2019-07-17
More than 150 attendees, health professionals, health authorities, health services professionals, academics and researchers from 11 countries in Latin America and Europe attended the delivery of results from the Equity LA II project, a six-year research project. The teams shared the results at the conference held at the Central House of the University of Chile on June 26-27, organized by the School of Public Health, Dr. Salvador Allende Gossens.
A great shared conclusion of the study has been that the contributions of this project are useful on a global scale, given the scarce production of knowledge in the region on a problem relevant to all health systems, such as fragmentation. The project "Impact of care integration strategies on the performance of health service networks in different health systems in Latin America" (Equity-LA II), funded by the EU's Seventh Framework Programme, studied for six years with an international research team made up of the EU (Spain and Belgium) and Latin America (Argentina, Brazil, Colombia, Chile, Mexico and Uruguay), ways of overcoming fragmentation and the scarce coordination and clinical integration of public health services. Several interventions were designed and implemented together with teams from the different levels of care in public networks in the six participating Latin American countries through a participatory action research methodology.
In addition to international speakers, the bulk of the seminar focused on the presentation of the most important results of the Equity-LA II project. On the one hand, the design and implementation of interventions to improve the integration of care through participatory action research processes and on the other hand, the result of these interventions on the coordination between levels, effectiveness, sustainability and applicability to other contexts.
In the roundtable on lessons learned and policy recommendations for the implementation of care integration strategies, project members, a representative of PAHO and the health authorities (Secretaries of Health, Ministry of Health) of all participating countries participated.
The results were presented by the researchers from each country and commented by professionals from the health service networks of the various countries attending, in an atmosphere of reflection that allowed experiences to be shared, analyzed and debated with the attending public from the countries participating in the study and also from other countries in the Region, such as Paraguay and Peru.
The inauguration was in charge of the representatives of the European Commission, Uli Wienrich; of the PAHO/WHO in Chile, Mario Cruz Peñate; of the Head of DIGERA of the Ministry of Health, Héctor Fuenzalida, of the Director of the Health and Social Consortium of Catalonia, José Augusto García Navarro and the General Director of the project, María Luisa Vázquez. While the closing was in charge of the Director (s) of the School of Public Health, Dr. Verónica Iglesias and the Rector of the University of Chile, Ennio Vivaldi.
About the study results
The General Director of the Project, Dr. María Luisa Vázquez, from the Catalan Health and Social Consortium, highlighted within the results how "different contexts suffer from similar problems, although with factors that aggravate them or make them more difficult to tackle; but in all these contexts solutions can be found that enthuse professionals to identify and adopt elements for improvement". He added that the relevance of developing bottom-up strategies is also demonstrated, but always with the support of the hierarchies and directors of the institutions that make it possible for these interventions to be developed.
For her part, Dr. Pamela Eguiguren, Deputy Director of the School of Public Health and Principal Investigator of the Equity LA Project in Chile pointed out that the research provides relevant background information, with qualitative and quantitative measurements, regarding the coordination and continuity of care in public health systems in the region, in the context in which political priority is given to the integration of health services.
"As an example of results we can mention that it was appreciated as a common problem in all countries and their health systems, the lack of linkage and communication between professionals at different levels, which leads to clinical disagreements that act to the detriment of patient care, and is a product of the structural fragmentation that we face, but it was also possible to observe, with the contribution of the participatory action research methodology, that it is a problem that can be tackled through joint work, democratic and horizontal relations between the teams at different levels that allow dialogue to articulate the resources with the user at the center of care management. He adds that the study shows elements that should be considered by policy makers, so that system reform proposals do not threaten to deepen the fragmentation or loss of territoriality of the network, but invest resources to strengthen the integration of public networks that have the capacity to provide continuous attention in the territories.
Dr. Vázquez also highlighted the opportunity offered by the study and the EC funding, through its research framework programme (FP7) and specific instrument (SICA), to "develop an international collaboration that has allowed us to learn from each other in different contexts, to establish what we have called a "community of practice and research" and where researchers and academics from the different institutions meet, as well as representatives and professionals from the health service networks who are in the trenches responding to the health needs of the population".
Finally, both academics agree on the enormous contribution of the PRA methodology that has contributed, on the one hand, to the development and implementation of interventions, but on the other hand, and very importantly, to introducing a different way of doing things in health services and also to the future sustainability of the interventions developed during the research project.
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