Desigualdad Social y Equidad en Salud: Perspectivas Internacionales

multiple objectives, such as improved efficiency, better responsiveness of local conditionsand local accountability to community priorities. (Mills, Vaughan et al. 1990;Livak, Ahmad et al. 1998)Often, however, even advocates of decentralization do not claim that these policiesare likely to improve the equity of a health system. It is commonly argued that thedecentralization of systems are more likely to redistribute resources in favour of thepoorest areas and that local control and local financing will disadvantage poor communitiesby allowing rich communities to fund more and better health care services.Another objective of the reforms was to free central government funds to pay thehuge public debts; shifting the financial burden of public services from the centralgovernment to provinces was an expedite way of accomplishing this. The policy ofdecentralization was introduced as a measure of democratization where the decisionmakingpower would be shifted from an indifferent and incompetent central bureaucracyto the people, even in countries under dictatorial and authoritarian regimes.The rationalization for decentralization of health services in Latin America can besummarized in the following points (Arredondo, Parada et al. 2004):a. Local decision-makers know and respond better to community needs, andavoid costly errors made by distant bureaucrats who tend to be ignorantof local health conditions.b. Community involvement in planning and supervision of local servicesincreases participation and supervision of local communities, which inturn promotes democracy.c. Local controls and adjustment services closer to local needs contribute toa more efficient use of resources and produce greater user satisfaction.Equity in HealthThe International Society for Equity in Health developed definitions of equity andinequity in health care which are now globally accepted:Equity in Health has been defined as the absence of systematic and potentially remediabledifferences in one or more aspects of health across populations or populationgroups defined socially, economically, demographically, or geographically.On the other hand, inequity in health is defined as the systematic and potentiallyremediable differences in one or more aspects of health across populations orpopulation groups defined socially, economically, demographically, or geographically.Using the above definitions as a starting point, it is key to point out that inequalitiesare not always inequities. It has been suggested by Whitehead and others that theterm inequity must be reserved for those differences that are unnecessary and avoid-Riutort, Cabarcas11