Health System Reform, Decentralization, Prevention, and the Control of Vector-Borne Diseases

Economic policies are changing Latin American health programs, particularly promoting decentralization. Numerous difficulties thus arise for the control of endemic diseases, since such activities traditionally depend on vertical & centralized structures. Theoretical arguments in favor of decentralization notwithstanding, no such tradition exists at the county level. The lack of program expertise at peripheral levels, intensive staff turnover, & even corruption are additional difficulties. Hence, the simple bureaucratic transfer of activities from the federal to the county level is often irresponsible. The loss of priority for control of endemic diseases in Latin America may mean the inexorable extinction of traditional control services. Malaria, dengue fever, & Chagas disease programs are examples of the loss of expertise & effectiveness in Latin America. A better strategy for responsible decentralization is required. In particular, a shared transition involving all governmental levels is desirable to effectively modernize programs. Maintenance of regional reference centers to ensure supervision, surveillance, & training is suggested. 22 References. Adapted from the source document.