Eraso Yolanda
Dynamis. 2014;34(1):73-99. doi: 10.4321/S0211-95362014000100005.
This article analyses the organisation of cancer control in Argentina, with a special focus on the initiatives, institutions, and models that targeted female or gynaecological cancers. It identifies and examines the main factors in the process of elaborating a national policy to control the disease drawing on a series of actors and instruments such as the state, medical professionals, institutions and services, and the use of technology (notably diagnostic tools) for the detection of the disease. It traces the developments in the organisation highlighting its transformations from a centralising to a decentralised model of service provision. Using the concept of "path-dependence" the article examines the continuities and changes observed in the organisation of female cancer critically signalling the particular time at which a path was taken where "fragmentation" became consolidated within the health system. It also argues that it was within the field of cancer diagnosis that Argentinian doctors first sought to create the foundational structures of cancer organisation. The article contends that the path-dependence analytical approach helps us acknowledge the importance of historical analysis in the identification of factors that led to the lack of service coordination, including the persistent strain between national/provincial states that hampered the development of comprehensive programmes, aspects that have continued to mark efforts in the elaboration of cancer policies to the present day.
本文分析了阿根廷癌症控制的组织情况,特别关注针对女性或妇科癌症的举措、机构和模式。它确定并研究了制定国家疾病控制政策过程中的主要因素,这些因素涉及一系列行为主体和手段,如国家、医学专业人员、机构和服务,以及用于疾病检测的技术(尤其是诊断工具)。文章追溯了该组织的发展历程,突出了其从集中式服务提供模式向分散式模式的转变。运用“路径依赖”概念,本文批判性地审视了女性癌症组织中观察到的连续性和变化,指出了在卫生系统中“碎片化”得以巩固的特定路径选择时间。文章还认为,正是在癌症诊断领域,阿根廷医生首次试图创建癌症组织的基础结构。文章认为,路径依赖分析方法有助于我们认识到历史分析在确定导致服务缺乏协调的因素方面的重要性,包括国家/省级政府之间持续存在的紧张关系阻碍了综合项目的发展,这些方面至今仍在影响癌症政策的制定工作。