title: Analysis of the enablers of capacities to produce primary health care-based reforms in Latin America: a multiple case study.
abstract: Primary health care (PHC)-based reforms have had different results in Latin America. Little attention has been paid to the enablers of collective action capacities required to produce a comprehensive PHC approach.
  
  
  
  To analyse the enablers of collective action capacities to transform health systems towards a comprehensive PHC approach in Latin American PHC-based reforms.
  
  
  
  We conducted a longitudinal, retrospective case study of three municipal PHC-based reforms in Bolivia and Argentina. We used multiple data sources and methodologies: document review; interviews with policymakers, managers and practitioners; and household and services surveys. We used temporal bracketing to analyse how the dynamic of interaction between the institutional reform process and the collective action characteristics enabled or hindered the enablers of collective action capacities required to produce the envisioned changes.
  
  
  
  The institutional structuring dynamics and collective action capacities were different in each case. In Cochabamba, there was an 'interrupted' structuring process that achieved the establishment of a primary level with a selective PHC approach. In Vicente López, there was a 'path-dependency' structuring process that permitted the consolidation of a 'primary care' approach, but with limited influence in hospitals. In Rosario, there was a 'dialectic' structuring process that favoured the development of the capacities needed to consolidate a comprehensive PHC approach that permeates the entire system.
  
  
  
  The institutional change processes achieved the development of a primary health care level with different degrees of consolidation and system-wide influence given how the characteristics of each collective action enabled or hindered the 'structuring' processes.
authors.affiliation: National Scientific and Technical Research Council (Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET), Center for Interdisciplinary Studies (Centro de Estudios Interdisciplinarios), National University of Rosario (Universidad Nacional de Rosario), Rosario, Argentina ebascolo@gmail.com.
authors.forename: Ernesto Pablo
authors.initials: EP
authors.lastname: Báscolo
authors.affiliation: National Scientific and Technical Research Council (Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET), Center for Interdisciplinary Studies (Centro de Estudios Interdisciplinarios), National University of Rosario (Universidad Nacional de Rosario), Rosario, Argentina.
authors.forename: Natalia
authors.initials: N
authors.lastname: Yavich
authors.affiliation: Canada Research Chair on Governance and Transformation of Health Organizations and Systems, École Nationale d'Administration Publique, Montréal, Québec, Canada.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Denis
mesh_terms: D001118:Argentina; D001838:Bolivia; D057191:Capacity Building; D018166:Health Care Reform / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D008137:Longitudinal Studies; D009936:Organizational Innovation; D011057:Politics; D011320:Primary Health Care / Q000639:trends*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Health care quality; access; and evaluation; health care reform; leadership; organizational innovation; politics; primary health care.