Health Surveillance and Disease Management / Communicable Diseases / Research

Decentralization and Management of Communicable Disease Control ion Latin America

(Edited by Zaida E. Yadón, Ricardo E. Gürtler, Federico Tobar & André C. Medici)
Descentralización y gestión ... América Latina

Full Text (350 pp, PDF, 2.9 Mb) This book contains articles in three languages (Spanish, Portuguese, and English), according to the title.

- Cover
- Prólogo
- Introducción
(translation to right)
(F. Tobar, R.E. Gürtler, Z.E. Yadón, A.C. Medici)

Sistemas de salud y descentralización
- Health systems and communicable diseases—How to reduce burden and inequity under decentralization? (E. Blas)

Descentralización y enfermedades transmisibles en América Latina y el Caribe
- Descentralización y reformas del sector salud en América Latina (F. Tobar)

Herramientas para lograr mejores resultados en los modelos descentralizados: el caso de las enfermedades transmisibles
- La reforma del sector salud y el control de la tuberculosis en Colombia (M.P. Arbeláez M.)
- Descentralización, reforma sectorial y control de la malaria en Colombia (G. Carrasquilla)
- O impacto da descentralização do sistema de saúde na prevenção e controle da tuberculose: o caso do Brasil (1980-2005)
(TC Scatena Villa, A Ruffino-Netto, RA Arcencio)
- Impacto da descentralização do Programa de Eliminação da Hanseníase no Brasil
(V. Andrade, T. Moreira, R. Castália França Ribeiro Soares)

El impacto de la descentralización de sistemas de salud en la prevención y control de la enfermedad de Chagas
- Descentralización del Programa de Control de la Transmisión de Trypanosoma cruzi (Chagas) en la Argentina (S. Sosa Estani, M. Zaidenberg, E.L. Segura)
- El impacto de la descentralización de los sistemas de salud en la prevención y control de la enfermedad de Chagas: el caso del Brasil (A.C. Silveira)
- Descentralización y enfermedad de Chagas, Brasil, 2005 (JC Pinto Dias)
- Modalidades de descentralización y control de la enfermedad de Chagas: análisis comparativo entre Guatemala, Honduras y El Salvador
(J. Nakagawa, M. Kojima, C. Zúñiga, K. Ota, M. Serpas)
- Impacto de la descentralización de los programas de control de las enfermedades transmisibles: el caso de la enfermedad de Chagas en Colombia
(F. Guhl, J.L. Robles, I. Ceded)
- Descentralización de las acciones de prevención, control y vigilancia de la enfermedad de Chagas
(R. Salvatella, A. Valencia)
- La descentralización en el sector salud y el control de la enfermedad de Chagas en el Ecuador (H.M. Aguilar V., F. Abad-Franch, M.J. Grijalva)
- Enfermedad de Chagas, descentralización y renta petrolera en Venezuela (R Briceño-León)

(A.C. Medici, F. Tobar, R.E. Gürtler, Z.E. Yadón)

PAHO Links: Chagas | Leprosy | Malaria |  Tuberculosis


Over the past twenty years, many countries in Latin America and the Caribbean have reformed their health systems. One of the strategies used in some of them was the decentralization of the activities and health programs towards the local level (states and municipalities).

Various national and international studies have addressed the subject of health-sector decentralization, pointing out its positive and negative effects on equity of access to services, social participation, and improvement of epidemiological indicators. However, there are still no analytical models that make it possible to classify sectoral decentralization in Latin America in relation to both the territorial and political entities in the countries (federal or local), socioeconomic and demographic status (income, urban growth), and the nature of its health systems (a broad range of models that ranges from the totally fragmented up to the fully integrated). This type of classification could help establish decentralization development standards that would allow for improved evaluation of achievements and problems.

In turn, the specific components of health-sector decentralization and prevention and control programs have not been evaluated, since many of the evaluations are associated with aspects related service delivery. One of the little-known subjects in Latin America and the Caribbean is the passage of vertical programs for communicable disease control to horizontal programs, including forms of implementation, results, and problems.

The lack of evaluation of the decentralization of communicable disease prevention and control programs is even more critical when one considers the heterogeneity of the decentralizing strategies used in the different countries, as well as the various types of communicable diseases. Within this framework, it becomes necessary to review different histories and results of decentralization activities in the area of communicable disease control, according to the institutional and material contexts where there were produced, with the goal of identifying the factors that led to better or worse results in the different countries of the Region. Advancing toward this type of analysis is the first step in preparing future good-practice guides, procedures, standards, and protocols associated with the decentralization of communicable disease programs.

On the basis of these considerations, the University of Buenos Aires, together with the Pan American Health Organization (PAHO) and with support from the Inter-American Development Bank (IDB), organized a meeting on Decentralization and Management of Programs for Communicable Disease Control in Latin America and the Caribbean, which was held in Buenos Aires in August 2005. The present document brings together part of the contributions presented at that meeting.