Resumo

LOPEZ, Yolanda Lucía; GONZALEZ, Claudia; GALLEGO, Berta Natalia  e  MORENO, Ana Lida. Stewardship of public health surveillance in the health system in Colombia: a cases study. Biomédica [online]. 2009, vol.29, n.4, pp.567-581. ISSN 0120-4157.

Introduction. With the reform of the Colombian health system in 1993, public health surveillance continued to be a governmental responsibility under the stewardship of the Ministry of Social Protection along with state and local health authorities. Objective. The effectiveness of the development and organization of state and municipality public health surveillance programs will be studied as they have evolved under the general social security system in Colombia. Materials and methods. Qualitative study and case-study method are applied to several institutions as they function in 5 states and 11 counties, ten years after the health system reforms. Results. Public health authorities have reduced resources for providing advice, technical assistance, supervision and control of the process of the public health surveillance. Weaknesses in administrative control are common. Quantity and quality of human resources, as well as, staffing and financial resources are inadequate to meet the responsibilities that have been assigned to each state and county. The public health surveillance has prioritized the notification and registration of cases, and the strength of development of particular areas occasionally has been subject to the particular interests of officials in charge, particularly in the public hospitals. Little commitment or interest is shown by mayors, insurance companies, and institutions providing health services that are supposed to be involved with monitoring. A lack of cross-institutional collaboration is apparent in the development of health services surveillance. Conclusion. The implementation of public health surveillance at state and local levels is weak due to problems with the governmental stewardship. These weaknesses are manifested in the lack of regulation, financing and control of the health system.

Palavras-chave : health systems; population surveillance; epidemiologic surveillance; health care reform; social security; health regulation and fiscalization; Colombia.

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