Public policy frameworks for reducing social and health inequities based on determinants of health and transectorality: an exploratory qualitative study on the policy-makers’ perspectives on the Cundinamarca - Colombia experiences
CONTEXT: Equity-oriented policies based on social determinants of health (SDH) and intersectoral approaches have become a high level priority on the public sector agenda (Whitehead et al, 2006) and generated much research (Roberts, 2009). However, little is known on the conditions leading to successful implementation of these policies and the challenges facing decision-makers (PAHO, 2014, WHO, 2015). This study aimed to provide more evidence on these conditions and challenges by drawing on the experience of Cundinamarca-Colombia. RESOURCES AND METHODS: This study followed an exploratory qualitative approach. Key informant interviews method was used, with face-to-face semi-structure interviews conducted with public policy-making leaders at the national (Colombia) and subnational levels (Cundinamarca). Thirty interviews were conducted from February 26 to April 14, 2015. Thematic content analysis was carried out on the interviews and Governmental documents and secondary data sources were reviewed (published literature from 1985 - 2015). RESULTS: Among the key elements identified by the participants to work on the “determinants of health” and “transectoral” approaches was the “paradigm shift” from a “dominant health thinking” of the public policies to the adoption of more “inclusive concepts” such as the determinants of quality of life. The strengthening of “territorial planning” and sectoral competencies”, the interrelation of “synergistic approaches”, and the use of Information and Communication Technologies were also mentioned. Likewise, respondents reported on a number of challenges such as the State structure and the uneven development of sectors; and barriers related to “sectoral sovereignty”. CONCLUSIONS: The analysis of the experience of Cundinamarca-Colombia has shown that emerging concepts such as “transectorality”, “Health Management Models”, and “Determinants of Quality of Life” along with considerations regarding the State structure and the role of subnational governments and communities should inform the implementation of equity-based policies. However, further work is needed to cover the full range of conditions to successful implementation and to better appraise the impact of these approaches on the population.
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