsky being these ones two of the three configuring edges of the decision spaces, and the scheme of Structure, Process and Outcome of Donabedian, among others as the Organization and management of care consumption. Moreover, the role of actors is highlighted, being responsible for the materialization of the decisions to be taken in the decision space, and the third edge that supports and sets up decision making between different instances of the model. Finally as one of the conclusions, it seems necessary the creation and timely implementation of effective accountability mechanisms making possible the monitoring of resources and the use of them among local agents and service providers, and between the main agent and the local general agents. Key Words: Systems thinking, systems reform, Health System. Primary health care, Health System. Research methodologies and methods, Research methodologies and methods Key Messages 1. Decision Spaces composed by actors means and functions. 2. Decentralization as an instrument to fix Health Market fails. 3. Importance of the monitoring of health outcomes to configure the interactions inside decision spaces.


Marta Cecilia Jaramillo-Mejia

Icesi University

I´m from Cali, Colombia.
I´m a doctor with PhD in Clinic Medicine and Public Health. I´m Professor in the Faculty of Economic and Administrative sciences, .Icesi University
My expertice are in Health Planning, Public Health, social comunity Health and Public Management.
I teach Public Management in the Organizational management Department, for Economic and Political Sciences students and, Public Health to the Medicine Students.
I research in Health Care Systema and Infant Health (my Doctoral Thesis).
Actually, I ´m working in the interdisciplinary Project about Design Primary Health Care for the Rural áreas, with differencial topics in the Pacific Litoral of Colombia.
I like to be a contacts and network