FOCAL POINT

Note from the Guest Editor - Reviewing Health Reform in the Americas
Ronald Rojas
Social policy practitioners have always sought to improve health and education because they would lead to better opportunities for the population. In South America, in particular, during the last 20 years, several reforms have been undertaken in both areas to reach the same goal. Reforms in the health sector such as the Brazilian in 1994 (Programa de Saude da Familia), the Colombian in 1993 (Health Sector Reform, Law 100) or the Chilean in 2000 (Chile Solidario) are good examples of this dynamic.

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Colombian Indigenous Health Promoting Enterprises: A Power Shift?
Javier Mignone
Indigenous organizations have used the legal framework of Colombia’s 1993 healthcare reform to create health insurance and health delivery entities, thus achieving more autonomy and control over their community’s health than before. Nonetheless, a number of tensions and limitations persist. The objectives of the reform were to create a general system of social health security through a decentralized health insurance, with the goal of achieving universal coverage within a decade. It was initially foreseen that, by 2001, the benefits in the subsidized regime would equal those of people who contributed a portion of their wages for healthcare coverage. However, universal coverage remains out of reach and, overall, health indicators have not improved and disease control programs have deteriorated.

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Public Health Insurance in Bolivia and Gaps Between Rural and Urban Areas
Rory Narváez
In Bolivia, public health insurance programs are publicly financed, primarily from federal taxes that are transferred to municipalities. It is very unlikely that another health insurance model, based on individual beneficiaries’ contributions to market-based health insurance, could be implemented, given the country’s high level of extreme poverty that reached 38 per cent of the population in 2006.

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El Aseguramiento Público en Salud en Bolivia y las Brechas Urbano Rurales
Rory Narváez
En Bolivia, los programas de aseguramiento público de salud se basan en financiamiento público, proveniente principalmente de impuestos, que son colectados por el nivel central y son transferidos a los municipios. Es muy difícil que otro tipo de modelos de aseguramiento, que contemplen aportes individuales basados en el mercado de seguros de salud, puedan implementarse considerando el elevado nivel de extrema pobreza del país que alcanzaba al 38 por ciento para 2006.
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The Persistence of Health Inequities in Colombia
Francisco J. Yepes
The 1993 Colombian Health Sector Reform (Law 100) established a national health insurance system with two regimes: 1) contributive for those with formal employment and those who can afford to contribute and, 2) subsidized for the poor. People with formal employment share the payment of the insurance premium (12.5 per cent of declared income) with the employer who pays two-thirds of it. Independent workers must pay the full premium.
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Capacity Development for Health Research
Victor R. Neufeld
"We need to look more closely . . . at the nature of capacity and capacity development, including individual skills, institutions and societal (system) capacities,” said Mark Malloch Brown of the United Nations Development Program (UNDP), in the foreword to the 2002 report “Capacity for Development.” This statement provides an excellent context for thinking about strengthening the capacity of health and health research systems.
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How Scientific Evidence Can Inform Health Policy and Decision-making in the Americas
Nathan Mendes Souza
In many countries in the Americas, the systematic input of the best available scientific evidence and best practices is commonly missing in healthcare and public health policy-making. The social actors involved in the policy-making process are government officials, researchers, and people from organized civil society and the private sector.
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Improving Health from Cradle to Grave in Canada and Latin America
Claire de Oliveira
The existence of health inequalities has become a major concern for researchers and policymakers for both developed and developing countries. While population health levels have improved substantially over the last few years, many Latin American countries continue to exhibit a high degree of health inequality. They are not alone in this regard. Despite Canada being a developed country, it also has health inequalities among different population groups, such as those between high- and low-income individuals.
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