Primary-Care Decentralization in the Southern Cone: Shantytown Health Care as Urban Social Movement

Abstract

Redemocratization in the Southern Cone has contended with a fiscally weakened state and ideologically divided groups. Years of free-market military rule have scaled back the welfare state and deteriorated public health care. Draconian cutbacks in public spending have forced private voluntary organizations (PVOs) to provide care for the urban poor. Shantytown health care and nongovernmental organizations (NGOs) have surfaced to fill the gap created by a shrinking public sector under military rule in Argentina, Chile, and Uruguay. This paper overcomes some shortcomings of Weberian and Marxian analyses of bureaucratic behavior and empowered social groups through the study of shantytown health care as a new social movement. A comparative review of medical-care policy in Buenos Aires, Santiago, and Montevideo reveals that only Santiago and Montevideo hold promise for decentralization. Neighborhood-based activities in shantytowns remove primary care from the marketplace by decommodifying it. Success of shantytown health care under democratic rule depends on its ability to remain autonomous. In doing so, it would avoid cooptation by political parties and the stigmatized public health system.