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Salud para todos

Approaches to "Health for all" in the pact for equity: from the diagnosis to a sustainable health system

Ornella Moreno

Ornella Moreno Mattar
Health Administrator,
MSc in Public Policy,
health economics lead

The 2018-2022 National Development Plan, hereinafter PND, has three pillars that are summarized in the following equation "legality + entrepreneurship = equity" (Figure 1). Each of these pillars has a structural pact within the PND. In addition to the structural pacts, the PND contains thirteen transversal and nine regional pacts (1).

Figure 1. Pillars of the National Development Plan

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Health within the National Development Plan

  1. The first structural pact that makes up the PND is the “Pact for legality: effective security and transparent justice so that we all live in freedom and in democracy”, which is oriented towards security and access to justice.
  2. The second is the "Pact for entrepreneurship, formalization and productivity: a dynamic, inclusive and sustainable economy that empowers all our talents" that seeks to increase labor and business formalization by promoting a sustainable and inclusive economy.
  3. Finally, the "Pact for equity: modern social policy focused on the family, efficient, of quality and connected to markets" that seeks to guarantee opportunities for all Colombians. Among its components is that of "Health for all with quality and efficiency, sustainable by all" (2).


"Health for all with quality and efficiency, sustainable by all" frames a series of actions to be developed within the health sector, aimed mainly at six problems of the Health System in Colombia, for which six objectives and a series of goals were defined. health and management indicators (1).


The health for all component within the Pact for Equity aims to "Improve the health status of the population, guaranteeing high standards of quality and user satisfaction", relating to other proposed pacts such as pacts for entrepreneurship. , legality, sustainability, digital transformation and ethnic groups (3).


This line of "Health for all" starts from the identification of a series of problems within the Health System and in the provision of services, some of these problems are:


  1. The opportunity, quality and access to health services in dispersed areas
  2. The high perception of corruption in the system
  3. Debts accumulated between the actors in the supply chain
  4. The cardiovascular and respiratory diseases that cause the highest mortality in Colombia


Faced with this diagnosis, the National Government proposed objectives and goals aimed at achieving user satisfaction, providing the country with human talent and infrastructure, controlling hypertension and reducing heart and cerebrovascular diseases and, an issue that has called much the attention from the different actors in the system, debt settlement and financial sustainability (Figure 2) (4).


Figure 2. Health goals for all with quality

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Source: DNP. "What you should know about health for all in the National Development Plan" P. 74.


The health goal of the "Pact for Colombia, pact for equity"

The PND proposes a series of goals in the different lines and pacts, however, it highlights 20 main goals aimed at the transformation of the country. Goal No. 6 is specific to the health sector and seeks to achieve the "Debt recovery from the contributory health regime as of December 31, 2019. Raise the performance index of the 922 public hospitals to offer better quality services." (5)


This goal has two directly related objectives within the Health for All component:


Objective 3. Articulate all the agents of the health sector around quality: which seeks, among other actions, "to generate performance incentives for quality, efficiency and improvement of health outcomes" through the implementation of quality management incentives, with proposals such as expanding the risk adjustment ex post at the UPC for pathologies such as cancer and arthritis, as well as the design of monetary, social and business recognition incentives for the different actors of the health system (1).


Goal 6. Financial sustainability, everyone's responsibility. Achieve efficient spending by optimizing available financial resources and generating new ones with the contribution of all: which seeks to make health spending more efficient, with an increase in financing sources and the reconciliation and consolidation of the portfolio among the actors of the health system (1).


In compliance with these objectives, an end-point agreement has been proposed, articulating actions of a different nature, some with the purpose of settling debts and others in search of long-term financial sustainability. Some of the transformational indicators that are a sectoral priority proposed to monitor the achievement of these objectives are:


  • Percentage of recoveries cleared for technologies not financed by the UPC of the Contributory Regime, provided as of December 31, 2019: 100% during the four-year period
  • Savings to the Health System for maximum recovery values in the contributory regime: 250 billion during the four-year period
  • Savings in expenses for recoveries as a result of pharmaceutical policy actions: 800 billion during the
  • Percentage of accounts payable from territorial entities for technologies not financed by the UPC of the subsidized regime, paid as of December 31, 2019: 60% during the
  • Hospitals at medium and high financial risk: go from 200 to 260 during the four-year period (1).



Progress and challenges in meeting the goal of sanitation and financial sustainability with quality

During the last year and a half of management, some steps aimed at achieving these objectives have been carried out, including the following regulations:


  • The maximum recovery values (Resolution No. 3514 of 2019)
  • Maximum budgets (Resolutions 205 and 206 of 2020)
  • The establishment of conditions for the management of UPC resources and maximum budgets by the EPS (Resolution No. 535 of 2020)
  • The sanitation of health services and technologies not financed by the UPC of the contributory regime (Decree 1333 of 2019, Decree 521 of 2020 and Resolution 618 of 2020)


It is estimated that to date 6.7 trillion pesos have been mobilized in order to settle debts among the system agents (5.2 trillion in the contributory regime and 1.2 trillion in the subsidized regime) (6).


Other regulations such as updating the list of technologies charged to the UPC or the allocation of resources for the centralized purchasing process were carried out before the entry into force of these regulations.


Although it seems that the health sector is moving towards a more financially sustainable scenario, there is still a gap in the norm and the NDP compliance agreements, that is, the establishment of quality indicators related to health outcomes.; Although the regulations related to the payment of resources and sanitation seem to advance in compliance with articles such as 237 and 245 of the PND, the establishment of health indicators is one of the challenges that the Health System must face in order to guarantee, not only savings, but results that positively impact the health of citizens.


However, health outcomes still have opportunities to be addressed in some regulatory projects under construction, such as the regulations in Chapter 4, Title 3, Part 5, Book 2 of the Sole Regulatory Decree of the Health and Social Protection Sector 780 of 2016 that regulates the relationships and voluntary agreements between entities responsible for payment and health service providers (in public consultation from October 14 to 28, 2020).


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1. National Planning Department. Pact for Colombia, pact for equity National Development Plan 2018-2022: Challenges, strategies and goals. Everything they haven't told you about the Plan. National Development Plan 2018-2022 Colombia; 2019 p. 220.

2. National Planning Department. ABC of the National Development Plan [Internet]. [cited 2020 Oct 15]. Available from: https://www.dnp.gov.co/DNPN/Paginas/Plan-Nacional-de-Desarrollo-ABC.aspx

3. Republic of Colombia - National Planning Department. Bases of the National Development Plan 2014-2018. Nac Planning Department. 2014; 861.

4. National Planning Department. What you should know about health for all in the National Development Plan [Internet]. Bogotá DC; 2019. Available from: https://www.dnp.gov.co/DNPN/Paginas/Lo-que-usted-debe-saber-sobre-el-Plan-Nacional-de-Desarrollo.aspx

5. National Planning Department. The 20 goals of the Pact for Colombia, pact for equity [Internet]. 2019 [cited 2020 Oct 15]. Available from: https://www.dnp.gov.co/DNPN/Paginas/Metas-del-Plan-Nacional-de-Desarrollo-2018-2022.aspx

6. Time. Economy and Business - Health Unit. End Point Agreement for health, at a slow pace [Internet]. Time. 2020 [cited 2020 Oct 20]. Available from: https://www.eltiempo.com/economia/sectores/en-que-van-el-saneamiento-de-las-deudas-entre-actores-del-sector-salud-537612

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