Promotion and prevention within a decentralized framework: changing health care in Brazil and Chile.

The study aims to define configurations of factors from local, regional and national levels that, within a context of decentralized health systems, enable or hinder change towards a health care model of promotion and disease prevention as advocated in current Latin American public health discourse. The project made in-depth case studies of prevention and promotion activities in eight local health systems in rural and urban Brazil and Chile allowing three levels of comparison: national, regional and local. The data are based on interviews, secondary sources, policy documentation and observations.

Implementation of promotion and prevention activities in decentralized health systems: comparative case studies from Chile and Brazil.

The policies for restructuring health systems in Latin America during the 1990s have included an emphasis on changing in the model of health care delivery to one that incorporates prevention and promotion activities. At the same time, health systems have been decentralized in their management, allowing room for greater variation in local interpretation and implementation of policy directives. Despite rhetoric and policy debate, there is no documentation or evaluation of actual experiences of prevention and promotion within decentralized health systems in Latin America.