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INFORME ALTERNATIVO SOBRE LA SALUD EN AMERICA LATINA22Uruguay: Community Participation inHealth and the Role of EpidemiologyMiguel Fernández, Sergio CurtoAgradecimiento:Los autores agradecen a laBr. Lucía Fernandez la informacióny asesoramiento sobre algunos temasincluidos en este trabajo.The onset of a progressive government in our country and the proposalof health system reform, implies not only institutional transformations butalso the expansion of theoretical and ethical principles for humanistic publicpolicies and services in the health system.At the center of this change, is people’swellbeing.This scenario requires new and diverse approaches to healthcare promotion, which focuses on citizens’ social rights.Relevant background to this community driven effort is the differentprograms implemented by recent progressive administrations of the MunicipalGovernment of Montevideo. An example of this is the decentralizationand health participation that made up part of the Zonal Care Plan.This Plan was founded on the ruling principle of integrating equity andsocial justice to action, to give rise to co-management with the diverselycomposed communities and organizations.The implementation of this municipalgovernment plan was articulated in conjunction with the civil society, bymeans of a clear agreement policy, which transferred resources to the neighboringcommissions to develop services and implement programs.The Municipal Intendance of Montevideo performs the ambulatory andextra-hospital care of 300,000 people through its Zonal Multi-clinics.This populationis comprised of a high percentage of homes with their basic needsunmet.210
Observatorio Latinoamericano de Salud.The Zonal Care Plan represents a new conceptin integral health care, as expressed in its mission: "todevelop Plans of Zonal Care of health which, startingfrom the Municipal Multi-clinics in coordination withother health institutions, substantiate the basis for theLocal Health System. This presupposes a transformationor reform process of the care model and of itsmanagement, as part of a political-administrative decentralizationand social participation process, articulatedby local government agencies".Components of the Plan of Zonal Care:1) The changing of the health care model: "To make progressin the transformation process of the health caremodel, reevaluating the concept of action integrality, withan emphasis on promotion and prevention. To developcare through integral programs, oriented towards highprioritygroups of population and selected social priorityproblems. To consolidate the interdisciplinary healthteams and strengthen their coordination with social workersof the Zonal Communal Centers" (DevelopmentProgram. Department of Hygiene and Social Care.Municipal Intendance of Montevideo – 1990).2) Programs of Integral Care (Promotion and Educationin Health, Health Control, Preventive Activities,Preventive Diagnosis, Recuperation and Rehabilitation).3) Technical Interdisciplinary Health Team made up ofprofessional and administrative members of the sameMulti-clinic.4) Zonal Health Diagnosis Systems (systems of epidemiologicalsurveillance with geographical and populationcriterion). The activation of the StrategicPlanning Methodology in Montevideo (1994), identifiedthe tactically important points at the departmentaland zonal levels, determined specific prioritiesand defined short and medium-term objectivesand goals.The Zonal Care Plan includes among its purposes:"to bring about the continual diagnosis of zonalhealth, as a guide to the activities of the health teamand the community, by way of a permanent processof participative planning-action".A component of the program is the Module of BasicZonal Information.This is an instrument to permanentlyprocess district health information, in orderto monitor and understand key aspects of thehealth-illness situation and improve health management.TheModule of Basic Zonal Information alsooperates as the "historical memory" of the district,and, therefore, can be used as a tool for improvingand updating the health program.5) Intra and intersectorial coordination.6) Continual management evaluation.7) Decentralization and neighborhood participation:To have social impact there must be communitycontribution. The work of neighborhood commissionsimplies a richer transdisciplinary outlook.This outlook must incorporate the vision of thoseinvolved, encompassing innovative perspectivesfrom cultural elements and knowledge not legitimizedin the academy.Via the Zonal Plan, several programmatic linesare executed.To demonstrate this, we mention:● The Program of Children’s Integral Care provides integralhealth care to children younger than 14 years,211
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PEOPLE’S HEALTH ASSEMBLY 2GLOBAL
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LATIN AMERICAN HEALTH WATCHAlternat
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"Our elders taught us that the cele
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12. Neoliberalism, Pesticide Use an
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1Alternative Health Report :A Tool
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Observatorio Latinoamericano de Sal
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Monopoly,Inequity and Health
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INFORME ALTERNATIVO SOBRE LA SALUD
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3The Right to Health and the Free T
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Institutionalizationof Violenceand
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Cultural Agresi nUniculturality and
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