Erwin Hernández-Rincón

Inclusion of the equity focus and social determinants of health in health care education programmes in Colombia: a qualitative approach

PURPOSE The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. METHODS Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). RESULTS The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. CONCLUSIONS The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended.

Estrategia educativa que promueve los hábitos saludables en adultos mayores con hipertensión arterial en un municipio de Colombia: estudio de investigación-acción participativa

OBJECTIVE To identify resources of the municipality of Sopó-Cundinamarca, Colombia, that are also opportunities to strengthen the development of an educational strategy that promotes healthy habits (healthy diet and exercise) as part of the comprehensive management of hypertension in the elderly. METHODS A qualitative study of a participatory-action research initiative in the Community Day Center of Sopó in the second semester of 2015. It was developed in three stages: first, a community diagnosis showed the need to integrate the culture, traditions and resources of the municipality as inputs that allow the adherence of healthy styles by the elderly for the control of hypertension; in the second stage, a work plan was established based on actions provided by the community; and in the third stage, we reflected on the results. RESULTS An effective and sustainable intervention for the elderly can be achieved through the following activities: appropriation of the agricultural resources, the strengthening of dance as a form of exercise, use of motivational strategies, support of institutions that work with the welfare of the elderly, and the empowerment of facilitators. CONCLUSIONS Interventions aimed at supporting the adherence of healthy lifestyles to the elderly should include and preserve the context of the community of which they are part, where community resources are the inputs that allow health promotion.

Building Community Capacity in Leadership for Primary Health Care in Colombia

ABSTRACT Primary health care looks beyond clinical services to health promotion and primary prevention at the population level. In 2011, Colombia adopted a normative approach to primary health care, to advance efforts to set health priorities and transcend a curative, hospital-based system. An intervention was carried out in eight communities in Bogota and Cundinamarca, Colombia to build community capacity to influence health. Activities included training community leaders to design and implement health improvement initiatives aimed at the most important health problems identified by their organizations. Twenty-eight leaders completed the training. They designed and implemented eight health improvement plans to address the most important health problems in their respective communities: protecting public spaces for children’s physical activities, improving family practices in child nutrition, organizing a health insurance beneficiaries’ health promotion network, organizing a service delivery network for homeless persons, connecting people with cognitive disabilities to treatment services, combatting violence against women, working against child abuse, and integrating health education into school curricula. Lessons were learned about capacity-building in primary care, approaches to strengthening intra- and interinstitutional conditions, and managing processes for community ownership. The intervention enabled development of initiatives for solving various problems by different types of organizations, highlighted participants’ understanding of their role as health agents, and promoted community participation and intersectoral action.