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Health Care System Decentralization, the Case of Venezuela Historic Evolution, Results, and Consequences of its Institutional Reversal

The author exposes the political, social, and technical foundations that motivate and justify the decentralization of health care services, as a means, not as an end. He highlights the Venezuelan constitutional and legal framework that establishes the foundations of transference and sets competencies. Throughout the article, the author highlights the fundamental role of the decentralization of modern Health Systems, for the equitable and efficient achievement and quality health services and products, with the participation of the communities, as well as the conditions and requirements for its application; the purposes, objectives, benefits, and new challenges derived from its implementation. A historical recount is made on the experience garnered by the decentralization of the health care sector in Venezuela. The process for the construction of the Decentralization and Transfer of Competencies Agreements is briefly described, as well as the scope, limitations, and implementation results in the Venezuelan health care system. Briefly I explain the process of nonapplication of the Constitutional norm, and later reversal of the decentralization in health care which occurred from 2007, and its consequences. Finally, I pose strategic proposals for the defense of decentralization.