First day of discussion on universal primary health care in Chile

The Social Development Division (DDS) of ECLAC, in collaboration with the Ministry of Health (MINSAL), organized on October 2, 2024 the first conference on the “Implementation of the Universalization of Primary Health Care Program in Chile: learnings and lessons from pioneering communes”, framed in the United Nations Development Account Project entitled “Resilient health systems with universal coverage in Latin America and the Caribbean”.

The objective of this day was to generate a space for reflection, dialogue and exchange of experiences between key actors, including representatives of the CONFUSAM (National Confederation of Municipal Health Officials), union representatives of the workers of the pioneer communes in the implementation of the Universal Primary Health Care program, and community management teams belonging to the Association of Municipalities of Chile.

The discussion revolved around the implementation of the program in the pioneer communities, addressing challenges and progress achieved in these first phases. The opening remarks were given by the Undersecretary (subrogative) of Public Health of Chile, Christian García, by the Director of the Social Development Division of ECLAC, Alberto Arenas de Mesa, by the National President of CONFUSAM, Gabriela Flores, and by the Mayor of La Granja, Felipe Delpín. They all highlighted the relevance of generating opportunities for meeting and dialogue between the MINSAL and municipal health unions, including prominent international organizations such as ECLAC, to face the challenges associated with the implementation of the Universal Primary Health Care (PHC) program. .

Then, the Head of the Department of Integration and Development, Alison Morales, spoke about the governance of the health system reform, emphasizing the importance of a solid governance structure to ensure the effectiveness and sustainability of Universal PHC, and Vanessa Díaz , national person in charge of universal PHC in the reform commission, presented the tools for monitoring and supervising actions related to Universal PHC, addressing the monitoring and evaluation mechanisms to ensure compliance with programmatic objectives.

Subsequently, 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 highlights the importance of considering the comprehensiveness of the program, emphasizing key factors such as the heterogeneity of local contexts, the governance of the process, and the need for sufficient and timely resources for successful implementation. Furthermore, the study highlights the challenges of securing the necessary inputs and the importance of evaluating both the processes and the results achieved in terms of the intended outputs. Valuable comments were also included from Alejandra Ávalos and Rocío Muñoz from MINSAL, Flavio Quintana, Director of Communal Health of Alhué, Mariluz Chaparro from the Linares civil servants association, and Cristian Rodríguez, director of CONFUSAM, who contributed various perspectives on the challenges that faces the implementation of the program at the local level.

Following the presentations, attendees were organized into six 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?

During the discussions, the importance of governance that considers the participation of unions from the initial phases of the process and greater closeness and commitment of the Regional Health Services (SEREMI) to the workers was highlighted. The need to make labor policies compatible with the reconciliation of family life was also highlighted through strategies such as extending working hours and promoting decent working conditions, particularly for those who currently work under fee-based contracts. Likewise, the relevance of training teams in advance to guarantee effective implementation was discussed, as well as the importance of promoting greater citizen involvement and local participatory bodies.