[Experience of implementing a primary attention model]

Identifying barriers and dynamic factors in setting up a primary health care (PHC) model in the Santander department during the last decade.

This was a qualitative study, focusing on pluralism and triangulating sources and actors, with a critical analysis of limits and judgments values (boundary critique).

Philosophical/conceptual and operational management problems were found from the emergent categories related to appropriating PHC attributes. The theoretical model design was in fact not developed in practice. The PHC strategy is selective and state-led (at department level), focusing on rural interventions developed by nursing assistants and orientated towards fulfilling public health goals in the first healthcare level.

Difficulties at national, state and local level were identified which could be useful in other national and international contexts. Structural healthcare system market barriers were the most important constraints since the model operates through the contractual logic of institutional segmentation and operational fragmentation. Human resource management focusing on skills, suitable local health management and systematic evaluation studies would thus be suggested as essential operational elements for facing the aforementioned problems and encourage an integral PHC model in Colombia.