Reestructuración y revitalización gubernamental: una hoja de ruta estratégica para modernizar el Estado y mejorar la salud y el bienestar de la población
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Introducción: este artículo desarrolla el segundo pilar de la estrategia tripartita descrita en la publicación “Una visión presidencial para Guatemala sustentada en los determinantes sociales de la salud”. Plantea la reestructuración y revitalización del Estado como una intervención estratégica de salud pública, vital para transformar instituciones. Objetivos: analizar causas estructurales y barreras institucionales que limitan el desarrollo sostenible en salud, y proponer un modelo que incremente la eficiencia, efectividad y equidad gubernamental. Métodos: se empleó un diseño cualitativo de análisis y síntesis conceptual, con enfoque inductivo-deductivo e histórico-ecológico, para identificar patrones de debilidad institucional y, a partir de referentes internacionales, construir un modelo operativo contextualizado de gobernanza en salud y nacional. Resultados: para mejorar la salud y el bienestar de la población, se propone un modelo de Reestructuración y Revitalización Gubernamental para modernizar la administración pública mediante tres metas estratégicas interdependientes con visión transformadora, nueve objetivos clave representando resultados intermedios y veintisiete estrategias prioritarias constituyendo acciones clave, organizadas en una Matriz 3x3x3. El modelo articula la modernización de las capacidades gubernamentales, la innovación programática y la generación de impacto nacional. Replantea la reestructuración gubernamental como una intervención de salud pública para enfrentar determinantes sociales que perpetúan exclusión, ineficiencia e inequidad. Conclusiones: este estudio establece que la reestructuración gubernamental —entendida como la redefinición de estructuras, procesos y funciones—y la revitalización institucional —orientada a fortalecer capacidades, motivación y desempeño— constituyen condiciones indispensables para superar el statu quo y lograr reformas sostenibles que mejoren la salud y el bienestar de la población.
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