Control del cáncer cervicouterino en Colombia: la perspectiva de los actores del sistema de salud.

Objectives. To characterize the health system stakeholder's perspective on the basics of the political, economic, and sanitary context, as well as the ways in which control activities are being realized in four of Colombia's health departments. Methods. This was a qualitative study of four Colombian health departments chosen for their differing cervical cancer mortality rates and their planned disease control efforts (Boyacá, Caldas, Magdalena, and Tolima). Semistructured interviews were conducted of health care managers, insurance coordinators, and public and private health institutions at the departmental and municipals levels. Focus groups comprised of professionals from health insurance companies and health care services providers were convened. Data analysis was based on the grounded theory with open codes related to the roles of health care managers, insurance companies, and heath care services provided. The technical reports were compared to the testimonies of interviewees. Results. Thirty-eight interviews and 14 focus groups (70.9% response rate) were conducted and 12 technical reports reviewed. Cervical cancer is not perceived to be a public health priority. Interest centers on the flow of financial resources within the health system. Findings indicated unsatisfactory communication among the stakeholders and no consensus on the subject. Planning is limited to meeting the status quo. Staffing is inadequate. Cases with positive outcomes are lost to follow-up due to the fragmentation that results from affiliation with different health care systems. Conclusions. The financial situation, normative planning, and the challenges of decentralization affect the skill-building, at-risk coverage, and the control activities needed for effective screening programs. What is needed is an integrated, more efficiently organized program in which all the health system stakeholders participate. [ABSTRACT FROM AUTHOR]