Reformas de atención primaria en América Latina: avances en Brasil, Chile, Colombia, México y Perú

Since the 1990s, structural reforms have been initiated in Latin America, with varying degrees of success. One of their main objectives has been to transform health systems, with an emphasis on strengthening primary health care (PHC). This implies promoting a comprehensive and cohesive approach, reducing fragmentation in the provision of services, improving coordination between the different levels of care, and ensuring better quality of care. The purpose of this article is to briefly reflect on the initiatives and reforms related to the implementation of PHC in recent years in Brazil, Chile, Colombia, Mexico, and Peru. These countries have had structural and historical differences between their PHC reforms, as well as some common characteristics. Despite the heterogeneity between the countries analyzed, there are common challenges to achieve universal access and equity in health. The reforms and programs implemented have recognized the importance of PHC as a central axis to improve access and reduce health inequities. Although different models of PHC have been designed, most share comprehensive, preventive and health-promoting approaches, with an emphasis on community participation. However, recent challenges accentuated by the pandemic have revealed the fragilities of PHC in these countries. To achieve effective and equitable universal access, greater political commitment, strong intersectoral initiatives, training and retention of PHC professionals, and sustainable financing mechanisms will be crucial.