Plan Decenal de Salud Pública PDSP, 2012-2021

Objectives

Colombia’s Decennial Public Health Plan 2012–2021 is a rights-based, cross-government framework for health equity, sustainable human development, wellbeing and quality of life. It seeks to secure the effective enjoyment of the right to health, improve living and health conditions, and maintain zero tolerance for avoidable morbidity, mortality and disability.[1][2]Health equity is understood as reducing unnecessary, avoidable and unjust differences between social groups through action on the social determinants of health.[3]

• Apply rights-based, differential, population, gender, ethnic and life-course approaches, recognising health as shaped by biological, mental, social, cultural, environmental and economic conditions.[4][5][6]
• Organise action across eight priority dimensions: environmental health; sexuality and sexual and reproductive rights; food and nutritional security; social coexistence and mental health; healthy living and communicable diseases; healthy living and non-communicable conditions; public health in emergencies and disasters; and health and work.[7]
• Address cross-cutting needs of children and adolescents, older people, women and gender-diverse populations, ethnic communities, people with disabilities, conflict victims, rural and dispersed populations, and other groups facing exclusion or vulnerability.[7][8][9]
• Promote healthy and sustainable environments, safe water and sanitation, healthy food, mental wellbeing, violence prevention, communicable-disease control, occupational safety, disaster resilience, and accessible quality health services.[10][11][12][13][14]
• Reduce inequities in access, use, timeliness and quality of care, including between urban and rural areas and across income groups and territories.[15][16]
• Deliver health promotion, health-risk management and public-health management as the Plan’s three operational lines.[2][17]

Implementation

Implementation combines national stewardship with decentralised territorial delivery, intersectoral action and community participation. The Ministry of Health and Social Protection leads national formulation, regulation, coordination, monitoring and evaluation, while governors, mayors, departments, districts and municipalities adapt and implement Territorial Health Plans according to local health situations, inequalities and population needs.[4][7][18]

• Align four-year Territorial Health Plans, annual operational plans and public investment plans with the Decennial Public Health Plan, using Health Situation Analysis based on a social-determinants approach to set territorial priorities.[19][20][21]
• Coordinate health action with sectors responsible for education, labour, environment, housing, agriculture, transport, justice, social protection and development, supported by the proposed Intersectoral Public Health Commission.[22][23][24]
• Engage communities, civil-society organisations, population networks, health-system actors, academia, private institutions and international partners in policy design, implementation, monitoring and social oversight.[25][26][27]
• Strengthen national, intermediate and local health authorities’ capacity for regulation, stewardship, financial management, service assurance, collective interventions, epidemiological and sanitary surveillance, social mobilisation and risk management.[28][29]
• Use Primary Health Care, integrated service networks, differentiated care models, outreach teams, telemedicine and territorial adaptations to improve continuity, access and quality, particularly in rural, dispersed, border and vulnerable-population settings.[30][16][31]
• Assign insurers, providers and occupational-risk administrators responsibilities for population health analysis, institutional planning, risk management, health promotion, prevention, surveillance, information reporting and annual accountability.[32][33][34]
• Support implementation through technical assistance, staff training, territorial management toolkits, communications strategies, online collaboration resources and guidance issued by the Ministry.[23][35][36]
• Operate an integrated monitoring and evaluation system across the eight priority and two cross-cutting dimensions, using baselines, observatories, registers, surveys, administrative data, surveillance systems and the Integrated Social Protection Information System, SISPRO.[37][38][39]
• Measure 216 indicators, comprising 94 outcome indicators and 127 management indicators, with biennial evaluation reports for 2012–2021 published in 2014, 2016, 2018, 2020 and 2022.[40][41]
• Mobilise resources through national and territorial public funding, earmarked revenues, insurance-related resources, royalties, social taxes, private investment and potential international cooperation; the supplied material does not specify an overall budget or quantified funding gap.[42][43][44]

Monitoring & Evaluation

The monitoring and evaluation framework for Colombia’s Decennial Public Health Plan 2012–2021 is designed to measure equitable and differentiated improvements in population health, health inequalities, territorial management and cross-sectoral action. It combines health-situation analysis, indicators, observatories, administrative records, surveys, surveillance systems and participatory oversight.[37][38][39]

• Use a baseline based on the Analysis of the Health Situation, applying a social determinants of health approach and drawing on administrative records, surveys, censuses and derived statistics.[37]
• Classify indicators as impact, outcome, output and process measures, covering societal effects, achievement of objectives, delivery of goods and services, and implementation inputs including personnel and budgets.[39]
• Monitor 216 indicators across the Plan, comprising 94 outcome indicators and 127 management indicators, across eight priority dimensions and two cross-cutting dimensions.[40]
• Measure indicators periodically against targets, with national and departmental baselines sourced from the Integrated System of Social Protection Information, known as SISPRO, according to available data disaggregation.[39][40]
• Publish biennial evaluation reports covering 2012–2013 in 2014, 2014–2015 in 2016, 2016–2017 in 2018, 2018–2019 in 2020, and 2020–2021 in 2022.[41][45]
• Use Ministry of Health and Social Protection observatories, registers, monitoring systems, situation rooms and cross-sectoral information to assess health status, policy effects, inequalities and implementation difficulties.[37][38]
• Strengthen surveillance through the National Public Health Surveillance System, SISPRO, public-health laboratory networks, environmental-health information systems, disease-specific reporting and territorial information flows.[15][46]
• Require territorial authorities, insurers, providers and occupational-risk administrators to generate health information, monitor plans and interventions, participate in surveillance, report annual results and support social oversight.[19][32][34]
• Promote accountability through public dissemination of complete, timely information, annual reporting on health outcomes and resource management, social participation, inspection, surveillance and control.[18][19]
• Support evidence use through official reports, interactive websites, policy briefs, training, seminars and public access to indicator results.[45][47]

Many dimensions specify annual outcome and management indicators, territorial disaggregation and 2015, 2017 or 2021 milestones, including environmental health, non-communicable diseases, mental health, nutrition, sexual and reproductive health, communicable diseases, emergencies, occupational health and differentiated population management.[48][49][50][51][52][53][54]The supplied material does not set out a single reporting template, uniform data-quality protocol, sanctions regime or independent evaluation mechanism for the whole Plan.[41]

Costing & Financing

The Plan envisages financing through a mix of national, territorial, insurance-related, earmarked-tax, royalty, private and international-cooperation resources, but the supplied material provides no consolidated budget, costed implementation plan, quantified funding gap or macroeconomic assumptions for the 2012–2021 period.[42][43][55][44]

• Mobilise resources from the national budget, territorial funds, the General System of Participations, royalties, family compensation funds, compulsory insurance, occupational-risk insurers, social taxes, fines, private investment and international cooperation.[43][55][44]
• Direct earmarked resources towards public health, primary health care, subsidised coverage, service provision, promotion and prevention, research, infrastructure, environmental sustainability, risk prevention and support for vulnerable groups.[42][43][55]
• Align territorial health plans, annual operational plans and public investment plans with national and territorial planning and budget instruments, while monitoring financial and accounting information and resource execution.[56][20][57]
• Strengthen financial management through controls on health-resource use and enrolment evasion, per-capita payment adjustments, reinsurance, risk adjustment, financial incentives and technology cost-effectiveness assessment.[58]
• Use direct payments, supply-side subsidies for selected providers and demand-side subsidies for poor populations not covered by subsidised affiliation to reduce access barriers.[16][31]
• Recognise insufficient public funding as a barrier to implementing policies addressing health inequalities, and prioritise effective, cost-effective interventions to improve resource use.[59][60][61]
• Strengthen institutional capacity through infrastructure, personnel, equipment, logistics and financial resources, particularly for territorial environmental-health entities, laboratories, surveillance and emergency response.[62][63]

Some fiscal and economic instruments are specified, including tobacco-tax increases, taxes on alcohol and unhealthy food and beverage products, and studies of the health costs associated with environmental risks.[11][64][65][66][67]However, no monetary allocations, revenues, unit costs, expenditure forecasts or financing targets are provided for these measures.[43][44]