Faculty Research Charles Briggs & Clara Mantini-Briggs "Research on Mission Barrio Adentro: An ethnography of popular participation in Venezuela’s revolutionary healthcare program"

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RESEARCH FINDINGS

Asamblea de Vecinos Barrio Adentro Comunidad Sergio Rodriguez, Caracas 2004.

The following findings regarding Mission Barrio Adentro can help us reflect on the factors that can facilitate the transformation of public health institutions and practices:

• Barrio Adentro was not formulated by high officials and then “implemented” at the local level, nor was it popular program that got professionalized. Plan Barrio Adentro emerged through interactions between working-class communities, municipal employees with the same class roots, professionals working in the Libertador Municipality government, and the Cuban Embassy. The circulation of LASM perspectives was crucial, but they became most effective when conveyed by community workers with working-class backgrounds and when hybridized with local perspectives.
• Local actors continue to play a crucial role in structuring MBA through the Health Committes. Poor communities became more than sites for implementing policies but spaces in which new perspectives and practices were developed. The name “Mission Bario Adentro” signaled that the locus of the program is in working-class communities and not in national offices.
• Remarkably, some of the anti-bureaucratic, creative, and problem-solving character of Plan Barrio Adentro was retained even as the program became a massive national effort. Administrative structures as still remarkably minimal, and many coordinators are physicians who see patients.
• Health became a key political issue and an important source of political capital. Remarkable opportunities for creating state-citizen partnerships emerge when a head of state treats public health as a key political issue and becomes a health educator and promoter.
• Integration: Popular movements and state policies AS shaped by LASM placed the goal of confronting health disparities into a much larger package of services, including both a range of medical and dental specialties and efforts to address hunger, literacy, education, housing, and access to jobs. Barrio Adentro significant strengthened the public health sector at the same time that it lost part of its autonomy.
• Macro and micro levels were consonant, creating continuity between statements by Chavez, government officials, and pro-Chavez politicians on the one hand and the tenor of doctor-patient interactions.
• The availability of well-trained physicians willing to live and work in poor neighborhoods and for whom maximizing financial rewards is irrelevant has been crucial to the success of MBA. The long-term success of the program is contingent on training physicians who share these same values; medical education, including continuing education, are thus crucial in transforming health disparities.

Santa Teresa 2004. (Photo by Clara Mantini-Briggs)