Integración del sistema comunitario de información para la gestión en salud en los sistemas de salud comunitario y distrital en Mpongwe, Zambia
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Introducción: Se ha prestado una atención considerable a la implementación y el fortalecimiento de los sistemas comunitarios de información para la gestión en salud (c-HMIS, por sus siglas en inglés) en países de ingresos bajos y medianos. En 2012, el Ministerio de Salud de Zambia, con el apoyo de la Clinton Health Access Initiative, desarrolló un c-HMIS. Guiados por el marco de Atun para la integración de intervenciones en los sistemas de salud, exploramos la aceptabilidad y adopción del c-HMIS en la comunidad y en el sistema de salud distrital del distrito de Mpongwe, Zambia.
Métodos: Se utilizó un diseño cualitativo de estudio de caso para examinar el proceso de integración del c-HMIS. Los datos se recopilaron mediante entrevistas en profundidad realizadas por teléfono a 66 participantes seleccionados de forma intencional a nivel comunitario, de establecimientos de salud, distrital, provincial y nacional (incluyendo líderes de los Comités de Salud Vecinales, voluntariado comunitario, asistentes comunitarios de salud (ACS), supervisores de ACS y personal del Ministerio de Salud). Los datos se analizaron mediante análisis temático.
Resultados: La naturaleza del problema, que incluía la persistente deficiencia en la calidad de los datos, motivó al Ministerio de Salud y a otros actores a adoptar el c-HMIS. Las características de la intervención, como la provisión de herramientas para la recolección de datos, la capacitación de los actores en su uso y la simplicidad percibida del c-HMIS, facilitaron el proceso de adopción. Asimismo, características del sistema de salud, como la disponibilidad oportuna de datos y la mejora en los procesos de retroalimentación de la información en salud, así como el contexto más amplio de adopción —incluida la participación comunitaria— promovieron el sentido de apropiación comunitaria del c-HMIS. Las barreras para la implementación incluyeron desafíos relacionados con las herramientas de recolección de datos y las plataformas digitales.
Conclusión: En conjunto, los hallazgos indican que, si bien el c-HMIS tiene un potencial considerable para fortalecer los sistemas de gestión de información en salud, su integración sostenida en los sistemas de salud comunitarios y distritales depende de aprovechar los facilitadores identificados y de abordar cuidadosamente las barreras sistémicas, del sistema de salud y del contexto.
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