Institutional Action and Social Control by Youth in the Investment in Health of Public Resources 2004-2005

The Colombian Social Security in Health System is composed by the contributory and the subsidized systems. The latter has been established to ensure the entry into the system on a fair basis of the poorest and most vulnerable sectors of the Colombian population. In 2004, official figures showed 13'856 927 million citizens in levels 1 and 2 of the Beneficiary Identification System (SISBEN, in Spanish) whom have their health care needs covered.  The subsidy for the attention in health of the poor and vulnerable in the country has resources that exceeded, by 2005,  2'825 million pesos, representing about 1.228 million dollars, the largest government investment in health.

The handling and low technical capacity to identify the beneficiaries of the subsidized regime, the poor understanding of the institutional and community stakeholders on how to operate the Social Security System in Health, and, in addition, the low technical and operational capacity of institutions to conduct timely and effective permanent control, have encouraged the improper diversion of resources to generate mistrust and uncertainty in the citizen towards State institutions and those administering the subsidized health regime.

There are several issues underlying each of these factors. Regarding the first, politicization, discretion in implementation, coupled with the lack of training and training of those who completed the SISBEN survey and corruption of the Administrators of the Subsidized Regime, have created serious distortions in the targeting of the beneficiary population. Regarding the second, the excessive and ever-changing regulations and the existence of a specialized and difficult language have impeded the management of institutions and the approach by citizens to access the subsidized system. Finally, the lack of coordination between enforcement agencies coupled with the lack of social control as a real possibility of citizen participation in the budget process, have facilitated the inefficiency of the audit bodies at a national and local level, leading to a misallocation of resources.

In this sense, the project "Institutional Action and Social Control by Youth in the Investment in Health of Public Resources" directed its efforts to monitor the targeting and management of resources to subsidize health care for the poor and vulnerable in 15 provinces of the department of Boyacá and 58 districts of the city of Ibagué, through the development and implementation of a methodology of social control and juvenile institutional action to strengthen transparency in the local allocation of resources.