Uso de un tablero de indicadores como herramienta y fuente de criterios para orientar el planeamiento y ejecución de servicios de control en los servicios de emergencia de los hospitales públicos del Perú
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2023
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Contraloría General de la República. Escuela Nacional de Control
Resumen
La salud se ha convertido, a raíz de la pandemia del COVID-19 que estamos viviendo, en el principal problema del Perú y el mundo. Nunca tuvo el Sector Salud tanta relevancia ni tanta atención por parte del conjunto de la sociedad como ahora, a pesar que en el país este sector ha mostrado desde antes de la pandemia bajos niveles de eficiencia, eficacia, calidad y oportunidad en la prestación de servicios a la ciudadanía. El presupuesto del Sector Salud en nuestro país, a raíz de la pandemia, ha recibido una inyección importante de recursos económicos, con la finalidad de reducir el impacto sanitario del COVID 19, asignándosele en el año 2021 más de 35 000 millones de soles entre el Sector Salud a nivel nacional y el presupuesto de ESSALUD. Existen diferentes estudios que señalan que el país pierde alrededor del 15% del total del presupuesto público ejecutado por actos de corrupción e inconducta funcional, siendo los sectores del gobierno nacional más afectados los de Transportes y Comunicaciones, Salud y Educación (Shack, Pérez & Portugal, 2020). De manera que es esencial potenciar el control gubernamental en el Sector Salud, en principio porque las Entidades Fiscalizadoras Superiores (EFS) son un factor importante para marcar la vida de los ciudadanos y en ese sentido un control gubernamental con impacto en el Sector Salud hace la diferencia. Además, se debe considerar la ingente cantidad de recursos económicos del sector que por ley la Contraloría General de la República (CGR) está obligada a controlar; así como la enorme corrupción que existe en este sector y que es misión de la CGR combatir. En el contexto del presente trabajo, la ineficiencia de la gestión en el Sector Salud, sumada al componente de corrupción, son las principales causas de los bajos niveles de calidad de la prestación del servicio de salud en el país. Por otra parte, la inadecuada provisión de servicios en el sector salud es un problema público que debemos atender para satisfacer la principal demanda social de la ciudadanía: lograr no solo el acceso, sino una atención con altos estándares de calidad en la provisión de servicios de salud, entendiendo el derecho a la salud como un derecho fundamental, tal como está 13 contemplado en la Constitución Política del Perú. En tal perspectiva, el control gubernamental en salud requiere, por su alta complejidad, necesariamente de un conocimiento profundo de la estructura y dinámica del Sistema Nacional de Salud, así como un dominio de los estándares de gestión sanitaria a efectos de poder medir la necesidad y el impacto de cada una de las intervenciones de control gubernamental. Por definición, no se puede controlar lo que no se conoce, y no se puede mejorar lo que no se mide. Por ende, para desarrollar recomendaciones que agreguen valor para la mejora de la gestión deben aplicarse estándares de gestión sanitaria que permitan realizar análisis, comparaciones y una intervención oportuna del control gubernamental, abarcando aspectos misionales del Sector Salud, con un enfoque centrado en el ciudadano usuario del Sistema Nacional de Salud. Ello, a su vez, debe estar alineado con las Normas Internacionales de las Entidades Fiscalizadoras Superiores (ISSAI) y con el mandato contenido en el Plan Estratégico 2017-2022 de la Organización Internacional de las Entidades Fiscalizadoras Superiores( INTOSAI), consistente en contribuir con el seguimiento y revisión de los Objetivos de Desarrollo Sostenible (ODS), e instando a los gobiernos nacionales a la implementación de la Agenda 2030; en este caso particular a la implementación del Objetivo de Desarrollo Sostenible 3 - Salud y Bienestar (ODS 3), en concordancia con el Manual de Auditoría de ODS de la Iniciativa de Desarrollo de la INTOSAI (ISAM). La atención que se brinda en el servicio de emergencia es la resultante de los procesos estratégicos, operativos y de soporte de los establecimientos de salud. Las nuevas generaciones del bicentenario de nuestro país merecen que luchemos impecable e implacablemente por un control gubernamental de clase mundial con estándares internacionales y un Sistema Nacional de Salud que se encuentre entre los mejores del mundo.
Health has become, as a result of the COVID-19 pandemic we are experiencing, the main problem in Peru and the world. The Health Sector has never had so much relevance or so much attention from the society as a whole as now, despite the fact that this sector in the country has shown low levels of efficiency, effectiveness, quality and timeliness in the provision of services to citizens since before the pandemic. The budget of the Health Sector in our country, as a result of the pandemic, has received an important injection of economic resources, with the purpose of reducing the sanitary impact of COVID 19, being assigned in the year 2021 more than 35,000 million soles between the Health Sector at national level and the budget of ESSALUD. There are different studies that indicate that the country loses around 15% of the total public budget executed due to acts of corruption and functional misconduct, being the most affected sectors of the national government those of Transport and Communications, Health and Education (Shack, Pérez & Portugal, 2020). Therefore, it is essential to strengthen governmental control in the Health Sector, in principle because Supreme Audit Institutions (SAIs) are an important factor in the lives of citizens and in this sense, governmental control with an impact on the Health Sector makes a difference. In addition, the enormous amount of economic resources of the sector that by law the Comptroller General of the Republic (CGR) is obliged to control must be considered, as well as the enormous corruption that exists in this sector and that it is the mission of the CGR to fight. In the context of the present work, the inefficiency of management in the Health Sector, together with the corruption component, are the main causes of the low levels of quality in the provision of health services in the country. On the other hand, the inadequate provision of services in the health sector is a public problem that we must address in order to satisfy the main social demand of the citizens: to achieve not only access, but also high quality care standards in the provision of health services, understanding the right to health as a fundamental right, as contemplated in the Political Constitution of Peru. In this perspective, governmental control in health requires, due to its 16 high complexity, necessarily a deep knowledge of the structure and dynamics of the National Health System, as well as a mastery of health management standards in order to be able to measure the need and impact of each of the governmental control interventions. By definition, you cannot control what you do not know, and you cannot improve what you do not measure. Therefore, in order to develop recommendations that add value for the improvement of management, health management standards must be applied that allow for analysis, comparisons and timely intervention of governmental control, covering the mission aspects of the Health Sector, with a focus on the citizen-user of the National Health System. This, in turn, must be aligned with the International Standards of Supreme Audit Institutions (ISSAI) and with the mandate contained in the Strategic Plan 2017-2022 of the International Organization of Supreme Audit Institutions (INTOSAI), consisting of contributing to the monitoring and review of the Sustainable Development Goals (SDGs), and urging national governments to implement the 2030 Agenda; in this particular case to the implementation of Sustainable Development Goal 3 - Health and Well-being (SDG 3), in accordance with the SDG Audit Manual of the INTOSAI Development Initiative (ISAM). The care provided in the emergency service is the result of the strategic, operational and support processes of health facilities. The new generations of our country's bicentennial deserve that we fight impeccably and relentlessly for a world-class government control with international standards and a National Health System that is among the best in the world.
Health has become, as a result of the COVID-19 pandemic we are experiencing, the main problem in Peru and the world. The Health Sector has never had so much relevance or so much attention from the society as a whole as now, despite the fact that this sector in the country has shown low levels of efficiency, effectiveness, quality and timeliness in the provision of services to citizens since before the pandemic. The budget of the Health Sector in our country, as a result of the pandemic, has received an important injection of economic resources, with the purpose of reducing the sanitary impact of COVID 19, being assigned in the year 2021 more than 35,000 million soles between the Health Sector at national level and the budget of ESSALUD. There are different studies that indicate that the country loses around 15% of the total public budget executed due to acts of corruption and functional misconduct, being the most affected sectors of the national government those of Transport and Communications, Health and Education (Shack, Pérez & Portugal, 2020). Therefore, it is essential to strengthen governmental control in the Health Sector, in principle because Supreme Audit Institutions (SAIs) are an important factor in the lives of citizens and in this sense, governmental control with an impact on the Health Sector makes a difference. In addition, the enormous amount of economic resources of the sector that by law the Comptroller General of the Republic (CGR) is obliged to control must be considered, as well as the enormous corruption that exists in this sector and that it is the mission of the CGR to fight. In the context of the present work, the inefficiency of management in the Health Sector, together with the corruption component, are the main causes of the low levels of quality in the provision of health services in the country. On the other hand, the inadequate provision of services in the health sector is a public problem that we must address in order to satisfy the main social demand of the citizens: to achieve not only access, but also high quality care standards in the provision of health services, understanding the right to health as a fundamental right, as contemplated in the Political Constitution of Peru. In this perspective, governmental control in health requires, due to its 16 high complexity, necessarily a deep knowledge of the structure and dynamics of the National Health System, as well as a mastery of health management standards in order to be able to measure the need and impact of each of the governmental control interventions. By definition, you cannot control what you do not know, and you cannot improve what you do not measure. Therefore, in order to develop recommendations that add value for the improvement of management, health management standards must be applied that allow for analysis, comparisons and timely intervention of governmental control, covering the mission aspects of the Health Sector, with a focus on the citizen-user of the National Health System. This, in turn, must be aligned with the International Standards of Supreme Audit Institutions (ISSAI) and with the mandate contained in the Strategic Plan 2017-2022 of the International Organization of Supreme Audit Institutions (INTOSAI), consisting of contributing to the monitoring and review of the Sustainable Development Goals (SDGs), and urging national governments to implement the 2030 Agenda; in this particular case to the implementation of Sustainable Development Goal 3 - Health and Well-being (SDG 3), in accordance with the SDG Audit Manual of the INTOSAI Development Initiative (ISAM). The care provided in the emergency service is the result of the strategic, operational and support processes of health facilities. The new generations of our country's bicentennial deserve that we fight impeccably and relentlessly for a world-class government control with international standards and a National Health System that is among the best in the world.
Descripción
Palabras clave
Servicios de control, Control gubernamental, Salud, Indicadores de gestión sanitaria
Citación
Suárez Beyodas, P. I. (2022). Uso de un tablero de indicadores como herramienta y fuente de criterios para orientar el planeamiento y ejecución de servicios de control en los servicios de emergencia de los hospitales públicos del Perú. [Trabajo de Investigación, Contraloría General de la República, Escuela Nacional de Control]. Repositorio de la Escuela Nacional de Control de la Contraloría General de la República del Perú.