Una aproximación a la investigación en las agendas políticas del sector salud en Colombia entre 1990 y 2010 / An approach to research in the political agendas of the health sector in Colombia between 1990 and 2010

RESUMEN Objetivo Entender la investigación en salud en Colombia como parte de agendas gubernamentales y legislativas relacionadas con el sector salud entre 1990 y 2010. Métodos Se usaron fuentes documentales oficiales como planes de desarrollo, proyectos de ley y otras publicaciones institucionales. Resultados El Gobierno Nacional, el Ministerio de Salud y Protección Social (MSPS) y el Congreso colombiano han puesto la atención a la investigación en salud como un problema público en diferentes periodos presidenciales debido al interés de reducir la brecha entre la investigación y las necesidades en salud. En los planes gubernamentales durante los años noventa se presentó mayor interés en la formulación de una política de Ciencia y Tecnología (CyT) en salud liderado por el MSPS, entidad que contaba con direcciones, comisiones y comités encargados de promover y planear la investigación en salud. En el Congreso, algunos proyectos de reforma al sistema de salud incluyeron iniciativas para formular una política de investigación en salud que no fueron aprobadas. Discusión La investigación en salud es reconocida como fundamental para contribuir a solucionar los problemas de salud. Sin embargo, este reconocimiento no ha sido constante por parte de los actores gubernamentales y legislativos, la institucionalidad en el sector salud ha sido precaria y no hubo insistente interés por formular una política de CyT en salud.(AU)

ABSTRACT Objective To understand health research in Colombia in the context of governmental and legislative agendas related to the health sector between 1990 and 2010. Methods Official sources were used such as development plans, bills and institutional documents. Results The National Government, the Ministry of Health and Social Protection (MSPS by its acronym in Spanish) and the Colombian Congress have focused their attention on health research as a public concern at certain presidential periods due to their interest in reducing the gap between research and health needs. In the 1990s, government plans showed greater interest in formulating a Science and Technology (S&T) policy in health led by the Ministry, an entity that had directorates, commissions and committees responsible for promoting and planning health research. In Congress, some health system reform projects included initiatives to formulate a health research policy that were not approved. Discussion Health research is recognized as a fundamental tool to help solve health problems. However, said recognition by governmental and legislative actors has not been constant and the institutionality in the health sector has been precarious considering that there is no permanent interest in formulating an S&T policy in health.(AU)

[An approach to research in the political agendas of the health sector in Colombia between 1990 and 2010]. / Una aproximación a la investigación en las agendas políticas del sector salud en Colombia entre 1990 y 2010.

OBJECTIVE: To understand health research in Colombia in the context of governmental and legislative agendas related to the health sector between 1990 and 2010. METHODS: Official sources were used such as development plans, bills and institutional documents. RESULTS: The National Government, the Ministry of Health and Social Protection (MSPS by its acronym in Spanish) and the Colombian Congress have focused their attention on health research as a public concern at certain presidential periods due to their interest in reducing the gap between research and health needs. In the 1990s, government plans showed greater interest in formulating a Science and Technology (S&T) policy in health led by the Ministry, an entity that had directorates, commissions and committees responsible for promoting and planning health research. In Congress, some health system reform projects included initiatives to formulate a health research policy that were not approved. DISCUSSION: Health research is recognized as a fundamental tool to help solve health problems. However, said recognition by governmental and legislative actors has not been constant and the institutionality in the health sector has been precarious considering that there is no permanent interest in formulating an S&T policy in health.

OBJETIVO: Entender la investigación en salud en Colombia como parte de agendas gubernamentales y legislativas relacionadas con el sector salud entre 1990 y 2010. MÉTODOS: Se usaron fuentes documentales oficiales como planes de desarrollo, proyectos de ley y otras publicaciones institucionales. RESULTADOS: El Gobierno Nacional, el Ministerio de Salud y Protección Social (MSPS) y el Congreso colombiano han puesto la atención a la investigación en salud como un problema público en diferentes periodos presidenciales debido al interés de reducir la brecha entre la investigación y las necesidades en salud. En los planes gubernamentales durante los años noventa se presentó mayor interés en la formulación de una política de Ciencia y Tecnología (CyT) en salud liderado por el MSPS, entidad que contaba con direcciones, comisiones y comités encargados de promover y planear la investigación en salud. En el Congreso, algunos proyectos de reforma al sistema de salud incluyeron iniciativas para formular una política de investigación en salud que no fueron aprobadas. DISCUSIÓN: La investigación en salud es reconocida como fundamental para contribuir a solucionar los problemas de salud. Sin embargo, este reconocimiento no ha sido constante por parte de los actores gubernamentales y legislativos, la institucionalidad en el sector salud ha sido precaria y no hubo insistente interés por formular una política de CyT en salud.

Investigación en salud como política pública en Colombia: balance y perspectivas / On health research as public policy in Colombia: assessment and perspectives

Este ensayo plantea algunos elementos de análisis sobre la investigación en salud en Colombia, como una política pública que se ha configurado desde 1990 con la normatividad instaurada sobre Ciencia y Tecnología. Una serie de ajustes institucionales se llevaron a cabo y se crearon el Programa y el Consejo Nacional de Ciencia y Tecnología de la Salud, además de la institucionalización de la convocatoria como mecanismo de selección de proyectos de investigación y asignación de recursos, de acuerdo con las necesidades y prioridades de los actores del Sistema Nacional de Ciencia y Tecnología. Aunque no ha habido mayores transformaciones posteriores en la gestión de la investigación en salud, excepto la creación del Fondo de Investigación en Salud en 2001, se han venido desarrollando algunas capacidades y, por supuesto, ha habido esfuerzos para formular una política de investigación de salud. Esta tarea, aún pendiente, podría por fin tener una oportunidad con la Ley Estatutaria en Salud, aprobada en 2015.(AU)

This essay presents some elements of analysis for thinking about health research in Colombia as a public policy, something which was formed starting in 1990 with the establishment of Science and Technology regulations. A set of institutional adjustments was carried out which led to the creation of the National Program of Health Science and Technology and the National Council of Health Science and Technology. In addition, it led to the institutionalization of calls for research proposals as a mechanism for selecting research projects and assigning resources in accordance with the needs and priorities of the National System of Science and Technology. Since then, there have been no major changes in the public management of health research, with the exception of the Health Research Fund, created in 2001. However, some efforts have been made to develop some capacities and -so far unsuccessfully- to formulate a national policy on health research. The Statutory Health Act approved in 2015 could be an important opportunity to realize and implement this policy decision.(AU)

[Identification of capacities in environmental health from environmental authorities in Colombia]. / Identificación de capacidades en salud ambiental de las autoridades ambientales en Colombia.

Objectives To diagnose the capabilities that environmental authorities and the Ministry of Environment and Sustainable Development have to assume their role in environmental health, based on the capacity model of the United Nations Program for Development UNDP. Method Document review, interviews on key issues and a commented survey were conducted. 84 entities were selected for a tailored survey; complete information was obtained from 76 institutions. Results The valuation of environment favorability was within the acceptable and unfavorable categories; knowledge management capabilities were found to be precarious and assessment of functional capabilities ranged between appropriate and acceptable. The assessment of specific capabilities had a rating of poor or barely acceptable. Conclusions Two major problems were found: a. The environmental authorities do not conceive or implement these capabilities based on the UNDP model but on the conventional model of the Ministry of Environment, Housing and Territorial Development; b. Environmental authorities show an incipient level of incorporation of environmental health policies in their field of action.

[On health research as public policy in Colombia: assessment and perspectives]. / Investigación en salud como política pública en Colombia: balance y perspectivas.

This essay presents some elements of analysis for thinking about health research in Colombia as a public policy, something which was formed starting in 1990 with the establishment of Science and Technology regulations. A set of institutional adjustments was carried out which led to the creation of the National Program of Health Science and Technology and the National Council of Health Science and Technology. In addition, it led to the institutionalization of calls for research proposals as a mechanism for selecting research projects and assigning resources in accordance with the needs and priorities of the National System of Science and Technology. Since then, there have been no major changes in the public management of health research, with the exception of the Health Research Fund, created in 2001. However, some efforts have been made to develop some capacities and -so far unsuccessfully- to formulate a national policy on health research. The Statutory Health Act approved in 2015 could be an important opportunity to realize and implement this policy decision.

Exploración de modelos para la evaluación del impacto económico, social, político y científico de la investigación en salud / Exploring models for the assessment of the economic, social, political, and scientific impact of health research

La investigación en salud incide sobre la salud de las poblaciones. El presente ensayo realiza un acercamiento a los marcos y modelos empleados por los países desarrollados para la evaluación del impacto de las investigaciones en salud, por medio del análisis documental. De esta manera se identifican dos ejes orientadores de análisis: uno de enfoque y el otro de énfasis, en los que se relacionan los modelos publicados, sus orígenes, sus alcances y sus usos. Esto permite conocer las características que poseen y los ámbitos en los cuales Colombia podría implementarlos. El modelo de evaluación "retorno de la inversión" es un modelo que permite seguir el proceso y los resultados de investigación, por medio de la categorización multidimensional de los impactos de la investigación.(AU)

Health research produces effects on the health of populations. This document approaches the frameworks and the models used by developed countries to assess the impact of health research through documentary analysis of research with the highest impact. With this, it was possible to identify two guiding axes of analysis: one having to do with focus, and the other having to do with emphasis. With these, the published models, their uses, their reach, and their origins are related. Our study brings awareness to the features they have and the areas in which Colombia could implement them. We found that the framework for evaluating health research known as the "payback model" is a model for monitoring research that tracks the process and research results with multidimensional categorization of the impacts of research.(AU)

[Exploring models for the assessment of the economic, social, political, and scientific impact of health research]. / Exploración de modelos para la evaluación del impacto económico, social, político y científico de la investigación en salud.

Health research produces effects on the health of populations. This document approaches the frameworks and the models used by developed countries to assess the impact of health research through documentary analysis of research with the highest impact. With this, it was possible to identify two guiding axes of analysis: one having to do with focus, and the other having to do with emphasis. With these, the published models, their uses, their reach, and their origins are related. Our study brings awareness to the features they have and the areas in which Colombia could implement them. We found that the framework for evaluating health research known as the "payback model" is a model for monitoring research that tracks the process and research results with multidimensional categorization of the impacts of research.

Evaluación de la política pública de escuela saludable en Colombia: fase de formulación (1999-2006) / Evaluating public policy regarding the concept of healthy schools in Colombia: the formulation phase (1999-2006)

Objetivo Evaluar la formulación de la política pública de escuela saludable en Colombia en el período de 1999 a 2006. Métodos Investigación cualitativa de análisis del ciclo de política pública. Se utilizaron como estrategias centrales de recolección de información la revisión documental de fuente secundaria y la entrevista semi-estructurada (fuente primaria). Se llevó a cabo el análisis de contenido temático. Resultados Se identificaron dos momentos de formulación de políticas o lineamientos de la Estrategia Escuelas Saludables en Colombia. El primero relacionado con la publicación del documento "Escuela Saludable, la alegría de vivir en paz", cuyo contenido presenta los lineamientos nacionales para implementar la política y el segundo posterior a la promulgación de la Declaración del Milenio, articulándose a la política los ámbitos de vivienda y salud. Los resultados tuvieron como categorías de integración de la información en normas, observación de actores, relaciones, problemas, objetivos, líneas de acción, tiempos de acción de la política y toma de decisión. Conclusiones La escuela saludable no ha sido objeto prioritario de las políticas pública del Estado Colombiano, pese a ser un compromiso asumido por el Estado con la Organización Panamericana de la Salud/Organización Mundial de la Salud, y de los altos mandatarios en las reuniones internacionales y ser una estrategia crucial para lograr las metas de los Objetivos de Desarrollo de Milenio.

Objective Evaluating public policy formulation regarding the concept of healthy schools in Colombia, 1999 to 2006. MethodsThis study involved qualitative research aimed at analysing the cycle of public policy. The main strategies used were collecting information, a documental review of secondary sources and holding semi-structured interviews (primary source). Thematic content was analysed. ResultsTwo moments were identified regarding the formulation of policy or guidelines for the "Healthy schools in Colombia" strategy. The first was related to the publication of a document entitled, "A healthy school: the joy of living in peace," whose content was aimed at presenting national guidelines for implementing such policy whilst the second (following the enactment of the United Nations' Millennium Declaration) was an attempt at promoting housing and healthcare policy. The results were seen in terms of categories for integrating information regarding standards, observing pertinent actors, relationships, problems, objectives, lines of action and time-lines regarding policy and decision-making time-frames. ConclusionsThe idea of a healthy school has not been a priority in the Colombian state's public policy, in spite of having been a state commitment in line with PAHO/WHO's stated policy, commitments promised by high officials during international meetings and representing a crucial strategy for achieving Millennium Development Goals (MDG).

[Evaluating public policy regarding the concept of healthy schools in Colombia: the formulation phase (1999-2006)]. / Evaluación de la política pública de escuela saludable en Colombia: fase de formulación (1999-2006).

OBJECTIVE: Evaluating public policy formulation regarding the concept of healthy schools in Colombia, 1999 to 2006. METHODS: This study involved qualitative research aimed at analysing the cycle of public policy. The main strategies used were collecting information, a documental review of secondary sources and holding semi-structured interviews (primary source). Thematic content was analysed. RESULTS: Two moments were identified regarding the formulation of policy or guidelines for the "Healthy schools in Colombia" strategy. The first was related to the publication of a document entitled, "A healthy school: the joy of living in peace," whose content was aimed at presenting national guidelines for implementing such policy whilst the second (following the enactment of the United Nations' Millennium Declaration) was an attempt at promoting housing and healthcare policy. The results were seen in terms of categories for integrating information regarding standards, observing pertinent actors, relationships, problems, objectives, lines of action and time-lines regarding policy and decision-making time-frames. CONCLUSIONS: The idea of a healthy school has not been a priority in the Colombian state's public policy, in spite of having been a state commitment in line with PAHO/WHO's stated policy, commitments promised by high officials during international meetings and representing a crucial strategy for achieving Millennium Development Goals (MDG).

Aproximación a la construcción teórica de la promoción de la salud / An approach to the theoretical construction of healthcare promotion

Se examinan las definiciones de promoción de la salud desde la teoría del conocimiento, en sus aspectos ontológicos y epistemológicos como son considerados por diversos paradigmas. Se utiliza una periodización en tres fases En la fase de antecedentes (1920-1973) se producen los primeros distanciamientos frente al paradigma positivista y la promoción de la salud hace parte de las definiciones de salud pública. En la fase fundacional (1974-1986) la promoción de la salud adquiere identidad propia y se transforma en políticas explícitas, en medio de escenarios de confluencia de paradigmas. En la fase de consolidación (1987-2008), se articulan ampliamente los paradigmas positivistas y no positivistas, extendiéndose a los aspectos metodológicos.

Definitions of healthcare promotion were examined from the theory of knowledge regarding its ontological and epistemological aspects as considered by several paradigms. Three-phase periodisation was used. The first distancing regarding the positivist paradigm and healthcare promotion through definitions of public health was made during the background phase (1920-1973). The promotion of healthcare acquired its own identity and became explicit policy in the midst of scenarios involving the confluence of paradigms during the foundational phase (1974-1986). Positivist and non-positivist paradigms became broadly articulated during the consolidation phase (1987-2008), becoming extended to methodological aspects.

[An approach to the theoretical construction of healthcare promotion]. / Aproximación a la construcción teórica de la promoción de la salud.

Definitions of healthcare promotion were examined from the theory of knowledge regarding its ontological and epistemological aspects as considered by several paradigms. Three-phase periodisation was used. The first distancing regarding the positivist paradigm and healthcare promotion through definitions of public health was made during the background phase (1920-1973). The promotion of healthcare acquired its own identity and became explicit policy in the midst of scenarios involving the confluence of paradigms during the foundational phase (1974-1986). Positivist and non-positivist paradigms became broadly articulated during the consolidation phase (1987-2008), becoming extended to methodological aspects.