Scholars of change management (1) have identified determining factors in the realization of deep and complex adjustments in organizations or societies, among which are the generation of a clear vision of the change sought, as well as the creation of consensus, the consolidation of the necessary skills, the setting up of incentives to promote the favorable participation of the instances that will be related to the change, the availability of the necessary resources to materialize the change process, and the definition of lucid sequences of action (plan) that will allow the desired change to be realized.

The current national government defines itself as “the government of change”. However, if one looks at each of the six factors mentioned above, at least in relation to the reform of the Social Security Health System (hereinafter, health system), one can identify actions that, if they had been more accurate in terms of the improvements that are essential for the well-being, health, and welfare of the population in Colombia, would provide a better scenario for the implementation of the reform, beyond the process in Congress.

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On a future occasion, we could analyze aspects to be improved in at least these six change management factors, for the sake of urgent advances in the health system. For the time being, however, it would be more pertinent to reflect on the precarious level of trust that is present in various instances in the health field in the country, which is not compatible with a smooth process of change and is rather consistent with uncertainty and distancing between sectors that are decisive in the current health system.

Trust building has been the subject of study by various disciplines, including social psychology. Scientific researchers in this field (2) highlight five factors to be considered in trust-building processes: integrity, consistency, suitability, loyalty, and open communication.

It would be convenient for the different bodies in charge of the health system in the country, including the national government, to be in a position to build intersectoral agendas in order to systematically promote trust, taking these factors into account.

In June every year, the Health Forum/Pharmaceutical Forum is held in Cartagena by the National Association of Colombian Businessmen (ANDI). A year ago, our column commented on the 28th edition of the event, which was held in the middle of the first and second rounds of the election for President/Vice President 2022-2026.

A little more than a year later, once again actions that took place within the framework of this national Forum are discussed in the June column. Among other issues worth highlighting are the participation of the Vice Minister of Public Health, Jaime Urrego; the National Superintendent of Health, Ulahi Beltrán, and the Director of ADRES (Administrator of the Resources of the General System of Social Security in Health), Félix León Martínez.

On Thursday, June 22, the Forum began with the participation of Superintendent Beltrán. Vice-Minister Urrego was not only the final speaker of the day but also participated in panels and was taking notes of the speakers’ proposals. Meanwhile, the final day, Friday 23, concluded with the participation of the Director of ADRES, Félix León Martínez.

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Although the tension between certain sectors of the audience and the Government was notorious, and the three representatives of the Government mentioned above claimed during their participation height in the debate due to inaccuracies and other expressions that they did not consider respectful during these months, it is noteworthy that within the framework of the Forum it was possible to listen to statements and clarifications between instances in which the distancing is evident.

Of course, this text is not intended to be a report on the Forum, which included numerous panels and conferences on highly relevant topics, such as the one on human talent in health, moderated by Carlos Francisco Fernández, which ended the inaugural day on Wednesday, June 21. Or the one related to the strengthening of the National Institute for Drug and Food Surveillance (Invima), which took place on the final day, was moderated by Tatiana Andia and included the participation of Claudia Vargas, Director of Medicines and Health Technologies of the Ministry of Health and Social Protection; Luis Guillermo Restrepo, Director of Medicines and Biological Products of Invima, and Aurelio Mejía, Manager of Colombia Productiva, an entity of the Ministry of Commerce, Industry and Tourism.

What is proposed here is that in order to bring about urgent changes in the health system, it is necessary to build trust as well as to manage with lucidity the appropriate changes that will allow, in terms of health autonomy, among other transcendental changes, the realization of a national strategy for primary health care, the protection of health resources, and the protection and dignity of the human talent in health that the country has and the students who have opted for any kind of health care, to ensure that they flow for the benefit of the genuine care of the population throughout the national territory and to protect and dignify the human talent in health that the country has, and the students who have chosen to qualify to join this essential talent for Colombia, as well as to protect and promote pharmaceutical capacities necessary for the Colombian society (3). Regarding these issues of the utmost importance for the country, our statements on Invima, contained in our previous column, are still valid, as well as the call to the government on the urgency of having a “Unique and integrated health information system”, which in January of this year the [National] Committee of Oversight and Cooperation in Health – CVCS (5) presented in an open letter to the then Minister Carolina Corcho.

NOTES:

1. Relevant reference in this regard is: T. Knoster, R. Villa and J. Thousand, “A framework for thinking about systems change” in Restructuring for caring and effective education: Piecing the puzzle together, Baltimore, MD:Paul H. Brookes Publishing Co, pp. 93-128, 2000.

2. Relevant reference is: Schindler, P.; Thomas, CH. The structure of interpersonal trust in the workplace. Psychological Reports, 1993, 73, 563-573.

3. As a precept of transparency, the author informs the readers and the Más Colombia team that he received support to participate in the event from ANDI and the National Association of Pharmaceutical Chemists of Colombia (National Level and Bogotá Cundinamarca Regional Unit).

He also clarifies that, as a professional pharmaceutical chemist, he is a member of the National Association of Pharmaceutical Chemists of Colombia (CNQFC), that he currently chairs the Bogotá Cundinamarca Regional Unit of the CNQFC, and that he is co-coordinator of the National Chamber Specialized in Pharmaceutical Industrial Policy pro Sanitary Autonomy of the CNQFC.

4. Relevant reference in this regard is: Amariles P, Salamanca C, Moreno C, Gutierrez JC, Machado MA. PHARMACEUTICAL INDUSTRIAL POLICY, A KEY REQUIREMENT FOR THE SANITARY AUTONOMY OF COLOMBIA. Salud UIS. 2023; 55: e23022. doi: https://doi.org/10.18273/saluduis.55.e:23022

5. The CVCS is composed of five civil society organizations in the health sector and one from the Colombian Catholic Church, as follows: the Episcopal Conference of Colombia, the Colombian Medical Federation, the Ifarma Foundation, the Observatory of Medicines of the Colombian Medical Federation (Observamed), the Medicines Information Center of the National University of Colombia (CIMUN) and Misión Salud.

This Committee was formed in 2012 at the initiative of Germán Holguín Zamorano (1936-2019), founder of Misión Salud, as a national inter-institutional mechanism for the defense of the fundamental right to health and the inherent right to access medicines and technologies necessary for the life, health and well-being of the human population.

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