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Yudey J. Rodríguez M., Marino J. González R., Elena Rincón O., Rodrigo Mijares S. MISIÓN

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Yudey J. Rodríguez M., Marino J. González R., Elena Rincón O., Rodrigo Mijares S. MISIÓN Mundo Nuevo Nº 10. Septiembre-Diciembre, 2012 . Caracas, Venezuela Año IV, Nº 10, 2012, pp. 139-181 Yudey J. Rodríguez M., Marino J. González R., Elena Rincón O., Rodrigo Mijares S. MISIÓN BARRIO ADENTRO, BALANCE Y PERSPECTIVAS RESUMEN: Este artículo pretende dar a conocer el impacto que ha tenido la Misión Barrio Adentro (MBA) en la sociedad venezolana, en sus diferentes niveles: I, II y III. Como objetivos específi cos se plantearon los siguientes: 1) Describir la MBA, según diversos criterios como: ámbito de acción, población objetivo, objetivos del programa, recursos invertidos, resultados, entre otros; 2) Realizar una Revisión Sistemática de la Literatura (RSL) en bases de datos nacionales e internacionales, durante el período 2003-2010; 3) Determinar sus principales alcances y limitaciones. Con la fi nalidad de profundizar en el análisis y evaluación de políticas públicas de salud en Venezuela, la presente investigación se orientó al estudio y aproximación, cualitativa y cuantitativa, de la MBA. Palabras clave: Misión Barrio Adentro, políticas públicas, programas de salud, Venezuela. MISSION BARRIO ADENTRO, ASSESSMENT AND PERSPECTIVES ABSTRACT: This article presents the impact that Mision Barrio Adentro, through its different levels (I, II and III), has had in society. The objectives of the study are threefold. Firstly, to describe the program using criteria which include the fi eld of action, target population, program objectives, invested resources and results. Secondly, to undertake a review of the literature in national and international data bases for the period 2003-2010 and fi nally to determine the scope and limitations of the program. This research used both qualitative and quantitative methods to analyze and evaluate this public health policy in Venezuela. Keywords: Mision Barrio Adentro, public policy, health program, Venezuela. 139 Mundo Nuevo Nº 10. Septiembre-Diciembre, 2012 1. Introducción Entender la MBA requiere como punto de partida considerar el contexto político, económico y social que caracterizó la realidad y el momento histórico en el que ésta surgió; la instauración de un nuevo modelo de atención en salud en Venezuela, inspirado en el modelo cubano; así como los diferentes momentos de la política de salud, implementada durante el gobierno del Presidente Hugo Chávez. Según Mujica y Rincón (2006), la trayectoria de la acción política del gobierno actual ha transcurrido por cuatro (4) momentos históricos. El primero comprende el período 1999-2000, en el cual la política social fue expansiva en gasto y centralizada en estructura, siendo los programas compensatorios la estrategia fundamental de intervención social. En el segundo, entre el 2000 y el 2001, el gobierno establece las premisas sobre las que se fundamenta la política social de la Quinta República. Durante este período la estrategia se mantuvo centrada en los programas compensatorios alrededor del Fondo Único Social y el Plan Bolívar 2000. El tercero, ubicado a comienzo del año 2002, se caracterizó por la defi nición del Plan Estratégico Social 2001-2007, cuyo principal objetivo era transformar las condiciones de vida de la población, garantizando los derechos sociales contenidos en la nueva Constitución de la República Bolivariana de Venezuela. En este momento se restringen y priorizan las áreas de atención de la política social, los programas que lo componen y las poblaciones objetivos. A fi nales del año 2002 y durante el primer trimestre del 2003, se da inicio al cuarto momento de la política social implementada durante el gobierno del Presidente Chávez, caracterizado por el surgimiento de las misiones sociales. Es precisamente durante este período, que surge la MBA, en un momento histórico en el que tanto la salud como la política estaban en crisis. Luego del golpe de Estado del 11 de abril de 2002 y el paro petrolero suscitado entre diciembre de 2002 y febrero de 2003, el deterioro del sector salud 140 Mundo Nuevo Nº 10. Septiembre-Diciembre, 2012 se hizo evidente, especialmente con los brotes de fi ebre amarilla y dengue (Aguirre, 2008, p. 226). La MBA nace veinticinco años después de la Declaración de Alma Ata, en la cual se establecen los principios de Atención Primaria de Salud (APS), como alternativa para contribuir a mejorar los niveles y condiciones de salud de la población (Rincón y Rodríguez: 2010, p. 516). Sus inicios se remontan a febrero de 2003, fecha en que la Alcaldía del Municipio Libertador, contacta a la Embajada de Cuba en Venezuela para solicitar la colaboración de la Misión Médica Cubana y se fi rma el Acuerdo de Cooperación Técnica con Cuba. Esta Misión venía trabajando en Venezuela desde diciembre de 1999, a raíz de la atención humanitaria prestada durante las inundaciones en el estado Vargas (Borroto et al. 2010, p. 118). En marzo de 2003, un equipo integrado por tres médicos cubanos llegó a Caracas para trabajar, en conjunto, con el Instituto Municipal de Desarrollo Endógeno de Caracas (IDEL), en el diseño de lo que para ese momento, se denominó “Plan Barrio Adentro”. Así surgió la idea de hablar con las comunidades de los barrios, las cuales se fueron organizando en grupos, seleccionados en asambleas de vecinos, que constituyeron lo que posteriormente se conocería como los Comités de Salud. El 16 de abril de 2003, llegó el primer grupo de médicos cubanos solicitado y se da inicio al Plan Barrio Adentro, en el marco del Convenio Venezuela-Cuba, como respuesta del Estado venezolano para la solución de las principales necesidades sociales y de salud, constituyéndose en el punto de partida para el desarrollo de la Red de Atención Primaria Integral, prevista en la Constitución de la República Bolivariana de Venezuela (MSAS, 2005, p. 50). En diciembre del año, antes citado, el Plan Barrio Adentro se transformó en lo que hoy se conoce como la Misión Barrio Adentro, mediante un decreto presidencial. En el año 2004, se extendió a los estados Barinas, Lara, Miranda, Trujillo, Vargas y Zulia, posteriormente al resto del país. 141 Mundo Nuevo Nº 10. Septiembre-Diciembre, 2012 Iniciándose, de esta manera, el camino hacia un cambio estructural en el acceso a la atención en salud para millones de venezolanos que hasta entonces habían estado excluidos de esa atención (Borroto et al., 2010, p. 118). La MBA, según el MSAS (2005), se ha desarrollado en las siguientes fases: una primera de experimentación, durante el período abril-junio de 2003, que consistió en medir el impacto y el apoyo de las comunidades, la constitución de los primeros Comités de Salud, la adaptación de los médicos y médicas cubanas y la evaluación de las enfermedades más frecuentes en cada localidad. Esta fase piloto se desarrolló en el Municipio Libertador, a través del Instituto de Economía Local (IDEL) de la alcaldía de dicho municipio. Una segunda fase, durante el período junio-agosto de 2003, que consistió en la expansión del Plan Barrio Adentro hacia diversos estados del territorio. Y una tercera fase, representada por la extensión masiva del Plan, hasta alcanzar todos los estados y el Distrito Capital, así como la realización de 26 actividades médicas diarias que incluyen consultas, educación para la salud, promoción de la salud, entre otras. Barrio Adentro es un sistema de atención integral de salud que, basado en la estrategia de atención primaria de salud, y en correspondencia con los principios de Alma Atá, garantiza la salud para todos los venezolanos, se constituye en el eje central del Sistema Público Nacional de Salud de la República Bolivariana de Venezuela (Barroto et al., 2010, p. 119). Este nuevo sistema de salud, está inspirado en el modelo de salud cubano y, en su primer nivel de atención, responde a los principios establecidos en la Declaración de Alma Ata. Barrio Adentro es un programa orientado formalmente al cumplimiento de estos principios, que busca combatir la exclusión y darles a los pobres la posibilidad de mejorar sus condiciones de vida (Rincón y Rodríguez: 2010, p. 524). Este trabajo presenta los resultados parciales de una investigación cuyo objetivo general consiste en dar a conocer el impacto que ha tenido la MBA en la población venezolana, en sus diferentes niveles de atención: 142 Mundo Nuevo Nº 10. Septiembre-Diciembre, 2012 Barrio Adentro I, II y III. Los objetivos específi cos planteados fueron: 1) Caracterizar la MBA, según diversos criterios como: ámbito de acción, defi nición, población objetivo, objetivos del programa, resultados, entre otros. 2) Realizar una RSL en bases de datos nacionales e internacionales, durante el período 2003-2010. 3) Determinar sus principales alcances y limitaciones. Del mismo modo, con la finalidad de profundizar en el análisis y evaluación de políticas públicas en Venezuela, la presente investigación estuvo orientada al estudio y aproximación, cualitativa y cuantitativa, de la MBA. La estrategia metodológica consistió en la realización de una RSL1 disponible, en bases de datos nacionales e internacionales, para el período antes mencionado; así como una revisión documental de trabajos o publicaciones disponibles en internet. El trabajo está dividido en 4 capítulos: el primero presenta algunos antecedentes y premisas de la MBA, los objetivos de la investigación y la estrategia metodológica utilizada; el segundo está dedicado a la caracterización de la MBA; el tercero describe los hallazgos de la RSL y el cuarto las conclusiones. 2. Caracterización de Barrio Adentro En este capítulo se presenta la información encontrada para cada uno de los niveles de atención que contempla Barrio Adentro, tomando en consideración los siguientes criterios: nombre de la misión o nivel de atención, fecha de creación, órgano de adscripción, población objetivo, objetivos del programa, recursos invertidos, resultados obtenidos, metas programadas y ejecutadas. En la tabla 1, se presenta la información 1 Para Mulrow (1994) las revisiones sistemáticas de literatura son estudios pormenorizados, selectivos y críticos que permiten identifi car, valorar y resumir los resultados de la gran cantidad de investigaciones que produce el conocimiento científi co.
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