Salud a su Casa / Territorios Saludables (community primary health care in Bogotá)
Description
Primary health care strategy of Bogotá's district government: territorial teams (doctors, nurses, public health technicians and community health workers) that visited, house by house, families in areas of high social fragility. It was born in 2004 as 'Salud a su Casa' and was expanded in 2012-2016 as 'Territorios Saludables' (1,000-1,005 microterritories of ~800 families, ~8,000 workers, reported coverage of 2.9-3.7 million people). Published ecological evaluations associate the strategy with reductions in infant mortality and in child health inequalities across localities. It was dismantled starting January 31, 2016 by the Peñalosa administration, which cited high cost, a weak information system and results that could not be demonstrated.
Lessons learned
A massive PHC program without a robust information system (records were on paper) is defenseless against a change of government: it could not demonstrate cost-effectiveness when its results were questioned. Precarious contracting (service provision orders for ~7,000 community workers) made the abrupt dismantling easier. Academic evidence of impact arrived late and from outside the program. The district's successor models (Salud a mi Barrio, MAS Bienestar) recycle the territorial approach, a sign that the idea outlived the institution.