title: [Stewardship of public health surveillance in the health system in Colombia: a case study].
abstract: BACKGROUND
  With the reform of the Colombian health system in 1993, public health surveillance continued to be a governmental responsibility under the stewardship of the Ministry of Social Protection along with state and local health authorities.
  
  
  OBJECTIVE
  The effectiveness of the development and organization of state and municipality public health surveillance programs will be studied as they have evolved under the general social security system in Colombia.
  
  
  METHODS
  Qualitative study and case-study method are applied to several institutions as they function in 5 states and 11 counties, ten years after the health system reforms.
  
  
  RESULTS
  Public health authorities have reduced resources for providing advice, technical assistance, supervision and control of the process of the public health surveillance. Weaknesses in administrative control are common. Quantity and quality of human resources, as well as, staffing and financial resources are inadequate to meet the responsibilities that have been assigned to each state and county. The public health surveillance has prioritized the notification and registration of cases, and the strength of development of particular areas occasionally has been subject to the particular interests of officials in charge, particularly in the public hospitals. Little commitment or interest is shown by mayors, insurance companies, and institutions providing health services that are supposed to be involved with monitoring. A lack of cross-institutional collaboration is apparent in the development of health services surveillance.
  
  
  CONCLUSIONS
  The implementation of public health surveillance at state and local levels is weak due to problems with the governmental stewardship. These weaknesses are manifested in the lack of regulation, financing and control of the health system.
authors.affiliation: Escuela de Microbiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia. yola@guajiros.udea.edu.co
authors.forename: Yolanda Lucía
authors.initials: YL
authors.lastname: López
authors.forename: Claudia
authors.initials: C
authors.lastname: González
authors.forename: Berta Natalia
authors.initials: BN
authors.lastname: Gallego
authors.forename: Ana Lida
authors.initials: AL
authors.lastname: Moreno
mesh_terms: D000047:Academies and Institutes / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D001290:Attitude; D003105:Colombia; D005380:Financing, Government; D018166:Health Care Reform; D006268:Health Facilities; D006779:Hospitals, Public; D006801:Humans; D007373:Interinstitutional Relations; D009042:Motivation; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011159:Population Surveillance; D011635:Public Health Administration / Q000331:legislation & jurisprudence; D011785:Quality Assurance, Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000639:trends; D012943:Social Security / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014504:Urban Health