At the election of June 19 In Colombia, he gave victory to the Colombia Humana party with the candidate Gustavo Petro in the presidency and the Afro-descendant Francia Márquez in the vice presidency. They managed to win, despite a strong and threatening mobilization launched by the so-called
urbanismthe Colombian extreme right that, in the context of the civil war, promoted paramilitary violence and the operation of
false positives of the army during the government of Álvaro Uribe, killing civilians to pass them off as combat casualties and thus collect compensation.
As in Chile, Petro-Márquez’s victory came after months of mobilization by young people who refused to give in to the repression, despite the high health costs for them. It is striking that the two Latin American countries with the greatest penetration of the neoliberal-privatizing model in health now place this aspect in an important place in their structural change agendas. In Colombia, a social security reform was applied in 1993, with Law 100, which covered both health services and pensions. It was implemented by JL Londoño, with whom J Frenk worked closely at the IDB, where together they formulated the model of the
structured pluralism. In this sense, the reform of the IMSS 1995-97 and that of the Popular Insurance of 2003 belong to the same conception of social policies. The difference is that Frenk had an intense conflict with the IMSS, because he was fighting for power in the sector for the Ministry of Health, while Santiago Levy wanted the stewardship for the IMSS as its general director.
The process of formulating the Petro-Márquez government program had popular participation as its principle. In the health field, 280 people took part with delegations from the country’s regions, the indigenous and Afro-descendant movement, as well as the LGBT community, among others. 156 meetings were held in a couple of weeks. There was an important participation of workers who have continued to fight against Law 100 since its approval. In this context, it must be recognized that even before the current situation, important changes had been achieved, but without fundamentally modifying the commodified and individualized approach of the 1993 reform.
It is important to remember that this system has generated a profound inequality between the subsidized and contributory regimes. In addition, its inability to finance services is characteristic and it has been bankrupt for a long time. The privatization policy was more radical in Colombia than in Mexico because part of the infrastructure was sold, leaving the public sector unable to provide service. On the other hand, there is evidence and allegations of corruption in the system that partially explain its bankruptcy. Another characteristic is the precariousness of work and employment and large-scale surrogacy.
The essential particularities of the new government’s project are that, on the one hand, it once again proposes basic ethical principles for the system in the sector and, on the other, it presents the actions to be taken as a series of staggered reforms. The claimed principles stem from the first constitutional article, which characterizes Colombia as a
Rule of Law, which means that the guarantees, including health, must be collective and not individual. This means that the person responsible for enforcing it is the State through the government.
The proposals for change in the new plan are presented in stages, that is, it is not a global reform, which suddenly transforms (the big bang Thai) the dysfunctional health system. It proposes a succession of changes that enforce ethical principles, without suspending the provision of services, since it harms the population. This shows that the authors of the health project of the Colombian popular government have a deep knowledge of the system they intend to transform. They also know that even poor systems have aspects that are valued by patients and staff. The most viable strategy then is to know where you want to go and never make decisions that get in the way.
The process of profound change in the health system in that country contains lessons for Mexico.
The most important is the need to start from a deep knowledge of what you want to transform and build the path to achieve it. Here failures and suffering of the population could have been avoided by respecting this principle.