Experiences in implementation of comprehensive healthcare routes in Cauca. A qualitative study

Abstract

Introduction: population dynamics, disease burden and political-economic structural changes have prompted the Colombian state to seek comprehensiveness in health care processes, and to this end it defined the implementation of Integrated Health Care Routes (RIAS). Objective: to understand the perception of the experience of process leaders in health entities regarding the implementation of the RIAS in Cauca, Colombia. Method: qualitative, inductive study with an interpretative phenomenology approach. The study group consisted of seven process leaders of health entities. Results: the interviewees feel that implementation is a difficult process, determined by the willingness and commitment of the health stakeholders. Changes in administration generate discontinuities affecting progress on the routes for which they are responsible. They perceive disarticulation in implementation, limited resources, administrative deficiencies, infrastructure and human talent, mainly health specialists. Discussion: the perception of the experiences denotes what several authors have described in relation to tensions in implementation and management processes in health: inaccessibility, discontinuity and fragmentation of services; weak health authority, curative approach and economic interests. Conclusions: from their experience, process leaders perceive the RIAS as a strategic foundation that favors comprehensive health care; however, there are gaps in the implementation caused by administrative and financial processes and the health model itself, restricting the fulfillment of the purpose for which they were created. At the same time, they perceive feelings of helplessness and hopelessness, difficulties and tensions in the implementation exercise.