Second day of discussion on universal primary health care in Chile

The discussion focused on the implementation of the program in the pioneer communes, analyzing both the challenges and the progress made during the initial phases. The opening remarks were given by prominent representatives, including: Alberto Arenas de MesaDirector of the DDS of ECLAC; Bernardo MartorellCoordinator of the MINSAL Reform; the head of the Primary Care Division (DIVAP); Sergio AlvarezCoordinator of the Social Comptroller Commission of ANCOSALUD; Juan GonzalezPresident of COTRASAM; the Coordinator of the Health Commission of the Chilean Association of Municipalities; Gabriela FaríasPresident of FENPRUSS; and Maria Cristina GomezPresident of AFUSAP DAP. All of them highlighted the importance of creating opportunities for meetings and dialogue between MINSAL, municipal health unions and international organizations such as ECLAC, to address the challenges associated with the implementation of Universal PHC.

Following the opening, the Head of the Department of Integration and Development, Alison Morales, presented on the governance of the health system reform, highlighting the need for a solid governance structure that guarantees the effectiveness and sustainability of Universal PHC. Then, Vanessa Díaz, national person in charge of universal PHC in the reform commission, explained the tools for monitoring and supervision of the program’s actions, emphasizing the monitoring and evaluation mechanisms necessary to ensure compliance with its objectives.

Carla Castillo, ECLAC consultant, presented the recently published document, entitled Universal primary health care in Chile: an analysis of the initial implementation of the project in pioneer communes. This report emphasizes the need to consider the comprehensiveness of the program, highlighting key factors such as the heterogeneity of local contexts, the governance of the process and the importance of having sufficient and timely resources for successful implementation. Likewise, the report addresses the challenges related to securing inputs and evaluating processes and results based on the planned products.

During the day, valuable comments were incorporated from local actors, including Alejandra Ávalos from MINSAL, Carlos Beiza, Health Director of Canela; Claudia Cabrera, representative of the Association of Alhué Officials; Claudia Fernández, from the Valdivia Civil Servants Association; and Sergio Álvarez, from the ANCOSALUD Social Comptroller Commission. These interventions provided diverse perspectives on the challenges facing the implementation of the program at the local level, enriching the discussion and strengthening the proposals to move towards a more inclusive and efficient health system. Following the presentations, attendees were organized into three working groups to address the following key questions:

1. How to achieve governance for Universal PHC that considers the participation of all those involved?

2. How to strengthen the capacities and training of Universal PHC implementing teams?

3. What mechanisms can be implemented to achieve family and work conciliation in the APS communes?

In relation to the first question, the working groups highlighted the importance of inclusive governance that guarantees the participation of unions from the initial stages of the process. Likewise, they highlighted the need to promote multi-stakeholder engagement, integrating key institutions such as ISAPRE and FONASA.

Regarding the second question, about how to strengthen the capacities and training of Universal PHC implementing teams, it was proposed to promote training initiatives managed by the communities themselves, promoting alliances and cooperation between them to share good practices and address common challenges. Among the recommendations, the creation of national and community internship systems stood out as a strategy to attract new talent, in addition to implementing prior training and awareness processes in PHC aimed at the teams. The need to incorporate the teaching of the role of PHC in university curricula, with a universalized approach, was also raised.

Additionally, it was proposed to carry out training for all teams and job categories, optimize bureaucratic processes with the aim of improving community care and promote external evaluation studies, such as those carried out by ECLAC.

Regarding the conciliation between family and work life in the APS communes, it was suggested to carry out specific diagnoses on the territorial characteristics and family situation of each commune. These diagnoses would allow strategies adapted to each particular context to be designed. Likewise, the importance of modifying legislation to guarantee fundamental rights, implementing compensatory mechanisms for extended hours, ensuring labor flexibility and incorporating digital technologies, such as telemedicine, in services was highlighted.

Finally, the day concluded with the interventions of María Luisa Marinho, Social Affairs Officer of ECLAC, and Vanessa Díaz, National Manager of Universal PHC of the MINSAL Reform Commission, who summarized the learning and reinforced the commitment to continue strengthening the implementation of the Universal APS.

Background

Within the framework of the Transformations Agenda that has been proposed by the government of President Gabriel Boric Font, which aims to address health inequalities evidenced in the disparities in access and health outcomes of the population, it has been defined that Primary Care Universal Health System (APS) will be the central axis of these changes. This not only responds to the current challenges of the health system, but also aims to transform the current paradigm, moving from an approach focused on the treatment of diseases and health outcomes, to one that prioritizes prevention and health promotion.

The implementation of the Universal PHC program began with an early implementation process in 7 communes in 2023. Later, in 2024, 14 communes were added, reaching a total of 21 communes, in which various strategies are being developed to move towards a universal, effective and timely access, prioritized according to the health needs of the population in each territory.

As in any implementation process, it is essential to generate evaluation instances, in which both good practices and the challenges faced by the teams in charge of implementation can be identified. In this context, the Economic Commission for Latin America and the Caribbean (ECLAC), which has highlighted the urgency of strengthening the capacity of countries to develop, adapt and implement strategies and policies that promote universal, comprehensive, sustainable and resilient health systems , which guarantee access to health in a timely manner, of quality, and at the time they require it, to all people, without leaving anyone behind, carried out an analysis of the implementation of the Universal PHC program in the communes pioneers in Chile during the year 2023. The report makes a series of recommendations to promote a successful process of advancement. Among them, the need to design and implement an internal or institutional communication strategy that makes the strategy known not only within the Ministry of Health, but also to all the institutions involved, including health workers, stands out. as a fundamental component.

To ensure the success of the implementation of the desired public policy, it is essential to create instances for the exchange of experiences, resolution of doubts, collective co-construction and the transmission of key contents. These spaces will help teams ensure consistency in the initial operation and in the development of the new policy.

It is in this context that ECLAC together with the Ministry of Health have organized this day of reflection, discussion and exchange of experiences between primary health care workers and representatives of municipal teams. This instance is also an opportunity to collect information about the implementation process, considering the different local realities. Not only will aspects related to the administrative reality of the communes be addressed, but also the enabling conditions for the advancement of Universal PHC, which is another of the recommendations incorporated in the report.