Two of the most used approaches to prioritize and analyze health problems, as well as to design and implement action plans are strategic situational planning (PES) and health situation analysis (Asis).the PES was proposed by Matus7, seeks to cover the complexity of social processes and is based on the analysis of problems that require intersectoral responses7-10.
The main objective of the PES is to transform the variables found by the different social actors into options to intervene efficiently and effectively in reality, based on projects and action plans that contribute to the improvement of the quality of life of the population10.For its part, the ASIS proposed by OPS11 is a tool that allows: (1) Identify health problems;
Identify health problems
Size, characterize and measure differences due to social inequities; (3) involve the health sector, the population itself, as well as other sectors (Education, Culture, Sport, economy and environment) in solving the community’s problems); and (4) provide the manager with the inputs that will enable him to prioritize in the process of equitable distribution of resources1,12.
- In this sense, the ASIS is a bridge that seeks to connect health processes and their determinants, equitable distribution and the pursuit of equity in health, through the active participation of the various social actors as a key factor for the interpretation of social reality.
- Priority problems for intervention are defined as a set of needs of special significance involving a complex process of negotiations between the different actors involved.
- According to Bergonzoli1 there is a general consensus to accept that, at each of the different levels of management, there is sufficient quantity and quality of data to implement an analysis process that facilitates decision-making.
However, there are few mechanisms for converting such data into information and knowledge needed to support health service planning and resource distribution in a strategic and equitable manner.
In order to assess and prioritize health problems
Venezuela does not escape this reality.In this sense, the Directorate of Epidemiology and Strategic Analysis of the Ministry of people’s power for health of Venezuela in 200215, designed the instrument of identification and representation of social needs, based on the explanatory moment of the PES proposed by Matus7-9 and the ASIS in order to assess and prioritize health problems, seeking optimal and timely responses for the population15.
This article analyzes the time explanatory of the PES and the ASIS as approaches applied in an integrated manner are magnified for identification, selection, prioritisation and analysis of problems of health feasible intervention, through the case study conducted in the parish Zuata in the State of Aragua in Venezuela.
Both approaches, despite being part of the same process are not always applied conjugate, possibly because the PES was not originally designed for the area of health or because the ASIS is sometimes reduced to a simple diagnosis of health, to be used by the department of epidemiology.
It highlights the importance of the articulation of the two approaches to the promotion of changes in the health management, through the development of skills in formulating and driving strategies for the confrontation of the problems of local priority, where citizen participation is a key and fundamental element for the interpretation of reality. Description of the approaches: PES and Asisthe PES emerged in Latin America in 1970, developed by Carlos Matus, Minister of Economy during the Allende government (1970-1973). The PES was originally designed to work at the central level, but it can be applied at other levels (regional, municipal or local).
It highlights the importance of the articulation
Its main objective is to build and implement effective and efficient intervention plans, with the participation of actors linked to the problem studied, starting from the conception that problems are socially constructed, that is, reality is a historical social construction10.
The PES approach encompasses the complexity of social processes and is based on the analysis of ill-structured or complex problems, such as most health problems that do not have a normative solution and require intersectoral responses10. Matus proposes four moments to develop the PES: the explanatory, the normative, the strategic and the tactical-operational.In the explanatory moment, the key actors select and analyse the problems on which they intend to intervene.
It constitutes an explanatory clipping of reality, as it was, is and tends to be.
Matus proposes a situational explanation that recognizes the existence of other actors with the ability to explain and plan, as well as the lack of evidence of a unique, rigorous and objective diagnosis of reality7-9.The framework for situational explanation will be given by the adoption of a specific institutional space, whether general (central government space), particular (state or regional space), or singular (local or district space).
According to Rivera16, the rules of social production, the capacities of action and the actors are in function of the space, so the same problem can be explained differently. For example, the problem of the “deficit in the distribution of medicines” can be explained differently by the Minister of Health, as compared to the Regional Director of health or a doctor attending a popular or outpatient clinic.
Education Team, Health team
This whole process of analysis requires the participation of actors who are aware of the social reality that we are studying. In our case, the analysis was carried out at the local level, for this it was necessary to have the participation of residents of the localities of the parish Zuata, specialists in the daily reality(citizens, communal councils, health councils, Education Team, Health team, among others).
This feature enhances the process, because it encourages the analysis of problems, the formulation of possible responses, and the commitment of all actors, contributing to the democratization of knowledge and the redistribution of power. Matus also stresses the importance of first understanding the initial situation, as it is the starting point for the calculation of future action and also points out that in practice the present situation involves the selection of a set of relevant problems, by considering its feasibility as a reference when it is in an intervention process.
In this sense, the explanation of the situation is not limited to a specific date at the beginning of the planning process and is always taken up at the other moments of the method.In the normative moment the action plan is designed; in the strategic one the feasibility of the plan is constructed; and in the tactical-operational one the plan is applied and evaluated.