Promotion and prevention within a decentralized framework: changing health care in Brazil and Chile

The study aims to define configurations of factors from local, regional and national levels that, within a context of decentralized health systems, enable or hinder change towards a health care model of promotion and disease prevention as advocated in current Latin American public health discourse. The project made in-depth case studies of prevention and promotion activities in eight local health systems in rural and urban Brazil and Chile allowing three levels of comparison: national, regional and local. The data are based on interviews, secondary sources, policy documentation and observations. The results are summarized as pathways through configurations of factors leading to what are termed active and basic degrees of activity related to disease prevention and health promotion at the local level. The results raise considerations for policy-makers at each of the three levels of health systems regarding vertical and horizontal system structures, relationships to local government, management options and human resource incentives. The findings from this study can serve as a guide or menu of issues to consider in the implementation of new models of health care provision, not only in Brazil and Chile, but also elsewhere in Latin America and more widely in the world.