Critical points of the debate on health for the next elections: rethinking the General System of Social Security in Health
Ornella Moreno Mattar
MSc in Public Policy,
health economics lead
On May 29, the first round of the next presidential elections will take place in Colombia and, after the health, economic and social crisis caused by the COVID-19 pandemic, citizens must be attentive to the proposals of the candidates, but what are the main challenges for a new period of government under this post-pandemic scenario in Colombia?
Through Resolution 385 of March 12, 2020 (1) the health emergency was declared in Colombia, a state that has been extended until November 30, 2021, demonstrating that this pandemic has been the greatest challenge for the current government.
In addition to the great impact on the health of the population, with more than 5 million cases diagnosed to date in the country (November 8, 2021) (2), this challenge has implied facing the problems of the system that have deepened, such as timely access to health services, financing of the system, infrastructure and endowments, the availability of human talent, and the food and financial insecurity of Colombians.
To face all these situations, from different national and territorial instances, health measures such as physical distancing, diagnostic tests, restructuring of service-providing institutions, vaccination and provisions for safe economic reactivation have been implemented in the country.
Some of these measures have been questioned due to the timing of their implementation, their procedures and some bureaucratic inefficiencies, others have been applauded and considered successful due to their results compared to countries in the region. Those same results are what now lead us to consider: What does the year 2022 hold and how will this situation be addressed by a new administration?
Although many of the first results of a new government depend on the efforts and the ground paid by previous administrations, the current citizenship is every day more critical and aware of the needs, problems and results that they expect from the rulers. This is why the proposals of the candidates who intend to assume the next government must be consistent with the diagnoses and the realities of the different territories in the country, but also clear and innovative.
In this sense, some of the health issues on which a response should be expected from the candidates for the next elections are mentioned below:
- Although health coverage in Colombia is almost universal, with 95% of the insured population (3), this does not guarantee that patients can access health services in a timely manner. The challenge in this regard is to move from assurance on paper, real and timely access to quality services in all corners of the country.
- The mental health should be a priority in the coming years, during the pandemic, the combination of social isolation, loss of family and friends, unemployment, uncertainty about the future and many other factors have triggered serious mental health effects on people who require immediate attention (4).
- The financial sustainability of the health system it was already a situation of imminent attention before the pandemic; however, the pandemic deepened this crisis by increasing debts between insurers and providers. In this framework, from different points of view and actors of the system, they discuss reforms to the insurance model, from specific changes such as structural and deep reforms.
- The comprehensive strengthening of human talent in health, which ranges from the dignity of employment through fair employment contracts, timely payments and endowments, to the training of more specialists from different areas and their availability throughout the territory, not only in the main cities.
- The territorialization of health servicesAs mentioned in the previous points, the differences in health care between capital cities and municipalities is significant in Colombia. For example, the difference between the mortality rate in children under 5 years of age due to ADD in urban areas was 2.2 per 100,000 children under five years of age in 2018, while in rural areas it was 6.2 (5) . These inequities must be addressed in a comprehensive manner, that is, addressing health problems, while reducing health inequities.
- Finally, guarantee the transparency of the health sector It is an imperative need for citizens. Mitigating the risks of corruption among the different actors in the supply chain and taking care of health resources is a challenge for all government officials and candidates for high public positions in the system. Some proposals discussed so far seek to promote oversight, strengthen control bodies, reduce intermediation, promote a culture of legality, among others.
Although the elections are still six months away, it is important for both candidates and citizens, including the actors in the system, to carefully review the legacy of the governments to date and reflect on the challenges that, as a country, we have in the face of future. Debates and proposals must be reviewed with a magnifying glass and objectivity.
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1. Ministry of Health and Social Protection. Resolution 385 of 2020. Colombia; 2020.
2. Ministry of Health and Social Protection. CORONAVIRUS (COVID-19) [Internet]. Covid-19 Reports and Dashboards. 2021 [cited 2021 Nov 9]. Available from: https://www.minsalud.gov.co/salud/publica/PET/Paginas/Covid-19_copia.aspx
3. Ministry of Health and Social Protection. Colombia continues to advance in universal health coverage. Press Bulletin No 920 of 2020. 2020.
4. World Health Organization. COVID-19 disrupting mental health services in most countries, WHO survey [Internet]. News release. 2020 [cited 2021 Nov 9]. Available from: https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey
5. Ministry of Health and Social Protection. National Rural Health Plan. Minist health [Internet]. 2018; 1–73. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/PES/msps-plan-nacional-salud-rural-2018.pdf