PRIMARY HEALTH CARE

1. PRIMARY HEALTH CARE HEALTH SYSTEM BASED ON PHC A Bogotá without Indifference

2. PRIMARY HEALTH CARE COLOMBIA BOGOTA, District Secretariat of Health TRANSECTORALITY ANDHEALTH DETERMINANTS

3. POPULATION BOGOTA COLOMBIA Area Urban 2005: 6,778,291inhabitants * 2005: 42,090,502 inhabitants * * Source DANE, 2005 Area Rural

4. TABLE OF CONTENTS POLITICAL FRAMEWORK MANAGING PRIMARY HEALTH CARE -Territory and Population PHC AND FIRST LEVEL HOSPITALS PHC AND TRANSECTORALITY EDUCATION HOUSING

5. POLICY FRAMEWORK

6. FOR-PROFIT INSURANCE SYSTEM UNIVERSAL RIGHT TO HEALTH FROM HEALTH TO QUALITY OF LIFE

7. THANKS

8. Subscribers to Subsidized Regime PMES IPS per UPZ

9. Transfer of population from the Paraíso Community from a subsidized system to the primary care IPS Transfer of population from the Paraíso Community from a contributive system to the primary care IPS

10. UNIVERSAL INSURANCE • INDIVIDUAL CONTRACTS ASSOCIATED WITH PAYMENTOF CLAIMS • ACCESS BARRIERS • Databases • Location of the first level of care • Limits of the Health Plan • COST CONTROL • Put off providing services to high-demand or high-cost populations • Forms of hiring and paying health providers, capitation and reports • Methods of payment and hiring health professionals

11. UNIVERSAL INSURANCE INSURANCE IS NOT SYNONYMOUS WITH HEALTH SERVICES. PERINATAL AND PERIOD MORTALITY RATES

12. HEALTH POLICY “BOGOTÁ WITHOUT INDIFFERENCE” “Creating conditions for the effective, steady, and sustainable exercise of thehuman rightsenshrined in the constitutional pact and international agreements and instruments.”

13. RIGHT TO HEALTH: “QUALITY OF LIFE AND HEALTH PROMOTIONAL STRATEGY” • Population in territories • Eliminating social inequities • Quality of life, a transectoral matter • Needs-based services • Comprehensive social management • Participatory processes. Social mobilization for the right to health

14. 2. MANAGING PRIMARY HEALTH CARE Territory and Population

15. PHC IN BOGOTÁ • Integrating services with population-based perspective (life cycle and vulnerability) • Ways of organizing sectoral responses and bridging them with those of other sectors • Coordinating individual and joint actions in areas of everyday life (home, neighborhood, school, work)

16. PRIMARY CARE FLOW CHART ENTRY POINTS AREAS HEALTH IN YOUR HOME HEALTH SERVICES The Family Schools: Health in Schools Kindergartens Community kitchens Vulnerable Micro territories ESE I-II-III Private IPS COMPREHENSIVE SOCIAL MANAGEMENT - SOCIAL PARTICIPATION

17. CAMI CHAPINERO UPA SAN LUIS UPA SANFERNANDO UPA JUANXXIII UPARIONEGRO MOBILE UPA

18. Health at Home Contribute to an improvement in the quality of life and health of people who live in vulnerable territories, with an assignment of 1200 families, by lowering access barriers to sectoral, comprehensive, and transectoral care and community empowerment.

19. Priorities • Pregnant Women • Children under 5 • Elderly • Disabled • Individuals diagnosed with diabetes and hypertension • Women of childbearing age • Individuals diagnosed with TB or leprosy • Compulsory notification events • Families living invulnerable housing conditions

20. LIVABLE HOUSING CONDITIONS UNLIVABLE HOUSING CONDITIONS ASSOCIATED MORBIDITY Privacy, enough space, Overcrowding Sexual abuse, domestic violence, Physically accessible child abuse and ensuing problems Zoonotic diseases Safe and secure enough Unsafe Violence in general Tenancy secured Adequate lighting Housing unit is cold, damp, dark TB, Skin diseases, COPD and is poorly ventilated Adequate heating and ventilation TB, Skin diseases, COPD, ARD Adequate walls, flooring and roofing Presence of cracks, Superficial and Deep Mycosis damage from moisture, holes, (fungus on the skin, lungs and other Water seepage and leaks in organs), Acaridiasis (skin and respiratory roofs and walls parasites), Dirt floors, and inappropriate Chronic Bronchial Allergic diseases roofing materials (Asthma), COPD, TBC, ARD, pyodermitis. Architectural conditions suited Architectural barriers to Worsening of individuals’ to disabilities movement inside the home disabilities (it is difficult to access the home, bathroom, dining room, stairs, etc.) Water supply services No potable water ADD, ARD, Skin diseases Basic sanitation Unhealthy conditions ADD, ARD, Malnutrition, COPD, Zoonotic and parasitic diseases Elimination of waste Unhealthy conditions in and ADD, ARD, Parasitic diseases (Excreta) around the housing unit Skin diseases Appropriate factors for the Inappropriate factors for the COPD, ARD quality of the environment in the home quality of environment in the home Food security Lack of food security Malnutrition (malnourishment, and loss of beneficial traditional knowledge overweight, obesity, and dietary deficiencies )

21. Healthy Housing Using sectoral management and health and environmental education to buttress the public health interventions that are moving forward through Health to Your Home, aimed at improving living and health conditions in the most vulnerable communities.

22. METHODOLOGY 1. Selecting the Health at Your Home territories 2. Housing assessment 3. Establishing agreements and commitments 4. Follow-up, monitoring, and evaluation

23. DISTRICT SECRETARIAT OF HEALTH ON THE ROAD TO HEALTHLY HOUSING – FOR MY HOUSEHOLD TO LIVE RECORD OF INTERVENTIONS PER FAMILY PLACE Chart No. VS NAME OF HEAD OF HOUSEHOLD No. inhabitants per housing unit ADDRESS NEIGHBORHOOD PHONE # NAME OF MICROTERRITORY ISSUES ADDRESSED VISIT 100 VISIT 200 VISIT 300 VISIT 400 VISIT 500 VISIT 600 DATE IF VISIT Sips of Life – Drinking water Excrement and Sewerage in Solid Waste Healthy & Sanitary dd/mm/yyyy Housing as a vital space On the look out for Disease/pests in the Home the open (Trash in the home) Food & Housing 101 102 103 104 105 FINAL 201 202 203 204 FINAL 301 302 303 304 305 FINAL 401 402 403 404 FINAL 501 502 503 504 FINAL 601 602 603 1. INITIAL ASSESSMENT 2. 3. 4. FINAL ASSESSMENT Commitments: 1 2 3 4 5 6 1 2 Signature of Sanitation Tech. 3 4

26. Progress with Characterization: Identifying Needs RISKS FOUND IN THE HOME DURING THE IDENTIFICATION AND CHARACTERIZATION OF FAMILY GROUPS 18% 16% 16% 16% 14% 12% 10% 7% 8% 7% 6% 5% 4% 2% 0% Geological Collapses, or Avalanches, faults rising waters land slides Flooding of property Floods Overflowing,

27. HEALTH AGREEMENT AND HABITAT AS A LINCHIPIN • … mutually aid habitat development and improve the quality of life and health of the families of Bogotá, as part of the Primary Health Care strategy and theHealthat Your Home program…

28. SUBSIDY FOR MAKING HOUSING MORE LIVABLE • Allocating resources for construction in the housing sector to improve basic health conditions, with priority given to improving bathrooms and kitchens or basic sanitation conditions.

29. UNLIVABLE HOUSING CONDITIONS INTERVENTION PROPSOAL Overcrowding Improve and/or redistribute living space inside the home Improve the conditions of bathrooms and kitchen Lack of security Doors, windows Home is cold, damp, dark and has poor ventilation Improve conditions with respect to ventilation, lighting, kitchen, bathrooms, and the home’s non-structural materials No potable water Connect to formal public services system or set up alternate potable water systems Improve kitchen and bathroom conditions Unhealthy conditions Connect to sewage or set up alternate human waste and trash elimination systems Provide toilets Improve kitchen and bathroom conditions Certain factors contributing to a poor quality home Improve kitchen and fuel use environment Food insecurity and loss of traditional knowledge Promote use of vegetable gardens, medicinal and/or edible plants through urban agriculture INTERVENTION PROPOSAL

30. SUBSIDY up to6.5 SMLMV $2,800,000 1,400 dollars

31. CARE APPROX. COST IN DOLLARS FIRST-LEVEL EXPENSE US 200 SECOND-LEVEL EXPENSE US 300 THIRD LEVEL EXPENSE US 400 INTENSIVE CARE UNIT (ICU) US 520 COST OF CARE FOR BOYS AND GIRLS WITHACUTE RESPIRATORY DISEASES

32. AVERAGE COST LIVABLE CONDITIONS Approximately US 1,500 SOURCE: CALCULOS CVP NOTE: THIS AVERAGE DOES NOT INCLUDE STRUCTURAL INTERVENTIONS

33. PRODUCTS • TECHNICAL ASSISTANCE FOR FAMILIES • APPLIYING FOR A SUBSIDY • HIRING BUILDERS • ASSISTANCE WITH PROPERTY TITLES

34. USME HOSPITAL • 19 TECHNICAL TEAMS: • ARCHITECT OR CIVIL ENGINEER • SANITATION TECHNICIAN • SOCIAL PROMOTER • TRAINING FOR THE TEAMS • APPLICATION OF FORMS: SANITATION, TECHNICAL, AND SOCIAL

35. POLITICAL RESULT • Notion of citizen health • Inclusion of health in development plans. Decisionmakers. • Organized mobilization of resources from other sectors • Better quality of life for the population

36. POLITICAL RESULT • National debate on the insurance model, especially the national public health plan. • Inclusion of structural health determinants. • Organizational process and social mobilization. • Bring other parts of the health sector into play, especially insurance companies in promotion and prevention. A PHC-BASED HEALTH SYSTEM PHC AND INSURANCE

38. HEALTH TO SCHOOL I FEEL WELL I LEARN WELL

39. THANK YOU!