Participación comunitaria a través de la coproducción y la responsabilidad social en Zambia: mapeo de agentes, roles e interfaces en la atención primaria de salud Participación comunitaria; actores; coproducción; responsabilidad social; atención primaria de salud
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Introducción: La participación comunitaria constituye un pilar esencial en la atención primaria de salud (APS). No obstante, las investigaciones acerca de las prácticas de participación comunitaria en este ámbito son escasas. Este estudio tiene como objetivo enriquecer la agenda de la APS en Zambia mediante la documentación de actores clave, sus roles, interacciones y los espacios o interfaces disponibles para la participación comunitaria. Además, busca identificar las condiciones y mecanismos que facilitan, así como las barreras que obstaculizan, dicha participación.
Métodos: Se emplearon métodos cualitativos exploratorios, incluyendo entrevistas semiestructuradas a asistentes sanitarios comunitarios (ASC) (n=10), trabajadores sanitarios (n=7) y líderes tradicionales (n=7). Se organizaron también grupos de discusión con miembros de los comités de salud de barrio (CSB) (n=53) y miembros de la comunidad (n=57). Los datos fueron analizados a través del análisis temático.
Resultados: Los ASC, los trabajadores sanitarios y los líderes tradicionales sirvieron como intermediarios clave entre los centros de salud y las comunidades, fomentando los procesos de coproducción y responsabilidad social. Los líderes tradicionales y las organizaciones de la sociedad civil frecuentemente actuaron como catalizadores de la participación comunitaria, facilitando las funciones subsiguientes de los ASC. Por su parte, los centros de salud y los CSB proporcionaron los espacios y plataformas para que los miembros de la comunidad configuraran su involucración en actividades participativas. La coproducción implicó contribuciones comunitarias tales como la mano de obra y la participación en la toma de decisiones dentro de los centros sanitarios. La responsabilidad social se manifestó a través de buzones de sugerencias y retroalimentación informal de los líderes tradicionales. Varias barreras contextuales, como la ambigüedad en las funciones dentro de los procesos de participación comunitaria, la falta de una estrategia de participación integral y la exclusión de los ASC de los procesos de los centros sanitarios, limitaron la participación.
Conclusiones: Las funciones de los ASC, junto con las de otros actores, resultaron fundamentales para apoyar tanto los procesos de coproducción como los de responsabilidad social. Para fortalecer la participación comunitaria en la atención primaria de salud, es imprescindible definir claramente las funciones de los distintos actores mediante el desarrollo de estrategias integrales de participación comunitaria.
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