Within the framework of the United Nations Development Account Project “Resilient health systems with universal coverage in Latin America and the Caribbean”, since 2023, the Economic Commission for Latin America and the Caribbean (ECLAC) has provided technical assistance to the team of the Infrastructure Subdirectorate of the Directorate of Health Services and Primary Care of the Ministry of Health and Social Protection of Colombia in the development of a proposed methodology that estimates the gap in installed capacity in health provision.
In this context, on May 29, 2024, a workshop was held at the Ministry’s facilities in Bogotá, the objective of which was to present and disseminate the methodological proposal that identifies gaps in installed capacity for health provision through a diagnosis of the gaps between capacity and potential demand for health services, according to the level of care.
The purpose of this methodology is to contribute to the planning of the necessary investments in infrastructure, medical devices, equipment and technology required to strengthen the public care network, and thus, move towards universal health coverage in Colombia. After contextualizing the Master Investment Plan of the current Colombian government and the methodological proposal developed by ECLAC, three sessions were held focused on the three components of the tool related to diagnosis, addressing gaps and investment plan, and monitoring. The event was attended by 150 people, 120 virtually and 30 in person with representatives from various institutions, mostly from the Departments of Health, State Social Enterprises (ESE) and Health Service Providers (IPS).
Background
Health is not only an essential human right, but also represents one of the basic guarantees of social protection systems, being a fundamental part of the comprehensive well-being of people in physical, mental and social terms. Without health, the enjoyment of other social rights is compromised, which hinders inclusive social development, and in effect, puts the achievement of sustainable development at risk. However, health systems in Latin America and the Caribbean suffer from a series of structural deficits in terms of chronic underfunding, fragmentation and segmentation, which limit effective and universal access to health. Furthermore, these systems are characterized by a lack of solidarity, deepening pre-existing inequalities, causing problems of inefficiency and coordination between the different levels of health care, as well as insufficient articulation with social protection systems (ECLAC, 2022; ECLAC/PAHO, 2021; ECLAC/PAHO, 2020).
In light of this scenario, the Economic Commission for Latin America and the Caribbean (ECLAC) emphasizes the need to enhance the capacity of countries to develop, adapt and implement strategies and policies that promote universal, comprehensive, sustainable and resilient health systems that guarantee timely, quality access to health care for all people when they need it, leaving no one behind.
According to insurance data (MinSalud, 2023) and population projections (DANE, 2021), Colombia has made significant progress in expanding the coverage of its health system. In 1998, coverage reached 59%, with 60% of the population in the contributory regime, while in 2022, nearly 99% of the population is affiliated with the health system, with a subsidized regime participation of 50%, surpassing the contributory regime by 4 percentage points. However, important challenges remain related to the effective and timely access of the population to health services, which is related to various dimensions, one of them being the installed capacity of the systems. In response, in 2021 and 2022, the Ministry of Health and Social Protection of Colombia has allocated financial resources to invest in the installed capacity for the provision of national health services in various municipalities (Resolution 1583; Resolution 2772) (MinSalud, 2022, 2021).
To address the need to move towards universal access to health services that meet the needs of individuals and families in terms of timeliness and quality, it is essential to properly understand and assess the existing health services on offer in the territories. This involves identifying the current capacity of the Colombian health system to meet the demand for medical services and determining the gaps that may exist between supply and demand. Thus, ECLAC has developed, together with the team from the Infrastructure Subdirectorate of the Directorate of Health Services and Primary Care of the Ministry of Health and Social Protection, a proposed methodology that estimates the gap in installed capacity in health provision in Colombia, in order to contribute to the planning of the necessary investments in infrastructure, medical devices, equipment and technology required to strengthen the public care network.
The methodology proposed by ECLAC comprises three elements. First, the diagnosis, which calculates the supply of health care facilities available at the national and territorial levels and the potential demand for health care, in order to then estimate the gaps taking into account international references for defining the optimal physical infrastructure facilities and the needs identified in the estimated potential demand for the country and the territories. Second, the approach to gaps and investment plan, which refers to the investment plan that the Ministry of Health should present in accordance with the country-level diagnosis and the territorial inputs provided by the Territorial Health Directorates (DTS). Lastly, the monitoring in terms of compliance with the plan and the operation of the health service networks that serve the population in the territories.
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