title: Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia.
abstract: BACKGROUND
  Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota.
  
  
  METHODS
  The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach.
  
  
  RESULTS
  The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation.
  
  
  CONCLUSIONS
  Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden; Postgraduate programs in Health Administration and Public Health, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Mosquera
authors.forename: Jineth
authors.initials: J
authors.lastname: Hernández
authors.forename: Román
authors.initials: R
authors.lastname: Vega
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonte
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Kjerstin
authors.initials: K
authors.lastname: Dahlblom
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastián
mesh_terms: D003105:Colombia; D003256:Community Participation; D004465:Economic Competition; D017144:Focus Groups; D018166:Health Care Reform; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
keywords: Bogota; barriers and enablers; primary health care; qualitative study