Comparative analysis of primary health care policies implementation from a governance perspective

Current analysis on health policy initiatives in Latin America usually focus on technical design, resource allocation or final results, neglecting the importance of the governance patterns that affect the policies’ implementation processes and the health policies results. The goal of this study is to contribute to a more comprehensive understanding of health policies’ implementation processes at the municipal level in Latin America, with a focus on the linkages between Social Protection in Health policies, Primary Health Care strategies and the access to health care services. Its main objective is to develop and test a methodology aimed at analyzing and assessing the influence of governance patterns on specific health policy implementation process. This methodology implies the development and field-testing of a new health systems research analytical framework developed by an international research network. It has a focus on the dynamics of relations between stakeholders (social interfaces), the development and implementation of social norms and the institutionalisation process. Its added value lies in its pragmatic (utilization focused approach) and realistic (non-normative) features. The research study includes three main activities: (a) the development of a evaluative research form a governance perspective, including a pilot study in the municipality of Rosario, Argentina; (b) the use of analytical methods to assess governance patterns and health access in five municipal case studies (three in Argentina and two in Bolivia); (c) a capacity-building strategy involving decision-makers and other stakeholders, as well as the discussion and dissemination of the methodology and case studies results. By comparing the results of the five case studies it will enable the identification of common “critical governance patterns” that influence the health care access conditions. Additionally, it will set the basis for developing new pathways aimed at improving access to health care services at the municipal level.