title: Mapping primary health care renewal in South America.
abstract: Primary health care (PHC) renewal processes are currently ongoing in South America (SA), but their characteristics have not been systematically described.
  
  
  
  The study aimed to describe and contrast the PHC approaches being implemented in SA to provide knowledge of current conceptions, models and challenges.
  
  
  
  This multiple case study used a qualitative approach with technical visits to health ministries in order to apply key-informant interviews of 129 PHC national policy makers and 53 local managers, as well as field observation of 57 selected PHC providers and document analysis, using a common matrix for data collection and analysis. PHC approaches were analysed by triangulating sources using the following categories: PHC philosophy and conception, service provision organization, intersectoral collaboration and social participation.
  
  
  
  Primary health care models were identified in association with existing health system types and the dynamics of PHC renewal in each country. A neo-selective model was found in three countries where coverage is segmented by private and public regimes; here, individual and collective care are separated. A comprehensive approach similar to the Alma-Ata model was found in seven countries where the public sector predominates and individual, family and community care are coordinated under the responsibility of the same health care team.
  
  
  
  The process of implementing a renewed PHC approach is affected by how health systems are funded and organized. Both models face many obstacles. In addition, care system organization, intersectoral coordination and social participation are weak in most of the countries.
authors.affiliation: Department of Public Health, Pontificia Universidad Javeriana, Cali, Colombia, naydu.acosta@javerianacali.edu.co.
authors.forename: Naydú
authors.initials: N
authors.lastname: Acosta Ramírez
authors.affiliation: Department of Administration and Planning in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Ligia
authors.initials: L
authors.lastname: Giovanella
authors.affiliation: Department of Administration and Planning in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, Public Health Institute, Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Roman
authors.initials: R
authors.lastname: Vega Romero
authors.affiliation: Faculty of Medicine, Universidad Mayor de San Andrés, La Paz, Bolivia.
authors.forename: Herland
authors.initials: H
authors.lastname: Tejerina Silva
authors.affiliation: Department of Health Planning, Fluminense Federal University, Niterói, Brazil.
authors.forename: Patty Fidelis
authors.initials: PF
authors.lastname: de Almeida
authors.affiliation: Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Ríos
authors.affiliation: Goede Public Health Cons Bureau, Independent Advisor, Paramaribo, Suriname and.
authors.forename: Hedwig
authors.initials: H
authors.lastname: Goede
authors.affiliation: Faculty of Psychology, Centro ABEU University, Rio de Janeiro, Brazil.
authors.forename: Suelen
authors.initials: S
authors.lastname: Oliveira
mesh_terms: D003906:Developing Countries; D018166:Health Care Reform / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D058992:Social Participation; D013020:South America
keywords: Comprehensive health care; South America; health care reform; primary health care; social participation; universal coverage.