Health worker unions, organized through PSI, met on October 4 to hear updates on the third version of the reform that the government of President Gustavo Petro is presenting to the Colombian parliament.

Participants agreed on the need for a more equitable and accessible system, highlighting the crucial role of unions in ensuring that workers' voices are heard during this process.

The current healthcare system, managed mainly by the EPS (Entidades Promotoras de Salud), has been strongly questioned for its fragmentation, inefficient management of resources, and inequities in access and quality of services. This is compounded by the lack of adequate coverage in rural areas, which has prompted the government to promote a structural reform in order to create a model that is fairer, more supportive and accessible to all.

PSI and its affiliates and allied trade union organizations have played a key role in the reform process since its inception. In July 2023, workers from 15 health organizations in the country participated in a declaration of support for the reform, where they also presented their concerns and needs to achieve decent work.

"For PSI it is important to be part of this process. That is why we have created spaces for dialogue with the Colombian government and unions, as well as with health unions in the Americas that met last year with parliamentarians to exchange experiences with other countries and the participation that workers have had in these processes," explains Susana Barria, PSI's Andean sub-regional secretary. However, the organization and the unions have not only been key advocates, but have also promoted education and awareness of the reform.

Through an information booklet on the myths and realities of the reform, they have led constant updates for their affiliated unions, generating spaces for dissemination and discussion not only with the leadership, but with all rank and file workers, who have also strongly accompanied demonstrations in support of the government's social reforms, actively contributing to the defense of the reform project. This support is not only a response to the labor situation, but also to the failures of the health system as a whole.

One of the main criticisms of the current health system is the commodification of the right to health, which not only hinders citizens' access to this fundamental right, but also prevents workers in the sector from enjoying decent working conditions and decent work. It also hinders the promotion and prevention of diseases, aspects that would significantly improve the quality of life of the population.

Another key pillar in this process is the formalization of employment throughout the sector. "Decent work would be the formalization of all personnel plants in all networks and state social enterprises linked to the public health sector, which serve the community in all regions and departments of the country," says Nancy Wilches, president of the SINALTRAESESES union and CTC executive in charge of the health sector. This formalization would not only improve the working conditions of workers, but also strengthen the care provided to the population in every corner of Colombia.

"Public health workers in Colombia are the only employees in the world who have to raise the resources to be paid their salary. In all other countries, the State guarantees the payroll," says Fabio Melo, Coordinator of the Federation of Health Unions of the Americas.

PSI's support has been fundamental in the construction and adjustment of the reform, both in the defense of labor rights and in the adaptation of the project to the country's needs.

"PSI has been important throughout the study and analysis of the bills we have presented. We have been able to participate in several spaces with the different publics that PSI has and we have been able to readapt the different articles that we have in the bill to the needs that we have in the country," expressed Luis Alberto Martinez, Vice Minister of Social Security of the Ministry of Health.

This joint effort between the government and the unions is a firm step towards a more humane and equitable health system. The transformation not only seeks to correct the structural flaws of the current system, but also to dignify those who day by day sustain health care in Colombia. With the active participation of health care workers, this reform process stands as a symbol of hope and change, where the well-being of people is at the center of every decision.