Descentralización y gestión de los servicios de salud en el Estado de Zulia (estudio de casos)

Abstract

The decentralization process that began in Venezuela in the late 1980’s has led to a set of reforms initiated by regional governments. This article explores the models of management developed by the government of Zulia State in the health service. The research conducted was descriptive and analytic, and it is based in documents, and semi structured interviews to qualified personnel. The cases of study were: San Francisco Ambulatory, Hospital of Pediatrics Specialties of Maracaibo, and Luis Sergio Perez Ambulatory. The main findings are the following: 1) both regional government and corporative organizations share functions in health management services, 2) centralized decision making processes, 3) presence of flexible and precarious labor, 4) Prevalence of controls depending both on the process of labor, and the results, 5) budget reductions in the health centers by the regional government have been covered by fees paid by the public, 6) prevalence of curative health service, and 7) the participation of citizens has been coopted by the state. The article concludes that decentralization has brought non-state public spaces and the privatization of the health service. Both are developments that are in opposition to the Constitution