The poor performance of large-scale « vertical » rural health programs tied to state Ministries of Health in Third World countries has often been attributed to a lack of « political will ».
But that term tells little about the conditions that favor health reform and may obscure disparate power relations and struggles over development.
This work explores such a struggle over community health that emerged as part of the peace process in a former war zone of El Salvador since the 1992 ceasefire.
The formalized negotiations (and behind-the-scenes confrontations) over health in Chalatenango province took place between Ministry of Health administrators and proponents of a « popular » health system that has functioned in repopulated villages of rebel-controlled Chalatenango since 1987.
The Ministry has set up its own national (U.S. AID-designed) community health worker program, and agreed in theory with the popular system's emphasis on village-based lay health promoters ; however, in negotiations and efforts at collaboration in Chalatenango the Ministry has been unwilling to support the promoters in the popular system, to accommodate local participation in health decision-making, or to restructure its own physician-centered practices around the need for more comprehensive approaches to health.
Mots-clés Pascal : Système santé, Soin santé primaire, Agent santé, Politique sanitaire, Salvador, Amérique Centrale, Amérique, Homme, Milieu rural, Aspect politique, Réforme, Processus paix, Santé communautaire
Mots-clés Pascal anglais : Health system, Primary health care, Health worker, Health policy, El Salvador, Central America, America, Human, Rural environment, Political aspect, Community health
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0239702
Code Inist : 002B30A01B. Création : 11/06/1997.