PRIMARY HEALTH CARE PRIMARY HEALTH CARE

HEALTH SYSTEMBASED ON PHC

A Bogotá without Indifference

PRIMARY HEALTH CARE PRIMARY HEALTH CARE

COLOMBIABOGOTA, District Secretariat of

Health

TRANSECTORALITY AND HEALTH

DETERMINANTS

AreaUrban

AreaRural

BOGOTACOLOMBIA

2005: 42,090,502 inhabitants * 2005: 6,778,291 inhabitants *

POPULATIONPOPULATION

* Source DANE, 2005

TABLE OF CONTENTS TABLE OF CONTENTS

1. POLITICAL FRAMEWORK

2. MANAGING PRIMARY HEALTH CARE - Territory and Population

3. PHC AND FIRST LEVEL HOSPITALS4. PHC AND TRANSECTORALITY

– EDUCATION – HOUSING

1.POLICY FRAMEWORK

FOR-PROFIT INSURANCE SYSTEM

UNIVERSAL RIGHT TO HEALTH

FROM HEALTH TO QUALITY OF LIFE

THANKS

Sub

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to S

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IPS

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Transfer of population from the Paraíso Community from a contributivesystem to the primary care IPS

Transfer of population from the Paraíso Community from a subsidizedsystem to the primary care IPS

UNIVERSAL INSURANCE UNIVERSAL INSURANCE

INDIVIDUAL CONTRACTS ASSOCIATED WITH PAYMENT OF CLAIMS

ACCESS BARRIERS•Databases•Location of the first level of care•Limits of the Health Plan

COST CONTROL•Put off providing services to high-demand or high-cost populations •Forms of hiring and paying health providers, capitation and reports•Methods of payment and hiring health professionals

UNIVERSAL INSURANCE UNIVERSAL INSURANCE

INSURANCE IS NOT SYNONYMOUS WITH HEALTH SERVICES.

PERINATAL AND PERIOD MORTALITY RATES

HEALTH POLICY HEALTH POLICY “BOGOTÁ WITHOUT INDIFFERENCE”“BOGOTÁ WITHOUT INDIFFERENCE”

“Creating conditions for the effective, steady, and sustainable exercise of the human rights enshrined in the constitutional pact and international agreements and instruments.”

RIGHT TO HEALTH: RIGHT TO HEALTH:

““QUALITY OF LIFE AND HEALTH PROMOTIONAL QUALITY OF LIFE AND HEALTH PROMOTIONAL STRATEGY”STRATEGY”

• Population in territories• Eliminating social inequities• Quality of life, a transectoral matter• Needs-based services • Comprehensive social management• Participatory processes. Social mobilization for the

right to health

2. MANAGING PRIMARY HEALTH

CARE

Territory and Population

Integrating services with population-based perspective (life cycle and vulnerability)

Ways of organizing sectoral responses and bridging them with those of other sectors

Coordinating individual and joint actions in areas of everyday life (home, neighborhood, school, work)

PHC IN BOGOTÁPHC IN BOGOTÁ

PRIMARYPRIMARY CARE FLOW CHART CARE FLOW CHART

ENTRY POINTSENTRY POINTS

AREAS HEALTH SERVICES

ESE I-II-III Private IPS

COMPREHENSIVE SOCIAL MANAGEMENT - SOCIAL PARTICIPATIONCOMPREHENSIVE SOCIAL MANAGEMENT - SOCIAL PARTICIPATION

HEALTH IN YOUR HOME

The FamilySchools: Health in SchoolsKindergartensCommunity kitchens

Vulnerable Micro territories

MOBILE UPA

UPA JUAN XXIII

UPA RIONEGRO

UPA SAN FERNANDO

CAMI CHAPINERO

UPA SAN LUIS

Contribute to an improvement in the quality of life and health of people who live in vulnerable territories, with an assignment of 1200 families, by lowering access barriers to sectoral, comprehensive, and transectoral care and community empowerment.

Health at HomeHealth at Home

PrioritiesPriorities

Pregnant WomenChildren under 5ElderlyDisabled Individuals diagnosed with diabetes and hypertensionWomen of childbearing ageIndividuals diagnosed with TB or leprosyCompulsory notification eventsFamilies living in vulnerable housing conditions

LIVABLE HOUSING CONDITIONS

UNLIVABLE HOUSING CONDITIONS

ASSOCIATED MORBIDITY

Privacy, enough space,Physically accessible

Overcrowding Sexual abuse, domestic violence, child abuse and ensuing problems Zoonotic diseases

Safe and secure enough Tenancy secured

Unsafe Violence in general

Adequate lighting TB, Skin diseases, COPD Adequate heating and ventilation

Housing unit is cold, damp, dark and is poorly ventilated TB, Skin diseases, COPD, ARD

Adequate walls, flooring and roofing

Presence of cracks, damage from moisture, holes,

Water seepage and leaks in roofs and walls Dirt floors, and inappropriate roofing materials

Superficial and Deep Mycosis (fungus on the skin, lungs and other organs), Acaridiasis (skin and respiratory parasites), Chronic Bronchial Allergic diseases(Asthma), COPD, TBC, ARD, pyodermitis.

Architectural conditions suited to disabilities

Architectural barriers to movement inside the home (it is difficult to access the home, bathroom, dining room, stairs, etc.)

Worsening of individuals’ disabilities

Water supply services Basic sanitation

No potable water ADD, ARD, Skin diseases

Unhealthy conditions ADD, ARD, Malnutrition, COPD, Zoonotic and parasitic diseases

Elimination of waste(Excreta)

Unhealthy conditions in and around the housing unit

ADD, ARD, Parasitic diseases Skin diseases

Appropriate factors for the quality of the environmentin the home

Inappropriate factors for thequality of environment in the home

COPD, ARD

Food security Lack of food securityand loss of beneficial traditional knowledge

Malnutrition (malnourishment, overweight, obesity, and dietary deficiencies)

Using sectoral management and health and environmental education to buttress the public health interventions that are moving forward through Health to Your Home, aimed at improving living and health conditions in the most vulnerable communities.

Healthy HousingHealthy Housing

METHODOLOGYMETHODOLOGY

1. Selecting the Health at Your Home territories

2. Housing assessment3. Establishing agreements and

commitments4. Follow-up, monitoring, and evaluation

Chart No. VS

NAME OF HEAD OF HOUSEHOLD No. inhabitants per housing unit

PHONE #

NAME OF MICROTERRITORY

101 102 103 104 105 FINAL 201 202 203 204 FINAL 301 302 303 304 305 FINAL 401 402 403 404 FINAL 501 502 503 504 FINAL 601 602 603

1. INITIAL ASSESSMENT

2.

3.

4. FINAL ASSESSMENT

Commitments:

1

2

3

4

5

6

1 2

3 4

NEIGHBORHOOD

DISTRICT SECRETARIAT OF HEALTH ON THE ROAD TO HEALTHLY HOUSING – FOR MY HOUSEHOLD TO LIVE

RECORD OF INTERVENTIONS PER FAMILY

PLACE

VISIT 200

Sips of Life – Drinking water in the Home

Signature of Sanitation Tech.

ADDRESS

DATE IF VISIT dd/mm/yyyy

VISIT 100

Housing as a vital space

ISSUES ADDRESSED

VISIT 300

Excrement and Sewerage in the open

VISIT 400

Solid Waste(Trash in the home)

VISIT 500

On the look out for Disease/pests

VISIT 600

Healthy & Sanitary Food & Housing

SUBJECT 1 HOUSING AS A VITAL SPACE

  VISIT 1 VISIT 4

  WE ARE LEARNING 708 119

  WE ARE ADVANCING 383 547

    WE ARE WELL 1409 1834

SUBJECT 2 SIPS OF DRINKING WATER

  VISIT 1 VISIT 4

  WE ARE LEARNING 711 79

  WE ARE ADVANCING 1285 1066

    WE ARE WELL 504 1355

SUBJECT 3 EXCREMENT AND SEWAGE IN THE OPEN

  VISIT 1 VISIT 4

  WE ARE LEARNING 466 154

  WE ARE ADVANCING 324 270

    WE ARE WELL 1710 2076

SUBJECT 4 SOLID WASTE IN THE HOME

  VISIT 1 VISIT 4

  WE ARE LEARNING 427 145

  WE ARE ADVANCING 1387 907

    WE ARE WELL 686 1448

SUBJECT 5 ON THE LOOK OUT FOR DISEASE/PESTS

  VISIT 1 VISIT 4

  WE ARE LEARNING 135 172

  WE ARE ADVANCING 1202 1016

    WE ARE WELL 1163 1312

SUBJECT 6 HEALTHY AND SANITARY FOOD AND HOUSING

  VISIT 1 VISIT 4

  WE ARE LEARNING 73 42

  WE ARE ADVANCING 787 336

    WE ARE WELL 1640 2122

Progress with Characterization: Identifying Needs

RISKS FOUND IN THE HOME DURING THE IDENTIFICATION AND CHARACTERIZATION OF

FAMILY GROUPS

5%7% 7%

16% 16%

0%2%4%6%8%

10%12%14%16%18%

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HEALTH AGREEMENT AND HABITAT HEALTH AGREEMENT AND HABITAT AS A LINCHIPINAS A LINCHIPIN

… mutually aid habitat development and improve the quality of life and health of the families of Bogotá, as part of the Primary Health Care strategy and the Health at Your Home program…

SUBSIDY FOR MAKING HOUSING MORE SUBSIDY FOR MAKING HOUSING MORE LIVABLE LIVABLE

Allocating resources for construction in the housing sector to improve basic health conditions, with priority given to improving bathrooms and kitchens or basic sanitation conditions.

INTERVENTION PROPOSAL

UNLIVABLE HOUSING CONDITIONS INTERVENTION PROPSOALOvercrowding Improve and/or redistribute living space inside

the homeImprove the conditions of bathrooms and kitchen

Lack of security Doors, windowsHome is cold, damp, dark and has poor ventilation Improve conditions with respect to ventilation,

lighting, kitchen, bathrooms, and the home’s non-structural materials

No potable water Connect to formal public services system or set up alternatepotable water systems

Improve kitchen and bathroom conditions

Unhealthy conditions Connect to sewage or set up alternate human waste and trashelimination systems

Provide toilets

Improve kitchen and bathroom conditionsCertain factors contributing to a poor quality homeenvironment

Improve kitchen and fuel use

Food insecurity and loss of traditional knowledge Promote use of vegetable gardens, medicinal and/or edible plants through urban agriculture

SUBSIDY SUBSIDY

up to 6.5 SMLMV

$2,800,000

1,400 dollars

COST OF CARE FOR BOYS AND GIRLS WITHCOST OF CARE FOR BOYS AND GIRLS WITH ACUTE RESPIRATORY DISEASESACUTE RESPIRATORY DISEASES

CARE APPROX. COST IN DOLLARS

FIRST-LEVEL EXPENSE US 200SECOND-LEVEL EXPENSE US 300THIRD LEVEL EXPENSE US 400INTENSIVE CARE UNIT (ICU) US 520

AVERAGE COST AVERAGE COST LIVABLE CONDITIONSLIVABLE CONDITIONS

Approximately US 1,500

SOURCE: CALCULOS CVP SOURCE: CALCULOS CVP NOTE: THIS AVERAGE DOES NOT INCLUDE STRUCTURAL NOTE: THIS AVERAGE DOES NOT INCLUDE STRUCTURAL INTERVENTIONSINTERVENTIONS

PRODUCTS

TECHNICAL ASSISTANCE FOR FAMILIESAPPLIYING FOR A SUBSIDY

HIRING BUILDERSASSISTANCE WITH PROPERTY TITLES

USME HOSPITAL

19 TECHNICAL TEAMS: ARCHITECT OR CIVIL ENGINEERSANITATION TECHNICIAN SOCIAL PROMOTER

TRAINING FOR THE TEAMS

APPLICATION OF FORMS: SANITATION, TECHNICAL, AND SOCIAL

POLITICAL RESULT

Notion of citizen health Inclusion of health in development plans. Decisionmakers.Organized mobilization of resources from other sectorsBetter quality of life for the population

POLITICAL RESULT

National debate on the insurance model, especially the national public health plan. Inclusion of structural health determinants. Organizational process and social mobilization. Bring other parts of the health sector into play, especially insurance companies in promotion and prevention.

A PHC-BASED HEALTH SYSTEM

PHC AND INSURANCE

HEALTH TO SCHOOL

I FEEL WELL I LEARN WELL

THANK YOU!