Abstract
Primary health care (PHC) has increased in global relevance as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems.
This article aims to review and summarize PHC strategies and the configuration of health networks in Latin American and Caribbean countries.
The review was carried out using keywords in at least 9 databases. Papers in languages other than English, Portuguese, and Spanish were excluded, while non-refereed articles and regional gray literature were incorporated. As a result, 1,146 papers were identified. After three instances of analysis, 142 articles were selected for this investigation. Data were analyzed according to an analysis by theme.
The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and care networks. These must be resilient to changes in the population’s needs and must be able to adapt to contexts of epidemiological accumulation.
Executive summary
The global relevance of primary health care (PHC) has increased as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems.
The motivation for this article stems from the investigation of PHC models and strategies implemented in the region of the Americas and the observance of the configuration of health networks from a PHC perspective.
A systematic literature review was conducted using keywords in at least 9 databases. Languages other than English, Portuguese and Spanish were established as exclusion criteria, and non-refereed articles and regional gray literature were incorporated. As a result, 1,146 articles were identified. After three instances of analysis, 142 were selected. These were classified according to six thematic areas.
The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and by consistent care networks that are resilient to changes in the population’s needs and that adapt to the contexts of epidemiological accumulation in the medium and long term.
Introduction
Primary health care (PHC) is considered a key strategy in the area of health since it favors social development, promotes community participation and generates wellbeing for societies [22].
The concept emerged in 1978 within the framework of the International Conference held in Alma-Ata as a proposal to remedy a common need of all governments to maintain and guarantee their populations’ health, understood as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” [43, 123]. It considers health to be a fundamental right, incorporating practices of disease prevention and health promotion, and requires intersectoral coordination and the involvement of communities since the first level of care is the fundamental space for contact between populations and the health system [44].
Towards the end of the eighties, the WHO/PAHO demonstrated the need to organize health services into levels of care and to develop reference and counter-reference systems as an instrument for the regional planning of health services [46, 124]. The need for integrated and decentralized levels of care was ratified by PAHO Member States in 2005 through the Montevideo Declaration [48] and the Health Agenda of the Americas 2008–2017 [49]. The document “Integrated Health Services Networks” belonging to the series “The Renewal of Primary Health Care in the Americas” [51] constitutes the basis of health system reforms that, under the PHC paradigm, reorient, strengthen and deepen four major areas: the care model, network governance and strategy, the organization and management of resources in general terms and allocation and economic incentives.
Latin America’s countries have historically shown wide inequalities, not only in health outcomes, but also in income distribution, education, access to clean water and sanitation, among others [84]. At the beginning of the nineties, almost all Latin American and Caribbean countries had initiated, or were considering initiating, health sector reforms [54]. Several key policies were included as part of the menu: separation of functions, decentralization, improvement of health insurance schemes through nominalization of patients, and explicit package of services, among others. In some cases, they involved a wider reform of the State, including National Constitutions [14, 17, 20, 26, 28, 36, 37]. Different studies have shown that health system reforms in Latin American countries have promoted inclusion, citizen empowerment, and health equity, achieving in many cases the establishment of legal rights associated with health, and universal coverage [3, 82] even reducing health indicator gaps among income groups [34]. With the motivation of social justice and the achievements of equity, civil society played a leading role in obtaining citizen's rights and the right to health. An example of these has been the efforts made by the Latin American Social Medicine (LASM) [72]. At the international level, several organizations have had an important influence in the region in order to improve the health system's functioning and its results, as well as promoting the adoption of PHC proposal. Some of them are PAHO, WHO, UNICEF, and the World Bank.
With the arrival of the new century, PHC gained increased relevance at a global level [44] as a mechanism that provides effective responses to the needs of health systems. Among the different forms that the implementation of PHC has taken are the comprehensive (CPHC), selective (SPHC) and renewed (RPHC) approaches. The first, interpreted as part of an integrated system of health care and the economic-social development of a society that involves cooperation with other sectors [44], has been criticized for being too idealistic and lacking in implementability, making its application difficult in different communities [12]. Subsequently, discussions began on SPHC, which focuses on specific interventions aimed at the highest risk populations without incorporating the social component of equity, intersectorality and community participation characteristic of CPHC [74]. Finally, RPHC emerged as an approach that combines a family and community perspective aimed at strengthening current health systems, seeking equity and sustainability in access and the provision of health services with defined populations and territories. In this way, it carries elements of citizenship, with social participation and emancipation [50, 125, 126].
During the eighties and nineties, in some countries SPHC models were adopted through programs aimed at specific population groups [29], and later, at the beginning of the twenty-first century, other countries came to the adoption of RPHC, promoted by international organizations, to achieve systems that guarantee universal access to health services [47]. Nevertheless, the interpretation of the scope of one PHC model or another is highly disputed in Latin America, and the heterogeneity in the way they are implemented reflect the political and economic instability of the region [9, 62, 67, 146, 147].
Analyzing different experiences of implementing PHC models, as well as the development and configuration of health care networks, can contribute to a better understanding of the scope of these tools, and their contribution to promoting equity and sustainability of health care systems. In this sense, this review seeks to demonstrate the ways in which the countries of the region have approached primary health care, paying special attention to two components: the experiences of implementing PHC models or strategies and the treatment of health networks. To these ends, an integrative reviewFootnote 1 was carried out during the period of December 2022 and May 2023, in order to systematically map the research conducted in this field based on the following research questions: how have PHC models and strategies been implemented? How have health networks been configured under a PHC perspective?
Articles published between 1982–2022 with qualitative, quantitative and mixed methodologies were included. The definition of the temporal space considered in the study reflects three different periods experienced by Latin American health systems. During the eighties, health systems mainly involved a supply subsidy approach, which shaped the development of traditional health provision structures. Subsequently, during the nineties, health systems reforms were embedded by a demand-side approach based on payment incentives. With the new century, the limitations of both approaches became visible, emerging mixed models as part of the menu for sustainable reforms.
The review identified six priority areas: the functioning of healthcare levels; cost-effectiveness in health; the operation and experiences of health networks; regulations and protocols used in health systems; services, strategies and programs oriented towards PHC; and new technologies implemented for PHC (Fig. 1)
The Latin American experience in PHC and health networks
In Latin America, public systems for the provision of health services have relied on PHC to address common problems such as the fragmentation of systems; the decentralization of care; the scarcity of economic and professional resources; and the indiscriminate demand related to high- and low-complexity pathologies in specialized centers [97, 100,101,102, 104, 106, 108, 109, 129, 134, 135, 138, 140].
Some countries have strengthened the logic of networks and levels of care [96, 114, 115]. In such cases, under the PHC model, the offer is organized from the first level of care to the third or fourth level of complexity and, among other characteristics, provides for universal services. On the supply-side, the objective is to break down economic barriers by establishing user fees that are usually zero or relatively low (compared to those of the private system). Meanwhile, each component of the network is responsible for a defined population, whose members must be identified and assigned responsibilities. The assignment of responsibilities must follow a risk criteria for the beneficiaries so as to efficiently cover different needs. In this way, each country will develop the network that is most appropriate according to the epidemiological, demographic, sociocultural and economic characteristics of its population, that is, considering not only the possibilities offered by the reform of supply but also the characteristics of demand [33, 110, 128].
The selection of nationsFootnote 2 seeks sub-regional representation, involving Mexico, Brazil, Central American countries, Andean countries, and the Southern Cone, providing special attention to differentiated health care organizations. Costa Rica, Chile, Brazil and Colombia were included as paradigmatic cases of PHC models, while Bolivia and Guatemala were included as nations with the presence of indigenous populations, needs and health perceptions, while Argentina and Uruguay represent countries with relatively high levels of socioeconomic development and recent programmatic reforms. In alphabetical order, below are the experiences of the countries mentioned.
In Argentina, Plan Nacer, which was designed in 2004, initially focused on the population of mothers and children that lacked formal insurance (with exclusive public coverage) in nine priority provinces in the north of the country. It was implemented based on the registration of users and the establishment of payments tied to the fulfillment of management commitments agreed between the National Ministry of Health and its provincial counterparts [111, 112, 122, 148]. The initiative was expanded to the rest of the country and to all social groups, adding coverage for specific lines of care [83, 116]. This format is maintained to the present day. In parallel, the Networks Program, Community Doctors Program (PMC) and the Remediar program were implemented.Footnote 3 The first of these proposed the promotion of equitable access to health services for those segments of the population without coverage; the second financed human resources and training at the first level of care; the third focused on providing coverage of essential medicines through primary care centers [51, 39, 64, 117, 118]. Based on interviews with key actors, [66] recorded that the financing of the PMC was limited and did not guarantee the insertion of professionals in the system. Meanwhile, Maceira, D., et al. [31], – through surveys of the user population and a control group and comparison of program purchase prices and secondary sources – and Tobar, F., [68] – through secondary descriptive statistics – showed that the Remediar Program allowed efficient purchases with a redistributive impact due to its focus on the PHC network, reducing out-of-pocket expenses for lower-income families.
In Brazil, the Family Health Strategy (ESF) has configured a person-centered PHC model. Its predecessor, the Health and Family Program, initiated in the 1990s, promoted the continuous training of health professionals and managed to improve indicators of malnutrition, infant mortality and hospitalization due to dehydration, among others [8]. In fact, a study carried out in 2006 [35] showed – through an econometric analysis – the association between program coverage and lower infant mortality rates, reflecting the program’s contribution to the fall in child mortality. Puentes Vacca, J. S., and Torres Ruda, Y. M. [58] point out that the ESF strengthened links between the community and actors in the health system as well as local and regional empowerment. However, Carneiro Junior, N., and Gené Badia, J., [7] criticize the ESF’s rigidity, noting that it does not take account of different regional realities, although they highlight the presence of greater annual resources allocated to PHC, a fundamental element for the consolidation of the Brazilian National Health System [50]. Regarding care networks, various studies have shown that their implementation has positively influenced the survival of people with breast cancer [13, 55, 98]. However, experiences of informality and an appropriation of resources in some municipalities show the need for greater levels of auditing and control [24, 56, 113, 130, 136, 137, 144].
In Bolivia, a series of reformsFootnote 4 developed during the nineties gave rise to the Intercultural Community Family Health Model (SAFCI), which functions as a PHC strategy, contemplating the principles of community participation, intersectorality, interculturality and integrality [21]. Although research on the current Bolivian health system and the operation of the SAFCI model is limited [2], during the last decades, Bolivia has shown improvements in the general implementation of the health system, promoting social participation in decision-making linked to health management and generating programs to approach the health of native peoples [57], which has improved indicators of prenatal care and the treatment of tuberculosis, etc. [45]. At the same time, the country has made progress in the formation of health networks in order to reduce the levels of maternal and infant mortality. The Integrated Health Service Delivery Networks (IHSDN) model is operationalized in the networks of municipal and departmental health services that must connect with the third level. The literature has shown that although efforts have been made to give each municipal network a reference center at the higher level, there remain difficulties in achieving adequate coordination [67].
The reforms that emerged in the year 2000 in Chile enabled the subsequent implementation of the country’s PHC strategy, giving rise to the creation of public organizations focused on health management and the development of service networks [19]. The Universal Access and Explicit Guarantees Plan (AUGE), in particular, is responsible for providing protection for certain priority pathologies [53, 119]. A study analyzed the situation before and after the implementation of this plan for patients with chronic kidney failure and determined that the main challenges were associated with a lack of human resources and equipment [25]. In contrast, another study evaluated the results in patients with acute myocardial infarction using econometric techniques and showed an association between the implementation of the AUGE Plan and a reduction in in-hospital mortality in at-risk patients undergoing thrombolysis and aged over 75 years, where other strategies were yet to achieve a great impact [42].
In the case of Colombia, a PHC strategy was initiated in Bogotá starting in 2004 based on the Salud a su Hogar Program (SHP), which aimed to reduce social inequality, improve access and use of health services and to promote the participation of civil society and communities [80, 95, 121]. A study carried out in 2008 based on an analysis of official data showed that implementation of the strategy had helped to improve the indicators of infant mortality, post-neonatal mortality and mortality due to pneumonia in children under 5 years of age [40]. Another study, using descriptive statistics, concluded that although the primary care model has been linked to an improved performance of health services, the aspects of access, family focus and community orientation are the least developed [60].
In Costa Rica, PHC reform was based on the establishment of multidisciplinary teams, community participation and the vertical integration of care at all levels. What stands out here are the measures of coverage and use of health services, whose performance has been associated with the population’s state of health and high life expectancy [69]. A quasi-experimental study attributes the decrease in infant and adult mortality to the reforms in PHC. In particular, it points out that the programs within the framework of the PHC strategy led the infant mortality rate to fall by 8%, the adult mortality rate by 2%, and inequity in access from 30 to 22% between 1985 and 2001 [61]. On the other hand, a study on the efficiency of primary health care spending identified a need to adjust the scarce resources of the Costa Rican Social Security Fund (CCSS) to respond to the current demographic change [27].
The experience of El Salvador with its Basic Comprehensive Health Systems (SIBASIS) has promoted access via the IHSDN model, promoting comprehensive care through Community Family Health Teams (ECOS). Here, the coordination of health networks based on the involvement of families and the community has led to improvements in the elimination of geographical, economic and cultural barriers affecting the Salvadoran population’s access to health services [5, 90].
In Guatemala, the Health Coverage Extension Program (PEC), with an emphasis on mother and child care, seeks to counteract a limited state offer in a country where 57% of the population still resorts to private services (PAHO, 2010). In this case, care networks not only seek to achieve efficiency in the allocation of resources but also to confront the challenge of improving access and expanding the coverage of services.
In Mexico, asymmetries have been observed between care provided by the health system and the needs of the population because an unequal geographical distribution of infrastructure reproduces regional inequalities, coinciding with the geographical distribution of poverty [71, 127, 131]. A recent study analyzing the barriers to access health services showed that, in 2018, 30.9% of the country's localities did not have physical access to basic health services. Among the main barriers are the travel time to health facilities, averaging 53.4 min [10]. The reforms produced by the General Health Law of 2003 gave rise to the Seguro Popular (SP), which sought to provide coverage to those who lacked social security [139]. Although some reports have indicated that it has helped to increase access for the most vulnerable sectors, Durán-Arenas, L., et al. [16] observed that those covered by social security and the popular insurance program do not receive the same type of coverage. They highlight a lack of indicators to allow an observation of the SP’s performance. At the same time, another study recorded an insufficient number of professionals to carry out health promotion and disease prevention activities and highlighted a need to adapt profiles to the established tasks [1]. A reform has recently been implemented, through which the SP has been replaced by a new organization: the Health Institute for Social Welfare, although the literature has not yet been able to analyze its performance.
In Paraguay, PHC has been developed through vertical programs with little connection or coordination. Although Law 1032 of 1996 recognized the importance of community participation in the implementation of health policies, plans and programs (aligned with the characteristics of PHC), 40% of Paraguayans do not have access to health services [58]. Among the main weaknesses, a lack of human and financial resources has been observed, along with the weak governance of public organizations [15]. Furthermore, through interviews with key actors, Villalba, B., et al. [73] identified a need to increase the level of qualification among professionals.
For its part, Uruguay created the National Integrated Health System (SNIS) in 2007. This established the organization of networks by level of care, prioritizing the first level of care under a PHC approach [21, 58, 120]. Sollazzo, A., & Berterretche, R., [65] observed that the segmentation of the system and the low level of coordination between levels of care negatively affected general health indicators, and that the lack of human resources constituted a threat to the PHC strategy.
Priority areas for the development of PHC strategies and health networks
While access and continuity in health care are two essential objectives in any primary care strategy [41], the presence of a high level of unmet health needs in populations dependent on both public and private sectors’ coverage demonstrates that care requirements exceed the capacity of resolution of a single provider [81, 91, 92]. Health outcomes -and outputs- are the result of a collaborative job, where different levels of care and multidisciplinary cooperation combined are required [133]. Therefore, how to implement effective health care networks, and how to guarantee the provision of care in segmented systems though a sound regulatory framework are part of a comprehensive PHC strategy.
The presence of healthcare networks operationally dependent on several intersecting jurisdictions -product of decentralized and/or segmented systems- makes the necessary coordination even more complex [32, 132, 142].
Factors commonly identified as obstacles to efficiency in networked healthcare system are the failure in the referral and counter-referral mechanisms; the absence of standardized information about patients; a failure in the performance of the body responsible for coordinating the service network; the lack of commitment and/or instruction of health personnel; and the absence of a perspective of ethnic and cultural diversity [11, 30, 38, 49, 59, 63, 76, 77, 85, 86, 89, 94, 103, 107]. As such, the discussion about the reasons why a health care network fails requires a comprehensive approach [23, 87].
Key elements that contribute to a better functioning of health care levels are financial incentives and the mechanisms of technology incorporation. The first -together with a wide range of policies oriented to strengthening professional careers- could stimulate healthcare personnel to switch clinical behavior towards preventive, sound diagnostic and informed treatment decisions [18, 79]. Reputation incentives contribute in the same way, particularly when information on the performance of professionals is published [6]. In turn, the incorporation of technologies has proven to be useful to facilitate learning, cooperation, better promotion and monitoring procedures, especially in rural setups, constituting a complement to care at the first level [52, 70, 75, 88, 93, 99, 141, 143].
Beyond this, the presence of different jurisdictions represented within a network opens a discussion on the structure of the vertical integration of services [145], not only in ownership but also in the design of spaces of governance, control and coordination [78]. Where budgetary sources are not necessarily aligned, the integration of services should shift to the presence of regulatory and protocolized ties that allow the distribution of tasks and responsibilities, achieving complementarity, which requires a common monitoring structure [32, 105]. Network governance is thus a key aspect that managers and designers must take into account when establishing priorities as part of a PHC plan. In brief, the leadership to unite wills and modify deep-rooted processes is the starting point for network governance [33].
Therefore, the institutional design of the region's health systems, political and economic disputes and the values of the different actors involved are key elements that determine the regulation of PHC [4]. As such, the disconnect among actors and the low leadership capacity in health systems condition the design of such strategies.
Conclusions
Although we recognize achievements in the process of building PHC and health networks in Latin America, which results are reflected in key health indicators, there are still key issues to be addressed based on the evidence analyzed.
First of all, the concept of primary health care is clearly rooted in institutional discourse and in the sectoral debate in the countries of the region. However, the approach is challenged by the organizational structure of the health systems themselves. Intense fragmentation, ineffective decentralization and the accumulation of programs along the line of care lead to the consolidation of a care model that deviates from what is considered good practice.
Profound inequality in income distribution operates as a segmentation mechanism in itself, generating different levels of coverage associated with the ability to pay. During the last decades, efforts have been observed in almost all countries in the region to promote coordinated models of care, although their results have been uneven and monitoring and evaluation of the impact achieved is scant.
The little coordination between subsystems amplifies differences and leads to the development of disjointed health networks strongly based on informality and a lack of protocolization. Dialogue between providers by subsystem is sparse, and the development of the private sector is not seen to be a space for coordination and complementation with the public and -in some cases- social security system but rather a mechanism that deepens care gaps.
The evidence collected for this review has highlighted some key themes addressed throughout the document. Among them, the need to intensify PHC models and care networks stands out, following the results documented. At the same time, the document identified the lack of coverage of other relevant topics, such as how health systems adapt to changes in population needs, and the adaptation to health systems to contexts of epidemiological accumulation, including mental health, addictions and environmental impacts.
In addition, this review found limited literature documenting changes of financial and non-financial incentives and their impact on health services’ provision, efficiency in the allocation of resources, as well as quality improvements, opening the room for future lines of research. This result might show the need for deeper interaction between research and political action in the Latin American and Caribbean region to facilitate an exchange of information, strengthen impact evaluation of interventions, and jointly design a research-action agenda with social impact.
Availability of data and materials
No datasets were generated or analysed during the current study.
Notes
A more complete methodological justification is included in the supplementary material section.
The structure used to describe what is being done in each country has been defined by the authors. Even though we recognize the value of the evaluation’s schemes for health systems programs and initiatives used by international organizations such as WHO, UNICEF, etc. we considered this way fits the objectives of the paper and allows us to better organize the evidence found.
Launched under Ministerial Resolution 844/2022, the current National Community Health Program proposes to continue the objective of strengthening the national PHC strategy.
Popular Participation Law (Law No. 1551), Administrative Decentralization Law (Law No. 1654).
Abbreviations
- AUGE:
-
Universal Access and Explicit Guarantees Plan
- CCSS:
-
Costa Rican Social Security Fund
- CPHC:
-
Comprehensive Primary Health Care
- ECOS:
-
Community Family Health Teams
- ESF:
-
Family Health Strategy
- IHSDN:
-
The Integrated Health Service Delivery Networks
- LASM:
-
Latin American Social Medicine
- PEC:
-
Health Coverage Extension Program
- PMC:
-
Community Doctors Program
- PHC:
-
Primary Health Care
- RPHC:
-
Renewed Primary Health Care
- SAFCI:
-
Intercultural Community Family Health Model
- SHP:
-
Salud a su Hogar Program
- SIBASIS:
-
Basic Comprehensive Health Systems
- SNIS:
-
National Integrated Health System
- SP:
-
Seguro Popular
- SPHC:
-
Selective Primary Health Care
References
Alcalde-Rabanal JE, Bärnighausen T, Nigenda-López G, Velasco-Mondragón HE, Sosa-Rubí SG. Profesionales necesarios para brindar servicios de prevención y promoción de la salud a población adulta en el primer nivel. Salud Publica Mex. 2013;2013(55):301–9.
Alvarez FN, Leys M, Mérida HE, Guzmán GE. Primary health care research in Bolivia: systematic review and analysis. Health Policy Plan. 2016;31(1):114–28. https://doi.org/10.1093/heapol/czv013.
Atun R, Monteiro O, de Andrade L, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, García P, Gómez-Dantés C, Knaul FM, Muntaner C, Braga de Paula J, Rígoli F, Castell-Florit Serrate P, Wagstaff A. Health-system reform and universal health coverage in Latin America. The Lancet. 2014. https://doi.org/10.1016/S0140-6736(14)61646-9.
Báscolo E. Gobernanza y economía política de las políticas de APS en América Latina. Ciencia & Saúde Colectiva. 2011;16(6):2763–72.
BID-ISALUD (2016). Panorama Regional. Sistemas de Salud de Latinoamérica y Estado de Situación del Modelo RISS. Documento colaborativo RISSALUD. Disponible en http://www.rissalud.net/images/pdfpublicos/Documento_Colaborativo_Rissalud_Oct_2016.pdf
Busse R, Blümel M. Payment systems to improve quality, efficiency, and care coordination for chronically ill patients – a framework and country examples. The Triple Aim for the Future of Health Care FUNCAS Social and Economic Studies. Madrid, Spain: Funcas; 2015. p. 83–100.
Carneiro Junior N, Gené Badia J. La atención primaria catalana vista desde la reforma brasileña de salud [Catalan Primary Health Care as seen from Brazilian health reform]. Atención primaria. 2011;43(11):611–6. https://doi.org/10.1016/j.aprim.2010.12.015.
Castillejo J, Vicente R, Dolz M, Prats M, Ramos E. Reflexiones sobre los sistemas sanitarios del Municipio de São Paulo y de Cataluña. Programa Salud y Familia São Paulo. Elementos clave comunes de ambos sistemas sanitarios (segunda parte) [Reflections on the health systems of São Paulo and Catalonia. Common key elements of both health systems (second part)]. Atencion Primaria. 2009;41(1):49–54. https://doi.org/10.1016/j.aprim.2008.04.001.
Conill EM, Fausto MCR, Giovanella L. Contribuições da análise comparada para um marco abrangente na avaliação de sistemas orientados pela atenção primária na América Latina. Rev Bras Saúde Matern Infant Recife. 2010;10(1):s14–27.
CONEVAL, Consejo Nacional de Evaluación de la Política de Desarrollo Social. Estudio diagnóstico del derecho a la salud. 2018. https://dds.cepal.org/redesoc/publicacion?id=4883.
Contreras Rengifo A. La promoción de la salud general y la salud oral: una estrategia conjunta. Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral. 2016;9(2):193–202. https://doi.org/10.1016/J.PIRO.2016.07.003.
Cueto M. The ORIGINS of primary health care and selective primary health care. Am J Public Health. 2004;94(11):1874. https://doi.org/10.2105/AJPH.94.11.1864.
De Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Access to cancer care: mapping hospital admissions and high-complexity outpatient care flows. The case of breast cancer. Cadernos de Saúde Pública. 2011;27(2):317–26. https://doi.org/10.1590/S0102-311X2011000200013.
De Siquiera BP. Reformas de los sistemas de salud: el caso de Brasil. Perú, Ministerio de Salud. Seminario Internacional sobre Reforma del Sector Salud. Lima: Ministerio de Salud; 1997. p. 55–60.
Dullak, R., Rodriguez-Riveros, M. I., Bursztyn, I., Cabral-Bejarano, M. S., Ruoti, M., Paredes, M. E., Wildberger, C., & Molinas, F. (2011). Atención Primaria en Salud en Paraguay: panorámica y perspectiva. Ciência & Saúde Coletiva, 16(6),2865–2875.[fecha de Consulta 31 de Mayo de 2023]. ISSN: 1413–8123. Recuperado de: https://www.redalyc.org/articulo.oa?id=63019110024
Durán-Arenas L, Salinas-Escudero G, Granados-García V, Martínez-Valverde S. La transformación del sistema de salud con base en la atención primaria. División de Estudios de Posgrado: Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F; 2012.
Ecuador, Consejo Nacional de Salud. Hacia la reforma del sector salud. Quito: Culturales; 1995.
Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011;2011(7):CD009255. https://doi.org/10.1002/14651858.CD009255.
Frenk J, González-Block MA. Primary care and reform of health systems: a framework for the analysis of Latin American experiences. Health Serv Manage Res. 1992;5(1):32–43. https://doi.org/10.1177/095148489200500104.
Frenk J. Comprehensive policy analysis for health system reform. Health Policy. 1995;1995(32):257–77.
Giovanella, L., Fidelis de Almeida, P., Vega Romero, R., Oliveira, S., & Tejerina Silva, H. (2015). Panorama de la Atención Primaria de Salud en Suramérica: concepciones, componentes y desafíos. Saúde em Debate, 39(105), 300–322.[fecha de Consulta 31 de Mayo de 2023]. ISSN: 0103–1104. Recuperado de: https://www.redalyc.org/articulo.oa?id=406341748002
Giraldo Osorio A, Vélez Álvarez C. La Atención Primaria de Salud: desafíos para su implementación en América Latina [Primary health care: challenges for implementation in Latin America]. Atención primaria. 2013;45(7):384–92. https://doi.org/10.1016/j.aprim.2012.12.016.
Goldman L, Freidin R, Cook EF, Eigner J, Grich P. A multivariate approach to the prediction of no-show behavior in a primary care center. Arch Intern Med. 1982;142(3):563–7. https://doi.org/10.1001/ARCHINTE.1982.00340160143026.
Gonçalves Serra C, de Almeida Rodrigues PH. Avaliação da referência e contrarreferência no Programa Saúde da Família na Região Metropolitana do Rio de Janeiro (RJ, Brasil). Cien Saude Colet. 2010;15(SUPPL. 3):3579–86. https://doi.org/10.1590/S1413-81232010000900033.
González F. Implementación del plan AUGE en pacientes con IRC. Rev Med Chil. 2003;131(5):545–51. https://doi.org/10.4067/S0034-98872003000500011.
González García G. La reforma del sector salud en la Argentina. En: Memoria del 1er seminario sobre los procesos de reforma de la seguridad social en materia de salud. Conferencia Interamericana de Seguridad Social, Secretaría General; 1998. (Serie Estudios No. 42). México, D.F.
Gonzalez Jimenez F. Análisis de la eficacia del gasto de atención primaria en salud. Sistema de estudios de posgrado. Centro Internacional de Política Económica para el desarrollo sostenible. Posgrado profesional en gestión y finanzas públicas (MGFP). Universidad Nacional de Costa Rica. 2018.
Jiménez de la Jara J, Bossert T. Chile´s health sector reform: lessons from four reform periods. Health Policy. 1995;1995(32):155–66.
Labonté R, Sanders D, Baum F, Schaay N, Packer C, Laplante D, Romero R, Viswanatha V, Barten F, Hurley C, Ali H, Manolakos H, Acosta Ramírez N, Pollard J, Narayan T, Mohamed S, Peperkamp L, Johns J, Ouldzeidoune N, Pooyak S. Aplicación efectividad y contexto político de la atención primaria integral de salud resultados preliminares de una revisión de la literatura mundial. Revista Gerencia y Políticas de Salud (Colombia) Num. 2009;16:8.
López, P., Suárez, I., Menchaca, S., Trujillo, N., Santiago, L., Cárdenas, S. (2009). Las Redes Integradas de Servicios de Salud desde la realidad cubana. Revista Cubana de Salud Pública. 35. https://doi.org/10.1590/S0864-34662009000400005.
Maceira D, I. Apella y E. Barbieri. Necesidades de la demanda y subsidios de medicamentos: La experiencia del Programa Remediar en Argentina. Buenos Aires, Nuevos Documentos del CEDES (Centro de Estudios de Estado y Sociedad) 51/2008. 2008. https://repositorio.cedes.org/handle/123456789/3677?locale=en.
Maceira D, y Palacios A. Estructura, Gestión y Desempeño de Cabeceras de Red Hospitalarias Perinatales. Dos estudios de caso en la Provincia de Buenos Aires, CEDES. 2012. https://www.danielmaceira.com.ar/wp-content/uploads/2014/07/MaceiraPalacios-WB-RedesPerinatales-final-22oct2012.pdf.
Maceira D, Melamud A, Palacios A. Capacidad Resolutiva y Desempeño de Redes Hospitalarias en Líneas de Cuidado Prevalentes. El Caso del Hospital Posadas y su Área de Influencia en la Zona Oeste de la Provincia de Buenos Aires. Documento de Trabajo CEDES, no.127. 2014. https://repositorio.cedes.org/bitstream/123456789/4443/1/Doc_t127.pdf.
Maceira, D., Brumana, L., Aleman, J.G. (2022). Reducing the equity gap in child health care and health system reforms in Latin America. Int J Equity Health. 2022 Feb 23;21(1):29. https://doi.org/10.1186/s12939-021-01617-w. Disponible en: http://repositorio.cedes.org/handle/123456789/4727
Macinko J, Guanais FC, de Fátima M, de Souza M. Evaluation of the impact of the family health program on infant mortality in Brazil, 1990–2002. J Epidemiol Community Health. 2006;60(1):13–9. https://doi.org/10.1136/jech.2005.038323.
México, Poder Ejecutivo Federal. Programa de reforma del sector salud, 1995–2000. México, D.F: PEF; 1995. https://www.dof.gob.mx/nota_detalle.php?codigo=4875243&fecha=11/03/1996.
Ministerio de Salud de Colombia y Organización Panamericana de la Salud. La reforma del sector salud en Colombia. Santa Fe de Bogotá: MS, OPS; 1995.
Ministerio de Salud. (2011). Proyecto de Inversión en Salud Materno Infantil Provincial. Serie Documentos Técnicos No 44. Asunto: Consideraciones preliminares para la nueva estrategia de financiamiento por resultados en Cirugías de Cardiopatías Congénitas en el marco del Plan Nacer. Buenos Aires: Ministerio de Salud de la Nación.
Ministerio de Salud, Argentina y SUMAR (2016). 5 años de implementación del Programa de Nacional de Cardiopatías Congénitas integrado en el modelo de gestión del Programa SUMAR: Recorridos y aprendizajes de una política de articulación nacional, Buenos Aires. http://iah.salud.gob.ar/doc/Documento145.pdf
Mosquera Méndez, P. A., Granados Hidalgo, G., & Romero, R. V. (2008). La estrategia de Atención Primaria en Salud (APS) para Bogotá-Colombia y su relación con la disminución de inequidades de resultados en salud. Revista Gerencia y Políticas de Salud, 7(14), 88–109. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-70272008000100006
Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA. 2003;289(8):1035–40. https://doi.org/10.1001/JAMA.289.8.1035.
Nazzal NC, Campos TP, Corbalán HR, Lanas ZF, Bartolucci JJ, Sanhueza CP, Cavada ChG, Prieto DJC. Impacto del plan AUGE en el tratamiento de pacientes con infarto agudo al miocardio con supradesnivel ST, en hospitales chilenos. Revista Médica de Chile. 2008;136(10):1231–9. https://doi.org/10.4067/S0034-98872008001000001.
World Health Organization. Constitution of the World Health Organization. 1946. https://pnsd.sanidad.gob.es/pnsd/legislacion/pdfestatal/i5.pdf.
World Health Organization. Primary Health Care Alma-Ata 1978. http://apps.who.int/iris/bitstream/handle/10665/39244/9243541358.pdf?sequence=1.
World Health Organization. Río Political Declaration of Social Determinants of Health. 2011. https://cdn.who.int/media/docs/default-source/documents/social-determinants-of-health/rio_political_declaration_spanish.pdf?sfvrsn=891f1a3b_5.
Organización Panamericana de la Salud. (1990). Los sistemas locales de salud. Conceptos, métodos, experiencias. https://iris.paho.org/handle/10665.2/51765
Pan American Health Organization. Regional Consultation on the Renewal of Primary Health Care in the Americas. Montevideo, Uruguay. 2005. http://www.paho.org/Spanish/AD/THS/aps_agenda.htm.
Pan American Health Organization & World Health Organization. Regional Declaration on the New Orientations of Primary Health Care (Montevideo Declaration). 2005. https://www.paho.org/es/documentos/declaracion-regional-sobre-nuevas-orientaciones-atencion-primaria-salud-declaracion.
Pan American Health Organization. Health Agenda for the Americas 2008–2017. Panama City. 2007. https://www3.paho.org/Spanish/DD/PIN/Agenda_de_Salud.pdf.
Pan American Health Organization. Health Systems based on Primary Health Care - Strategies for the Development of PHC Teams. 2008. https://www.paho.org/hq/dmdocuments/2010/APS-Estrategias_Desarrollo_Equipos_APS.pdf.
Pan American Health Organization. Integrated Health Services Networks: Concepts, Policy Options and Road Map for Implementation in the Americas. 2010. https://www.paho.org/uru/dmdocuments/RISS%202010-Doc%20Posicion%20revisado%20pos%20CD.pdf.
Ortiz-Chacha, C. S., Blázquez-Morales, M. S. L., García-González, J., Duarte-Gómez, M. B., De-San-Jorge-Cárdenas, X. M. D. C., & Méndez-Main, S. M. (2018). Tecnologías de la información y comunicación para el cuidado y atención del embarazo en el primer nivel de atención . CienciaUAT, 12(2),40–53.[fecha de Consulta 31 de Mayo de 2023]. ISSN: 2007–7521. Recuperado de: https://www.redalyc.org/articulo.oa?id=441955208004
Osorio, N. V. (2016). Relaciones de la APS con los sistemas de salud y modelos de desarrollo en Chile y Colombia. Facultad Nacional de Salud Pública Héctor Abad Gómez, Universidad de Antioquia, Antioquia. Recuperado el marzo de 2019, de https://bibliotecadigital.udea.edu.co/bitstream/10495/5558/1/VelasquezNatalia_2016_APSSistemasSaludModelos.pdf
Pan American Health Organization, Executive Committee of the Directing Council. Progress of activities in health sector reform. Presentado en la 26.a Reunión del Subcomité de Planificación y Programación, Washington, D.C., 25 a 27 de Marzo de 1996. https://iris.paho.org/handle/10665.2/20736?locale-attribute=pt.
Pautasso F, Camargo LT, Dias FC, Aquino CR. Enfermero navegador: desarrollo de un programa para Brasil. Rev Latino-Am Enfermagem. 2020;28:e3275.
Pereira, J.S., Machado, W.C.A. (2016). Referência e contrarreferência entre os serviços de reabilitação física da pessoa com deficiência: a (des)articulação na microrregião Centro-Sul Fluminense, Rio de Janeiro, Brasil. Physis Revista de Saúde Coletiva, Rio de Janeiro. https://doi.org/10.1590/S0103-73312016000300016
Polo Andrade S. Evaluación del grado de aplicabilidad del modelo de salud familiar comunitario intercultural en el Servicio Departamental de Salud de Chuquisaca durante el periodo 2018–2019. Universidad Andina Simón Bolívar. Ministerio de Salud del Estado Plurinacional de Bolivia. Revista Ciencia, Tecnología e Innovación Gestión 2020 Volumen 18. Número. 2020;22:69–94.
Puentes Vacca, JS, Torres Ruda YM. (2012). Atención Primaria en Salud en Latinoamérica: Revisión Temática [Universidad Nacional de Colombia]. https://repositorio.unal.edu.co/bitstream/handle/unal/10429/jeimysenaidapuentesvacca.2012.pdf?sequence=1&isAllowed=y
Ramos, S., Straw, C., Viniegra, M., Almada, C., Schneider, M., Pesce, V., Mignini, L., Tabares, G., Robles, N., Romero, I., & Moretto, V. (2018). Barreras y facilitadores en las trayectorias de mujeres con cáncer de mama usuarias de hospitales públicos. Revista Argentina de Salud Pública 9(36);14–21. Recuperado en 31 de mayo de 2023, de http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1853-810X2018000300003&lng=es&tlng=es.
Rodriguez-Villamizar, L. A., Acosta-Ramírez, N., & Ruíz-Rodríguez, M. (2013). Evaluación del desempeño de servicios de Atención Primaria en Salud: experiencia en municipios rurales en Santander, Colombia. Revista de Salud Pública, 15(2);167–179. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/38073
Rosero-Bixby L. Spatial access to health care in Costa Rica and its equity: a GIS-based study. Social Sci Med. 2004;58(7):1271–84. https://doi.org/10.1016/S0277-9536(03)00322-8. ISSN 0277-9536.
Rovere, M., (2012). Atención Primaria de la Salud en Debate. Saúde em Debate, 36(94);327–342. [fecha de Consulta 31 de Mayo de 2023]. ISSN: 0103–1104. Recuperado de: https://www.redalyc.org/articulo.oa?id=406341762003
Sandes, L. F. F., Freitas, D. A., de Souza, M. F. N. S., & de Sousa Leite, K. B. (2018). Atenção primária à saúde de indígenas sul-americanos: revisão integrativa da literatura. Rev Panam Salud Publica, 42(Special). https://doi.org/10.26633/RPSP.2018.163
Scaglia, M.C. (2012). Curarse en salud. Saber en atención primaria de la salud : la implementación del programa Médicos Comunitarios en Florencio Varela, Argentina. Facultad de Filosofía y Letras, Universidad de Buenos Aires. URI: http://repositorio.filo.uba.ar/handle/filodigital/1639
Sollazzo A, Berterretche R. El sistema nacional integrado de Salud en Uruguay y los desafíos para la Atención Primaria. Cien Saude Colet. 2011;16:2829–40.
Stolkiner A, Comes Y, Garbus P. Alcances y potencialidades de la Atención Primaria de la Salud en Argentina. Cien Saude Colet. 2011;16:2807–16.
Tejerina Silva, H., Soors, W., De Paepe, P., Aguilar Santacruz, E., Closon, M.-C., & Unger, J.-P. (2010). Reformas de gobiernos socialistas a las políticas de salud en Bolivia y Ecuador: el potencial subestimado de la Atención Primaria Integral de Salud para impactar los determinantes sociales en salud. Medicina Social Social Medicine, 4(4), 273–282. Recuperado a partir de https://www.medicinasocial.info/index.php/medicinasocial/article/view/396
Tobar, F. (2004). Políticas para promoción del acceso a medicamentos: El caso del Programa Remediar de Argentina. Nota técnica de discusión de salud 002/2004. Banco Interamericano de Desarrollo, Departamento de Desarrollo Sostenible, División de Programas Sociales, Washington D.C.
Unger JP, De Paepe P, Buitrón R, Soors W. Costa Rica: achievements of a heterodox health policy. Am J Public Health. 2008;98(4):636–43. https://doi.org/10.2105/AJPH.2006.099598.
Uribe, C. J., Serrano, N. C., Carolina Ortiz-Badillo, A., Luna-González, M., Contreras Contreras, N., & Carrillo, E. (2020). La realidad virtual para educación en cáncer de mama: Una oportunidad de innovar en Latinoamérica. Revista Ibértica de Sistemas e Tecnologías de Informacao, E33, 164–174. https://www.proquest.com/openview/b2abaff195313a5fa6bad09e4f0a2cd5/1?pq-origsite=gscholar&cbl=1006393
Vanegas L. La economía de la salud en México, en Revista de la CEPAL. Número. 2020;132:195–208.
Victora CG. Latin American social medicine. Am J Public Health. 2003;93(12):1987.
Villalba B, Molinas FA, Cabral-Bejarano M. Factores que facilitan o dificultan la Continuidad del Cuidado en la Red de Servicios del Departamento de Presidente Hayes según atributos de las RIISS, Paraguay, 2018–2019. Revista de Salud Publica Del Paraguay. 2020;10(2):50–8. https://doi.org/10.18004/RSPP.2020.DICIEMBRE.50.
Werner, D., Sanders, D., (2000). Cuestionando la Solución: Las políticas de Atención Primaria de Salud y Supervivencia Infantil. http://www.healthwrights.org/spanish/Libros/question.htm
Complementary Bibliographic references
Alfaro M, Bonis J, Bravo R, Fluiters E, Minué S. Nuevas tecnologías en atención primaria: personas, máquinas, historias y redes. Informe SESPAS, Gaceta Sanitaria. 2012;26(1):107–12.
Alves MJM, Bustamante-Teixeira MT, Ferreira RP, Oliveira CM, Azevedo CB, Souza AIS. Regionalization and organization of the care networks in the southeast macro-region of Minas Gerais: limitations for challenges for the programming of breast cancer services. Revista APS, Juiz de Fora. 2010;13:s26–34.
Angarita Ribero CT, Duitama Vergara LL, Hurtado Sánchez MJ, Córdoba Núñez MA, Guzmán Cruz PC. Caracterización clínica y paraclínica de los pacientes pediátricos con diagnóstico de leucemia linfoide aguda atendidos en el Centro Javeriano de Oncología (2004–2012). Colombia: Pontificia Universidad Javeriana; 2013.
Artaza Barrios O, Mendez C, Holder Morrison R, Suárez Jimenez J. Redes Integradas de Servicios de Salud: El desafío de los Hospitales. Representación OPS/OMS Chile, no.1. 2011. https://www.researchgate.net/publication/259576869_Redes_integradas_de_servicios_de_salud_el_desafio_de_los_hospitales.
Borroto Cruz ER, Salas Perea RS, Díaz Rojas PA. Un nuevo modelo formativo de médicos en la Universidad Barrio Adentro, República Bolivariana de Venezuela. Educ Méd Sup. 2010;2010(24):111–35.
Bruno Rubio V, Bustamante Llinás MJ, Jiménez Hamburgen A, Maldonado Mendoza L, Segura Barrios I, Tuesca Molina R. Atención Primaria en Salud Una mirada desde los profesionales de enfermería: Barreras, conocimientos y actividades Barranquilla. Revista Salud Uninorte. 2015;31(2):295.
Cetrángolo O, Goldschmit A. Las obras sociales y otras instituciones de la seguridad social para la salud en Argentina.Origen y situación actual de un sistema altamente desigual. CECE. 2018. https://biblio.unaj.edu.ar/cgi-bin/koha/opac-detail.pl?biblionumber=8394.
Cid C, Báscolo E, Morales C. La eficiencia en la agenda de la estrategia de acceso y cobertura universal en salud en las Américas. Salud Pública de México. 2016;58(5):496–503.
Codarini G, Andracchio M, Viggiani F, Gonzalez P, Lev D. Intervenciones Sanitarias - Programa Nacional de Salud Escolar: una política de cuidado de niñas, niños y adolescentes en edad escolar de Argentina. Revista Argentina de Salud Pública. 2018;9(35):38–41.
Comisión sobre Determinantes Sociales de la Salud. (2005). Acción sobre los Factores Sociales Determinantes de la Salud: Aprender de las experiencias anteriores. Organización Mundial de la Salud. https://pss17.files.wordpress.com/2009/01/fdsalud_oms.pdf
Crojethovic M, Maceira D. Burocracia o prácticas informales: Los límites del sistema burocrático y las prácticas informales en las organizaciones hospitalarias, abastecimiento de medicamentos en el caso de los hospitales porteños. Medicina y Sociedad. 2009;28(2).
Cunha KS, Higashi GDC, Erdmann AL, Kahl C, Koerich C, Meirelles BHS. Myocardial revascularization: factors intervening in the reference and counter-reference in primary health care. Rev Esc Enferm USP. 2016;50(6):963–70.
Dabas E. Redes sociales, niveles de abordaje en la intervención y organización en red. Panorama. 2001. http://biblioteca.udgvirtual.udg.mx/jspui/handle/123456789/953.
Dias C. O valor da inovação: criar o futuro do sistema de saúde. Coimbra: Edições Almedina. 2015. https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/csc/v21n6/1413-8123-csc-21-06-1985.pdf.
Field JK, Oudkerk M, Pedersen JH, Duffy SW. Prospects for population screening and diagnosis of lung cancer. Lancet (London, England). 2013;382(9893):732–41. https://doi.org/10.1016/S0140-6736(13)61614-1.
Fuentes-Alabi S, Bhakta N, Vasquez RF, Gupta S, Horton SE. The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: a report from the childhood cancer 2030 network. Cancer. 2018;124:391–7. https://doi.org/10.1002/cncr.31022.
Fuentes-Alabi S. Costo-efectividad en Cáncer Pediátrico. Webinar Organización Panamericana de la Salud. 2022. https://www.paho.org/es/documentos/costo-efectividad-cancer-pediatrico-soad-fuentes-alabi.
Fung A, Horton S, Zabih V. Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review BMJ. Global Health. 2019;2019(4):e001825.
Ganguly S, Bakhshi S. Teleconsultations and shared care in pediatric oncology during COVID-19. Indian J Pediatr. 2021;88:1–2. https://doi.org/10.1007/s12098-020-03499-2.
García-Molina M, Chicaíza-Becerra LA, Quitian-Reyes H, Linares A, Ramírez O. Costo efectividad de las pruebas para estratificar riesgo en el tratamiento de la leucemia mieloide aguda (LMA) en población pediátrica. Revista de Salud Pública. 2017;19(5):657–63. https://doi.org/10.15446/rsap.v19n5.56508.
García-Subirats I, Vargas Lorenzo I, Mogollón-Pérez AS, Paepe P, Ferreira da Silva MR, Unger JP, Vázquez Navarrete ML. Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil. Gac Sanit. 2014;28(6):480–8. https://doi.org/10.1016/j.gaceta.2014.05.010.
Giovanella L, Vega R, Tejerina-Silva H, Acosta-Ramirez N, Parada-Lezcano M, Ríos G, Iturrieta D, Fidelis de Almeida P, Feo O. ¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica? Trabalho, Educação e Saúde. 2021;19:1–18. https://doi.org/10.1590/1981-7746-SOL00310.
Giraldo Osorio, A., & Vélez Álvarez, C. (2016). Desafíos en la formación del talento humano para la atención primaria de salud en América Latina. Revista Costarricense de Salud Pública, 25(2), 54–70. from http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-14292016000200054&lng=en&tlng=es. Retrieved May 31, 2023
Gouveia de Oliveira E. Access to cancer care: mapping hospital admissions and high-complexity outpatient care flows. The case of breast cancer. Cadernos de Saúde Pública. 2011;27(2):317–26.
Guanyabens Calvet, J. (2016). Las TIC y la salud. Universidad Oberta de Catalunya.
Gupta, S., Howard, S.C., Hunger, S.P., Antillon, F.G., Metzger, M.L., Israels, T., Harif, M., Rodriguez-Galindo, C. (2015). Treating Childhood Cancers in Low- and Middle-Income Countries. In: Disease Control Priorities (third edition): Volume 3, Cancer, edited by H. Gelband, P. Jha, R. Sankaranarayanan, S. Horton. Washington, DC: World Bank.
Guzman CPC, Cordoba MA, Godoy N, Castaño A, Ribeiro KB, Moreno F, de Vries E. Childhood cancer in Latin America: from detection to palliative care and survivorship. Cancer Epidemiol. 2021;71(Pt B):101837. https://doi.org/10.1016/j.canep.2020.101837.
Guzmán JDJJ, Hernandez JGV. Modelo “plural-integral” de atención primaria a la salud y satisfacción de los usuarios. Criterio Libre. 2013;11(18):155–68. https://doi.org/10.18041/1900-0642/CRITERIOLIBRE.2013V11N18.1129.
Handayani K, Sitaresmi MN, Supriyadi E, Widjajanto PH, Susilawati D, Njuguna F, van de Ven PM, Kaspers GJ, Mostert S. Delays in diagnosis and treatment of childhood cancer in Indonesia. Pediatr Blood Cancer. 2016;63(12):2189–96. https://doi.org/10.1002/pbc.26174.
Integrated Cancer Control Initiative in Latin America - ICCI-LA (2020). Cómo enfrentar la creciente carga del cáncer en Argentina: Desafíos y oportunidades. Disponible en https://www.uicc.org/resources/c%C3%B3mo-enfrentar-la-creciente-carga-del-c%C3%A1ncer-en-argentina-desaf%C3%ADos-y-oportunidades#
Jasso-Gutiérrez L, Dorantes E, Rodríguez-Ortega E, Pasillas Torres E, Hernández O. Estudio de caso: estimación de los costos de la quimioterapia aplicando el protocolo completo en niños con leucemia linfoblástica aguda o con linfoma de Hodgkin. Bol Med Hosp Infant Mex. 2012;69:11–23. https://pesquisa.bvsalud.org/portal/resource/pt/lil-700974.
Joseph JM, Farron AM, Renella R, Gapany C. Can smaller-scale comprehensive cancer centers provide outstanding care in abdominal and thoracic pediatric solid tumor surgery? Results of a 14-year retrospective single-center analysis. Ann Surg Oncol. 2014;21(5):1726–31.
Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. 2nd ed. Hoboken, New Jersey: Wiley-Interscience; 2002.
Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science (New York, NY). 2019;363(6432):1182–6. https://doi.org/10.1126/science.aaw4892.
Maceira, D. (2006). Descentralización y equidad en el sistema de salud argentino. Buenos Aires. CEDES. Disponible en https://repositorio.cedes.org/
Maceira, D., Palacios, A. y Urrutia, M. (2013) Desempeño de Cabeceras de Redes Perinatales en la Provincia de Salta, Documento de Trabajo CEDES, no.120.
Maceira, D. (2020). Caracterización del sistema de salud argentino: debate en el contexto latinoamericano (dossier). Revista Estado y Políticas Públicas 8(14);155–179. https://revistaeypp.flacso.org.ar/files/revistas/1590800112_155-179.pdf
Maceira, D. (2021). El sistema de salud argentino en imágenes. Buenos Aires. Fundar. Disponible en https://www.fund.ar/publicacion/el-sistema-de-salud-argentino-en-imagenes/
Melo DF, Criscuolo MBR, Viegas SM. Reference and counter-reference in everyday health care in Minas Gerais, Brazil: the support to decisions of primary care. Revista de Pesquisa: Cuidado é Fundamental Online. 2016;8(4):4986–95. https://doi.org/10.9789/2175-5361.2016.v8i4.4986-4995.
Mendes EV. Health Care Networks. Ciência & Saúde Coletiva. 2010:2297–305. https://www.proquest.com/openview/5a9bf9ad6a0018a8f3f60c3522eb6679/1?pq-origsite=gscholar&cbl=2034998.
Mendes EV. Las Redes de Atención en Salud. Organización Panamericana de la Salud. 2013. https://iris.paho.org/handle/10665.2/3147.
Ministerio de Salud. Evaluación de la incorporación del Plan Nacer al Programa Nacional de Cardiopatías Congénitas (PNCC). Buenos Aires: Ministerio de Salud Nacional; 2013.
Ministerio de Salud (2015). Evaluar para seguir adelante: Resultados del Programa Redes. Buenos Aires, Argentina.
Ministerio de Salud (2019). Monitoreo de procesos de Red en el primer nivel de atención: La experiencia del Programa Redes. Buenos Aires, Argentina.
Ministerio de Salud de Chile - Vargas L. Manual Detección cáncer infantil en centros de salud primaria: "¿Cómo y cuándo sospechar cáncer en el niño?". 2010. https://docplayer.es/1279829-Deteccion-cancer-infantil-en-centros-de-salud-primaria.html.
Ministerio de Salud de Uruguay. (2006). Guía clínica para identificación, evaluación y manejo del paciente con enfermedad renal crónica en el primer nivel de atención. Programa de Salud Renal. Obtenido de https://www.fnr.gub.uy/wp-content/uploads/2014/10/Guia_ERC_2006.pdf
Ministerio de Salud y Protección Social, & Instituto Nacional de Cancerología, E. (2012). Plan Decenal para el Control del Cáncer en Colombia, 2012 – 2021 (Ministerio de Salud y Protección Social, Ed.; 1st ed.). Ministerio de Salud y Protección Social. https://www.minsalud.gov.co/Documents/Plan-Decenal-Cancer/PlanDecenal_ControlCancer_2012-2021.pdf
Ministerio de Salud, Argentina. (s.f.). Plan Estratégico para la reducción de la Mortalidad Materna y la Mortalidad Infantil 2009–2011. http://www.asumen.org.ar/pdf/plan_mortalidadmaterna.pdf
Organización Mundial de la Salud. (1946). Official Record of the World Health Organization N° 2. Conferencia Sanitaria Internacional, (pág. 100). New York. Recuperado el enero de 2019, de https://apps.who.int/iris/bitstream/handle/10665/85573/Official_record2_eng.pdf;jsessionid=2743A55B74AE94F10715897DF4DE84C4?sequence=1
Organización Panamericana de la Salud. (1992). Atención primaria en salud, principios y métodos.
Organización Panamericana de la Salud, & Organización Mundial de la Salud. (2007). La Renovación de la Atención Primaria de Salud en las Américas. https://www.paho.org/hq/dmdocuments/2010/Renovacion_Atencion_Primaria_Salud_Americas-OPS.pdf
Organización Panamericana de la Salud. (2007). Agenda de Salud para las Américas 2008–2017. https://www.paho.org/hq/dmdocuments/2009/Agenda_Salud_para_las_Americas_2008-2017.pdf
Pacheco-Domínguez, R.L., Durán-Arenas, L., Rojas-Russell, M.E., Escamilla-Santiago, R.A., & López-Cervantes, M. (2011). Diagnóstico de la enfermedad renal crónica como trazador de la capacidad técnica en la atención médica en 20 estados de México. Salud Pública de México, 53(Supl. 4), 499–505. Recuperado en 31 de mayo de 2023, de http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342011001000014&lng=es&tlng=es.
Pérez SL, Arrivillaga M. Redes integradas de servicios de salud en el marco de la atención primaria en salud en países seleccionados de América Latina. Salutem Scientia Spiritus. 2017;3(2):32–49.
Pérez-Oliva Díaz JF, Herrera Valdés R, Almaguer LM. ¿Cómo mejorar el manejo de la enfermedad renal crónica? Consideraciones y recomendaciones prácticas. Revista Habanera Médica. 2008;VII(1):1–9.
Protasio APL, Silva PB, Lima EC, Gomes LB, Machado LS, Valença AMG. Evaluation of the reference and counter-reference system based on the responses of the Primary Care professionals in the first External Evaluation cycle of PMAQ-AB in the state of Paraíba. Saúde debate. 2014;38:209–20. https://doi.org/10.5935/0103-1104.2014S016. ISSN 0103-1104.
Ramírez-Tirado LA, Tirado-Gómez LL, López-Cervantes M. Desigualdad en intervenciones de atención primaria para el cuidado de la salud materno infantil en México. Rev Panam Salud Publica. 2014;35(4):235–41.
Rosen, R., Trust, N., Ham, C. (2008) Integrated Care: Lessons from Evidence and Experience. University of Birmingham.
Sada YH, Street RL Jr, Singh H, Shada RE, Naik AD. Primary care and communication in shared cancer care: a qualitative study. Am J Manag Care. 2011;17(4):259–65.
Schwarcz R, Diaz AG, Fescina R, Duverges C. Control prenatal y atención del parto. En: Kroeguer A, Luna R. Atención primaria de la salud, Mexico, PaxMexico, Segunda edición. 1992;1992:293–326.
Schwarcs R, Díaz AG, Fescina RH, De Mucio B, Belitzky R, Delgado L. Salud reproductiva materna perinatal. Atención prenatal y del parto de bajo riesgo. Publicación Científica. 1995;1321:231.
Serra CG, Rodrigues PH. Avaliação da referência e contrarreferência no Programa Saúde da Família na Região Metropolitana do Rio de Janeiro (RJ, Brasil) [Evaluation of reference and counter-reference in the family health program at the metropolitan region of Rio de Janeiro (RJ, Brazil)]. Ciencia Saude Coletiva. 2010;15(Suppl 3):3579–86. https://doi.org/10.1590/s1413-81232010000900033.
Silva SF. The organization of regional and integrated healthcare delivery systems: challenges facing Brazil’s Unified Health System. Ciencia Saude coletiva. 2011;16(6):2753–61.
Sussman J, Baldwin LM. The interface of primary and oncology specialty care: from diagnosis through primary treatment. J Natl Cancer Inst Monographs. 2010;2010(40):18–24. https://doi.org/10.1093/jncimonographs/lgq007.
Tamez González S, Eibenschutz C. El Seguro Popular de Salud en México: Pieza Clave de la Inequidad en Salud. Departamento de Atención a la Salud. Área de investigación Estado y servicios de salud Universidad Autónoma Metropolitana. México D.F. Rev. Salud Pública. 2008;10(1):133–45.
Torregrosa-Maicas I, Juan-García I, Solís-Salguero MÁ, Ramos-Tomás C, Puchades-Montesa MJ, González-Rico M, Tomás-Simó P, Ribés-Cruz J, Tejedor-Alonso S, Abarca-González A, Miguel-Carrasco A. Avanzando en el manejo de la enfermedad renal crónica: resultados de la implantación de una consulta de rápida resolución. Nefrología (Madrid). 2013;33(1):93–8. https://doi.org/10.3265/Nefrologia.pre2012.Oct.11560.
Torres Fernández, T., Guerra Giménez, L., Ordás González, A., Salas San Juan, O., Sánchez Padilla, L.M. (2019). Desarrollo científico y tecnológico. Su impacto en la Atención Primaria de Salud.. Rev Panorama. Cuba y Salud; 13(3):91–96. Disponible en: http://www.revpanorama.sld.cu/index.php/rpan/article/view/
Van Goudoever H. Concentrating childhood cancer treatment in the Netherlands. Padiatrie und Padologie. 2015;50(Suppl 2):38–41. https://doi.org/10.1007/s00608-015-0282-3.
Vásquez L, Montoya J, Ugaz C, Ríos L, León E, Maza I, Maradiegue E, Chávez S, Tarrillo F, Diaz R, Pascual C, Rojas N, Tello M, Moore C, Shah D, Cotrina B, Bartolo J, Perez J, Palacios V. ONCOPEDS: a mobile application to improve early diagnosis and timely referral in childhood cancer in a low- and middle-income country-a pilot study. Pediatr Blood Cancer. 2021;68(4):e28908. https://doi.org/10.1002/pbc.28908.
Venancio SI, do Nascimento PR, Rosa TE, del Salum Morais M, Martins PN, Voloschko A. Referenciamento regional em saúde: estudo comparado de cinco casos no Estado de São Paulo, Brasil [Management practices of regional referencing: a comparative study of five cases in the State of São Paulo, Brazil]. Ciência Saúde Coletiva. 2011;16(9):3951–64. https://doi.org/10.1590/s1413-81232011001000032.
Williamson, O. E. (1971). The Vertical Integration of Production: Market Failure Considerations. The American Economic Review, 61(2), 112–123. http://www.jstor.org/stable/1816983
World Health Organization. (2011). Global Health Observatory Data Repository. http://apps.who.int/gho/data/node.main.519. Accessed 20 October 2013
World Health Organization. (2002). National Cancer Control Programmes Policies and Managerial Guidelines. https://apps.who.int/iris/bitstream/handle/10665/42494/9241545577.pdf?sequence=1&isAllowed=y
Zanetta C. Case Study - ARGENTINA. The Establishment of Argentina's Federal Network for the Care of Congenital Heart Defects under the Plan Nacer/SUMAR. WHO. 2020. https://www.effectivecooperation.org/system/files/2021-06/gdi_case_study_argentina_chds_english.pdf.
Acknowledgements
Not applicable.
Funding
The authors acknowledge the financial support provided by the Pan-American Health Organization to develop this study.
Author information
Authors and Affiliations
Contributions
All the authors worked on the identification and the organization of the studies under analysis. PS and LP analyzed the data regarding Latin America’s experience in primary health care and health networks. DM and EP identified priority areas for the development of primary health care strategies and health networks. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Maceira, D., Quintero, R.E.P., Suarez, P. et al. Primary health care as a tool to promote equity and sustainability; a review of Latin American and Caribbean literature. Int J Equity Health 23, 91 (2024). https://doi.org/10.1186/s12939-024-02149-9
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12939-024-02149-9