Valparaíso Health Service - San Antonio

Valparafso Region

Ministry of
Health

PARTICIPATORY DIAGNOSIS OF
COMMUNITY MENTAL HEALTH

Community Mental Health Center

Domingo Asún Salazar

VALPARAISO
2017 - 2019

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 INTRODUCTION

The “Domingo Asún Salazar” Community Mental Health Center Valparaíso (CSMC) ,
through its Participation and Social Inclusion Area, developed the 1st Participatory Diagnosis Meeting
of Community Mental Health (DGPSM) , on September 27 of the year 2017 in the offices of the
Mutual de Seguros de Chile in the commune of Valparaíso. In this instance, a total of 55 people
from the community participated, representing a total of 25 organizations: Users from the Health
Network of the Valparaíso-San Antonio Health Service (SSVSA), officials from SSVSA
establishments, representatives of institutions and programs of the Intersector such as Education,
Network of People in Street Situation; organized community represented by Cultural Centers of the
territory of Playa Ancha, Las Cañas, La Cruz and; representatives of the Intercultural Health Board
of Native Peoples of the Valparaíso-San Antonio Health Service.

The objective of this meeting was to carry out a diagnosis of the main problems felt at the
community level, and how these affect the quality of Mental Health in the territory corresponding to
the work area and jurisdiction of the CSMC.

This experience consolidates a community pre-diagnosis process, which began with the
beginnings of the Community Mental Health Center in 2016.

This document, apart from showing the process of its construction, seeks to become an
essential input for the preparation of work proposals in/for/with the community, to address the
different problems prioritized during this process; such as: the reactivation of citizen participation in
health processes , prevention of harmful consumption of alcohol and drugs , the violation of the
rights of children and adolescents and the operation of the Mental Health Network in Valparaíso.

The Domingo Asún Center team will continue with this Participatory Planning process,
holding an upcoming Meeting to Socialize the Results of the proposals that will be reflected in the
Strategic Planning of Mental Health in the community and with the formation of the future Local
Development Council formed with representatives of users, the community and Intersector to
monitor these proposals.

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 INDEX

PARTICIPATORY DIAGNOSIS OF COMMUNITY MENTAL HEALTH.....................................1

INTRODUCTION.............................................................................................................................2
FOUNDATION OF THE ACTIVITY..............................................................................................4
WORKING METHODOLOGY OF THE MEETING......................................................................5
CONCLUSIONS OF THE MEETING.............................................................................................5
FOUNDATION OF THE ACTIVITY .............................................................................................7
WORK METHODOLOGY...............................................................................................................7
CONCLUSIONS OF THE MEETING.............................................................................................7
BACKGROUND...............................................................................................................................9
PARTICIPATION OF THE CSMC TEAM IN THE NETWORK...................................................9
2.1. CONTEXTUALIZATION PHASE.....................................................................................10
2.2. ANALYSIS PHASE OF CRITICAL KNOTS THROUGH PROBLEM TREE.................10
2.3. PHASE TABLE OF SOLUTIONS......................................................................................10
2.4. PLENARY PHASE AND CLOSING..................................................................................11
1.1. LACK OF KNOWLEDGE OF THE OPERATION OF THE MENTAL HEALTH
NETWORK IN VALPARAÍSO......................................................................................................12
1.2. CONSUMPTION OF ALCOHOL AND OTHER DRUGS.................................................13
1.3. LOW CITIZEN PARTICIPATION.....................................................................................13
1.4. MENTAL HEALTH AND VULNERABILITY OF THE RIGHTS OF CHILDREN AND
ADOLESCENCE............................................................................................................................14
1.5. GENERAL SUMMARY OF CONCLUSIONS...................................................................15
ANNEXES.......................................................................................................................................16
Group No. 1.....................................................................................................................................19
Group No. 2.....................................................................................................................................19
ANNEX N° 4: RESULTS OF THE CONVERSATION “HOW DO YOUNG PEOPLE ACCESS
PUBLIC HEALTH?”......................................................................................................................21
1. Access and use of information about benefits of the Valparaíso San Antonio Health Service
network:...........................................................................................................................................22
2. Mental health ...........................................................................................................................22
3. Proposals..................................................................................................................................22
ANNEX N°5: RESULTS OF ANALYSIS USING PROBLEM TREE AND PROPOSED
SOLUTIONS OF DGPSM BY GROUP.........................................................................................25
Group 1............................................................................................................................................25
Group 2............................................................................................................................................25

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 Group 3............................................................................................................................................26

CONTEXTUALIZATION OF PARTICIPATORY DIAGNOSIS: PRE-DIAGNOSIS PHASE

1.1. FIRST MEETING WITH COMMUNITY ORGANIZATIONS AND

INTERSECTOR OF THE TERRITORY BELONGING TO CESFAM JEAN AND
MARIE THIERRY

FOUNDATION OF THE ACTIVITY.

In the context of the launch of the Domingo Asún Salazar Community Mental Health Center
in Valparaíso, during the second half of 2016, one of the four psychosocial teams began a process
on the ground, aimed at getting to know the Intersector organizations in situ and community
organizations that develop activities aimed at the population, in the territory of jurisdiction of
CESFAM Jean and Marie Thierry (JMT).

Contact with the respective organizations was made through dialogue with community
leaders or leaders with a semi-structured interview consisting of: 1. Presentation of the
psychosocial duo Psychologist and Social Worker; 2. Presentation of the Community Mental Health
Center, with its objectives, ways to access care, and its role in the SSVSA health network. This was
complemented through the application of four guiding questions, related to how these organizations
link with the CESFAM JMT, other community organizations and which instances are seen as
necessary in terms of mental health in their environment.

From the information collected in the field, the following conclusions have been drawn:

• Common problems are seen throughout the territory, related to Mental Health, mainly
associated with the consumption of alcohol and drugs in public.

• The link between the territory's organizations around Mental Health is considered a
challenge, since they are diverse in terms of their objectives, age groups and motivations
that bring them together.

• The functional organizations present in the territory perceive a fragile connection with the
CESFAM JMT in general terms, in addition to a lack of knowledge regarding the functioning
of the Mental Health Network in Valparaíso.

• Different degrees of social participation and development of objectives are observed in the
various known organizations.

• The work process in the territory manages to realize that there are multiple organizations.

• There are active community leaders validated by their peers.

• There is a high need for the Intersector to address Mental Health issues with homeless
users.

With all these inputs, the CSMC psychosocial team, together with the CESFAM JMT, consider
it pertinent to organize a process of returning the information obtained to the participating
organizations, in addition to working on these results in groups, so that the experience can yield
community intervention guidelines, highlighting the most important topics perceived by the
community as priority areas of intervention in said topics. Furthermore, the proposal of this meeting
is that the representatives of the organizations get to know each other and the space becomes the

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beginning of joint work in favor of territorial and sectoral objectives.

This is how a Meeting with Community Organizations and Intersector of the Territory Belonging
to CESFAM Jean and Marie Thierry is organized in conjunction with the “Domingo Asún Salazar”
Community Mental Health Center – Valparaíso . Which took place on March 28, 2017, Hall of the
Immaculate Heart of Mary Church in Valparaíso.

WORKING METHODOLOGY OF THE MEETING

The event consisted of a linking event between community organizations, which were
contacted by the CSMC team, to make themselves known and descriptively present the
rapprochement process in the territory during the second half of 2016. (Annex No. 1 contains the
database of the 37 organizations participating in this meeting).

Through the consolidated results of the interviews with each organization during this period,
a group work is structured at the meeting using the Focus Group methodology, reflecting on two
main premises, the results of which are presented through a final plenary session:

1. The mental health problems they identify in the community;

2. The approach proposals that they identify from the institutions and the community.
(In Annex No. 2 there is a record of the results worked on and constructed by each of the four groups of the activity,
which had an average of nine participants each).

CONCLUSIONS OF THE MEETING

This territorial community activity constituted the first milestone in the process of
approaching mental health in the community by the CSMC, in the sense of knowing from
community representatives their vision about the state of mental health in their territories.

Furthermore, it was an interesting instance to learn about the proposals that arise from
those involved, along with evidencing the need to propose and work on strategies that should be
addressed in a coordinated and collaborative manner between the different community actors, but
as articulating agents the Public Health Centers such as CESFAM Jean and Marie Thierry and the
Domingo Asún Salazar Community Mental Health Center.

Then, the main areas of intervention are directed to: 1. address violence as a social
phenomenon present in different areas, whether in the family, the workplace or in the treatment of
the migrant population; 2. problematic substance use in the population; and 3. have better
information from institutional networks to treat mental health problems in Valparaíso.

In general, it can be seen that these areas of intervention identified by the community in the
group work are related to what was previously known in the interview in the territory. This shows
that the perception of mental health problems and the needs of the community are generally
shared, being recognized as imperative to be addressed together with health services.

On the proposals side, it should be noted that community representatives are conceived as
active and necessary parts of the process of addressing the identified problems. Which constitutes
a powerful resource to promote a process of addressing mental health problems in their different
manifestations.

Likewise, they demand greater participation, either through training and delivery of
knowledge to form volunteers (an interesting and feasible proposal to operationalize in the medium
term), added to direct and close work with the most vulnerable population such as children, older

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adults. and their caregivers and in addition to strengthening the network coordination of
organizations and the health sector, with attitudes and values oriented to respect for diversity,
empathy and active listening.

This entire exercise of participation and community linkage of a health center manages to
constitute a fundamental input for the future construction of the Participatory Diagnosis of
Community Mental Health of the CSMC Domingo Asún Salazar.

This instance was also analyzed by the center's work team using the SWOT matrix, the analysis of which is
contained in Annex N°3.

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1.2. CONVERSATION “HOW DO YOUNG PEOPLE ACCESS PUBLIC HEALTH?”

FOUNDATION OF THE ACTIVITY .

During the month of June 2017, an activity is planned that brings together two outpatient
mental health care devices in Valparaíso, such as the Hospital del Salvador (HDS) and the
Domingo Asún Salazar Community Mental Health Center (CSMC), in the dissemination and
communication policy framework of the Valparaíso-San Antonio Health Service Network (SSVSA),
to respond to COMGES Management Commitment 10.
On Tuesday, June 20, 2017, this activity was carried out in the Hall of Honor of the Town
Hall Building of the I. Municipality of Valparaíso, in a conversation format, called “Youth and Public
Health in Valparaíso” , with the objective of making a diagnosis that accounts for the perception of
young people regarding the access and use of the information they handle regarding the SSVSA,
the benefits and services that it provides in its healthcare network.

The target group of the activity is people between 15 and 29 years of age, belonging to
establishments with secondary education, who are members of the Childhood and Adolescence
Network (RIA) of the commune of Valparaíso; in addition to university students from institutions
with which contact has been previously maintained. In turn, professionals and officials from the
Intersector who work with young people are summoned to contribute with their perspective
regarding the relationship that young people and public health would have in the commune.
In total, 12 institutions attended, of which 7 correspond to educational establishments,
including: Liceo Eduardo de la Barra, Colegio Patricio Lynch, Liceo Matilde Brandau de Ross,
Liceo la Igualdad, Liceo Leonardo Murialdo, Universidad de Playa Ancha and Colegio Juan Luis
Vives. . The other 5 institutions correspond to the intersector that works on issues of and with
young people, among them: OPD Valparaíso, ONG Galerna, PDE DEM, PDE 24 Horas and PPF
Almendral.

WORK METHODOLOGY

For the diagnostic survey in question, it has been proposed to use participatory techniques,
with emphasis on Focus Groups or Focus Groups , with guiding questions focusing the discussions
regarding the specific topic of the conversation: access and use of young people's information
about health services. public in the commune . This, in addition to reflecting and discussing the
mental health problems identified in the youth population.

The groups seek to develop three guiding questions towards the aforementioned axes, the
results of which were presented in the final plenary session of the day.

These results are contained in Annex N°4.

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CONCLUSIONS OF THE MEETING

From the conversations and discussions within each focus group, clear proposals were
distinguished regarding the delivery of health information and the benefits of the Valparaíso – San
Antonio Health Service network.

These are fundamentally oriented towards a greater presence of health institutions in school
and university establishments, with the development of talks and “face-to-face” activities, in which
the institutions become closer to the community, this should be complemented with the delivery of
material informative printout. However, within the activity, the needs of young people are revealed
in “more talks, less pamphlets.”

At the same time, it is proposed to encourage greater participation of young people

themselves in instances of communication and transmission of information on public health in the
commune. This, through formal training so that said population collaborates in counseling instances
in their own educational establishments, with their peers, acting in the role of health promoters.

Likewise, both the young people and the adults participating in the activity propose the
inclusion of young people in the health and education commissions (COMSE) as health delegates
of their institution, for direct access, together with education officials, of the information about
features and benefits to which they can opt as users.

It is suggested to improve internet portals, with clearer and more accessible information,
through audiovisual material with data on health prevention, in addition to strengthening and
improving the social networks already available.

Likewise, focus groups give great importance to the permanent generation of activities in
community spaces, including young people and children, in order to bring health information closer
to various spaces in the community, promoting the formation of networks. territorial in relation to
health and intersectorality.

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1.3. PLAYA ANCHA COMMUNITY HEALTH NETWORK

BACKGROUND.

Within the territorial radius of action of the CSMC Domingo Asún Salazar is located a
functional community organization called Centro Cultural Playa Ancha , which within its wide range
of activities of a cultural, recreational, social participation and self-management in the community,
invites members of the CSMC team to participate in the Playa Ancha Community Health
Network .
This instance brings together different organizations from the area limited to the territory of Playa
Ancha in order to carry out a diagnosis regarding the priority health issues to be addressed through
organized social participation.

PARTICIPATION OF THE CSMC TEAM IN THE NETWORK

During 2017, various meetings were held, in which the main health problems observed in
the population of the territory were presented, and the areas of intervention were prioritized for
networking.
These themes are:

1 .- Children's rights and parenting and parental styles

2 .- Mental health
3 .- Network Participation

The Playa Ancha Cultural Center becomes, in this way, an articulator of both a local health
diagnosis, as well as territorial strategies to address prioritized issues. This, with a strong emphasis
on self-management and empowerment of addressing actions, carrying out concrete measures for
the prevention of health problems at the individual, family and community level in the territory of
Playa Ancha.

The work carried out by the Playa Ancha Community Health Network, with the participation of
CSMC, constitutes a relevant source of data to complement the collection of community needs
regarding mental health in Valparaíso. Therefore, it is also part of the subsequent DGPSM for the
year 2017 as input.

1. PARTICIPATORY COMMUNITY MENTAL HEALTH DIAGNOSIS DAY (DGPSM)

Based on the CSMC guidelines regarding Participation and Social Inclusion, the need arises to
carry out a Participatory Diagnosis of Community Mental Health (DGPSM), seeking to complement
the Pre-diagnosis process in order to continue working on the themes. systematized and the
problems identified in the previous activities.

Given that in the different instances described above, various problems associated with mental
health were recognized in the commune of Valparaíso, the team from the Participation and Social
Inclusion Area of the CSMC, responsible for the activity, grouped them into five general problems,
which allowed provide order and methodological structure to the work day.

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 The selected topics were the following:

1. Lack of knowledge of the functioning of the Mental Health Network in

Valparaíso
2. Alcohol and other drug use
3. Low citizen participation
4. Violation of Rights in childhood and youth
5. Overload of caregivers of people with dependency

The DGPSM day took place on September 26, 2017, in which 55 people participated,
representing 25 community organizations. The methodology used to develop the diagnosis is
based on a qualitative descriptive study using focus group, brainstorming and solution tree
techniques. For the development of the activity and the active participation of all attendees, five
work groups were formed with random distribution of the participants.

2.1. CONTEXTUALIZATION PHASE

The day begins with the Contextualization Phase, which consists of the presentation of the
results of the participatory instances in which the CSMC team took part during 2016 and 2017 –
which have been described previously in the pre-diagnosis process. -.

This allows, in addition to explaining the objective of the DGPSM day and the expected work
methodology, to analyze and define the five priority themes selected and that directly affect the
population of the commune.

2.2. ANALYSIS PHASE OF CRITICAL KNOTS THROUGH PROBLEM TREE

Once the pre-diagnosis background is presented, focus groups are formed, with random
distribution of their participants, tending to ensure that they are heterogeneous in age, origin and
organizational representation. This is complemented by the participation of at least one moderator
and secretary of the CSMC team in each group.

Each focus group was in charge of choosing one of the five problems presented, and then
identifying and analyzing its causes and effects, using the Problem Tree technique.

4 of the 5 problems raised were worked on; 1. Lack of knowledge of the functioning of the
Mental Health Network in Valparaíso, 2. Consumption of alcohol and other drugs, 3. Low citizen
participation and 5. Violation of Rights in childhood and youth.

Based on these selected problems, the analysis in question has been carried out.

The systematization of the Group Problem Trees is contained in Annex N°5.

2.3. PHASE TABLE OF SOLUTIONS

After analyzing the cause and effect of the problems, it is proposed to identify solutions,
using a table built by the day's executing team (attached in Annex No. 5) , which includes both the
solutions/objectives of the approach as well as the actors responsible for its management.
(Individual and family, Intersector, Organized community and Health sector).

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 To complete this table, it is proposed to use the brainstorming technique, in which the
various approach possibilities recognized by the group are collected, emphasizing collaborative
actions between the different actors, promoting their autonomy in the mental health of the patients.
public and/or private health devices.

2.4. PLENARY PHASE AND CLOSING

To finish the activity, each group shares their analysis of phases 2. and 3., giving space to the
discussion and summary of the general conclusions and future proposals for solutions.

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II. RESULTS OF THE PARTICIPATORY COMMUNITY MENTAL HEALTH DIAGNOSIS
(DGPSM)

After carrying out the work of analysis and discussion of the themes selected by the groups,
which were shared and reinforced in a plenary session, during the DGPSM day it is possible to
conclude the following:

1.1. LACK OF KNOWLEDGE OF THE OPERATION OF THE MENTAL HEALTH NETWORK IN

VALPARAÍSO.

When analyzing this problem in the group, after the sustained discussion , lack of knowledge
of mental health networks in Valparaíso emerges as a critical point of the analysis, since it would be
a situation that is experienced differently by the participants, according to their needs. in health and
the roles that each one plays.

These differences affect the way in which the phenomenon is analyzed, which allows broad
content and approaches to be provided in addressing its causes and possible solutions. In this
regard, it is concluded that:

• The use of various means of communication effectively is essential to obtain information about
the health network in the commune, the form of access and the possibilities of care according
to complexity.

• The community is also seen as a fundamental actor to maintain a constant link between the
health system and its territories, recognizing its capabilities to actively participate in the Mental
Health Network.

The most recognized practices currently present in the network are: the constitution and
operation of the Health Advisory Councils, the Ecological Program and the multifamily self-help
groups, Local Programs with a territorial health focus, the More Self-Employed Older Adults
Program, among others.

• The self-management of citizens and their families as responsible for their health-disease
processes is considered key in this issue.

It is impressive that people were unmotivated to inform themselves and participate in the
dissemination and communication initiatives offered by the health system in the commune.
This could lead to prevention measures (primary and secondary) to the point that they are no
longer effective, which would have an impact on people arriving at the health system with a
declared pathology, strongly impacting their recovery processes. recovery and/or rehabilitation.

• Generating adequate spaces in the community, with a strong link between community
family health teams and their territory, coordinated actions with all levels of health care
and coordinated intersectoral work, are evidenced as a fundamental need to address
the problem in question.

• It is important that health teams have the necessary preparation to carry out community work.
This would be achieved to the extent that the community's health centers commit to and
emphasize community work, based on the Family and Community Health Model and the
Community Mental Health Model, defining it as a style of mental health work. This, in addition
to ensuring training opportunities for teams on relevant and transversal topics at different levels
of care; along with enhancing the interest and involvement of officials in carrying out tasks with
and in the community.

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1.2. CONSUMPTION OF ALCOHOL AND OTHER DRUGS

This topic is analyzed during the day as a problem that would be presented throughout the
life course in the territories of the commune. Drug consumption is associated with other mental
health situations that are not being addressed, these being the causes of the problem.

This is a complex situation to be able to design effective intervention strategies in the

territory, since it involves long-term work; which is perceived with a barely visible impact in the
immediacy, since transgenerational aspects of substance consumption at the family level are
affected.

Due to this, the prevailing need to carry out coordinated work is concluded, in which all social
actors are actively involved towards achieving results in the future, aimed at reducing drug
consumption and preventing complications at a psychosocial level.

Suggested elements to plan and execute work in this sense would be:

• Carry out work at the family level to strengthen ties within the nucleus, despite the fact that it is
suspected that there would be difficulty in carrying out actions in this area in all the families of a
territory. Faced with this problem, a more community approach is conceived by the planned
territorial organizations, with advice from the institutions of the health sector or intersector,
projecting work in the short, medium and long term.

• Promote collaborative ties between institutions and the community, with the purpose of
generating networks and meetings between them. It should be noted that, although these
instances have been present in the development of public policies, they have not been
evaluated or considered as significant for the community.

• In general, it is expected that communities could influence the decision-making of the

organizational aspects of their neighborhoods, which are considered in local public
policies, such as restricting access to alcohol licenses in the sectors close to their
residences.

1.3. LOW CITIZEN PARTICIPATION

The main analysis carried out by the participants concludes with the perception that low
citizen participation is a problem with many determining factors, with a high complexity when
seeking solutions, which is why it constitutes a vicious cycle of low motivation and Therefore, little
social participation.

Among the causes described in the event are three different systems or social units: family,
community and State. These would be related to each other and, with different positions and
responsibilities for addressing the problem:

• At the family level, there is a perceived decline in the delivery of values from childhood. This
would have repercussions on the training of “future citizens”, since the importance of the role of
parents in this process is not evident, but rather it is felt that responsibility for this learning is
attributed to external institutions.

• At the community level, it is recognized that the process of citizen participation has been
diminished mainly due to the individualism prevailing in society. This has been a gradual but
rapidly advancing process that has affected and changed the traditional form of what is

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 expected in terms of “citizen participation.” There is then evidence of a weakening of the
communal and community organization throughout the territory of Valparaíso, added to a lack
of involvement of the youth population in these instances and the insufficient turnover in the
leadership of the organizations, generating a lack of credibility and trust of these spaces.

• At the State level, the installation and deepening of the post-dictatorship neoliberal model is
distinguished, loss of spaces for social participation, withdrawal of civic education plans in
secondary education and, a vertical logic in the relationship of the State with citizens,
reproducing individualism and repression of social movements.

The objectives in the family would be aimed at promoting family lifestyles, expanding spaces
for collaboration and cooperation, in addition to promoting education in principles and values. At the
community level, the self-education of citizens on relevant topics is evident as fundamental, valuing
the incidence of forms of social participation in a wide variety of topics and the increase in self-care
in health at the group and community level. The State, for its part, should have a greater impact on
this process, by restoring civic education instances in educational plans and programs,
strengthening health systems and increasing channels of participation.

1.4. MENTAL HEALTH AND VULNERABILITY OF THE RIGHTS OF CHILDREN AND

ADOLESCENCE

This theme is highly relevant for the participants of the day, since most of them feel linked to
the area of childhood and adolescence, in the different spaces of daily life.

It has been perceived that the main problems in this area would be:

• Ignorance of the general health network and the intersector: This difficulty would be present in
the different institutions, to the extent that it has been observed that the devices sometimes
would not have security regarding referrals, flows and admission profiles for health care. or
other area of need. This would have an impact on the continuity of care for children and young
people, given that institutions do not respond in a timely manner to the demand of said
population. This would be mainly related to the lack of resources in the network, both financial
and the supply of professionals and treatment providers, along with spaces for intervention.

• The problems at the structural level of society, in relation to the implementation of public
policies, which is perceived as a fact decontextualized from the reality of the territories and
often not very flexible and adaptable by health teams. This situation restricts the problems
associated with children and young people from taking a comprehensive and timely approach.

• The occurrence of various situations at the local level that impact and perpetuate the problem.
These refer to stigmatization and prejudice towards the public system in general and mental
health problems in the child and youth population, minimization of violations of rights, and
general ignorance of what this situation entails.

The main conclusion from the analysis of the problem raised refers to the need to have a
strong network that allows for human and clinical support, with a perspective of human rights in
childhood and youth.

It is recognized that most of the solutions or addressing needs refer to mental health
devices, but that they can and should be complemented in a synergistic manner with the other
institutions of the network in the commune of Valparaíso.

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 It is proposed as an example, based on the national contingency to date, the importance of
integrated work with the National Service for Minors (SENAME), after the institutional resolve has
been questioned due to the violation of the protection of minors. the rights of children and youth
regarding their health and general integrity.

1.5. GENERAL SUMMARY OF CONCLUSIONS

After presenting the analysis of the four problems chosen during the DGPSM day,
highlighting the perception that the participating population has about their causes and
consequences, along with the proposal of solutions and possibilities of addressing, it is possible to
point out that the majority of these are shared for all problems.

It is recognized that for the four themes discussed there is an interconnection of the
problems-solutions along with the need and importance of carrying out intervention at the
community level. This in order to influence a better quality of life, especially with regard to mental
health for the entire user population in Valparaíso, intentional positive relationships within family
units and participatory life in the community.

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ANNEXES

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ANNEX N°1: LIST OF PARTICIPANTS MEETING WITH COMMUNITY ORGANIZATIONS AND INTERSECTOR OF
THE TERRITORY BELONGING TO CESFAM JEAN AND MARIE THIERRY.

No. Name Organization Address

1 Crib Room and Kindergarten “Semillita” Almirante Barroso 531, Valparaíso
Cardonal Market, 2nd Floor.
2 ASOCOMERCAR. Cardonal Market Merchants Society. Valparaiso.
3 Valparaíso Basketball Sports Association. Rawson 360. Valparaiso
4 "Vitamin" Nursery and Kindergarten 2730 Errázuriz Street. Valparaiso
"Raúl Villarroel Correa" Day Center Don Bosco
Avda Errázuriz 2830, Valparaíso
5 Foundation
6 "Charlie Brown" Kindergarten and Nursery Room Av. Brazil 2725. Valparaiso
7 Kindergarten and Nursery Room "Fantasy of Colors" Avda Errázuriz 2960, Valparaíso
8 Bresky Corporation 999 El Liter Street. Valparaiso
9 ASR PRE VALPO Avda Errázuriz 2692, Valparaíso
10 Hope Fund Acharan Passage 40, Valparaíso.
2750 Carlos Van Buren Street.
"The Dwarves" Kindergarten
11 Valparaiso
2741 Carlos Van Buren Street.
“Little People” Kindergarten
12 Valparaiso
Comprehensive Care Center for women of the Adorable 2715 Carlos Van Buren Street.
13 Sisters Valparaiso
Cardonal Market, 2nd Floor.
Cardonal Market Administration
14 Valparaiso
15 Hospedería del Hogar de Cristo Retamo 839, Valparaiso
Territorial Table sector 4 Childhood and Adolescence
Chiloé Street 1960. Valparaiso
16 Network (RIA)
17 Providence Nursing Home Orella 1030, Valparaíso.
18 SERPAJ Orella 1015, Valparaíso.
19 Providencia Kindergarten Rodríguez Alfaro 975, Valparaíso.
20 Geropolis Hontaneda 2653, 4th floor. Valparaiso.

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No. Name Organization Address
21 Plaza O'Higgins Antique Dealers Association Plaza O'Higgins. Valparaiso
22 Union No. 1 of Merchants Avenida Uruguay. Uruguay Avenue. Valparaiso.
23 Union No. 2 of Merchants Avenida Uruguay Uruguay Avenue. Valparaiso.

24 Immaculate Heart of Mary Parish Uruguay with Pocuro 834

25 Union No. 9 of Merchants Avenida Uruguay. Uruguay Avenue. Valparaiso.

26 Group of Older Adults “Rebirth to life” Uruguay with Pocuro 834
27 Plaza O'higgins Brisqueros Association Plaza O'Higgins. Valparaiso
Union No. 3 of Merchants Avenida Uruguay. "The Porteños"
28 Uruguay Avenue. Valparaiso.

La Fontaine 230, C° El Litre.

29 Neighborhood Meeting No. 17 C° El Liter
Valparaiso.

30 Neighborhood Council No. 186 C° El Litre

31 "El Liter" Sports Club
32 "Santa Ana" Mothers Center
33 "Arturo Prat" School El Vergel 203, Valparaiso

34 Uruguay Avenue. Valparaiso.

Union of "Yellow Cars" of merchants on Av. Uruguay
35 Uruguay Avenue. Valparaiso.
Union No. 6 "El Almendral" of merchants on Av. Uruguay
36 "River Chile" Sports Club

Page18 of 34
ANNEX N°2: RECORD OF THE CONCLUSIONS OF THE GROUP WORK AT THE MEETING WITH COMMUNITY AND
INTERSECTOR ORGANIZATIONS – MARCH 28, 2017

Group No. 1
Mental Health Issues
1. Absence of spaces, instances of intervention and treatment for drug use problems, family interventions
2. Lack of knowledge of the offer and referral mechanisms to address mental health problems, mainly for adults
3. Need for intervention and treatment of problems associated with experiencing traumatic situations related to natural disasters
4. Need to address mental health problems that occur in bedridden people, given their general health condition and that of their
caregivers.
Solutions
1. Promote mental health prevention at the territorial level.
2. Train monitors as health volunteers.
3. That health teams support and train organizations .

Group No. 2
Mental Health Issues
1. Evidence of family dysfunction with absent fathers; disruptive behaviors in basic education.
2. Parents with problems with alcoholism, drugs, domestic violence and depression.
3. Presence of a diagnosis of depression, lack of support networks, domestic violence, social isolation
4. Little connection with the community.
5. Difficulty for the migrant population in adapting to Chilean society, mainly in relation to the language barrier.
Solutions
1. Focus the work on parents for training in normative crises of children and young people or parenting skills.
2. Carry out direct work with children and parents, carry out network referrals and case follow-up.
3. Carry out more training in intercultural care for health officials, training for immigrants in access to the community network.
4. Coordinate greater ties with the union, for a sense of belonging to the community.

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GROUP N°3
Mental Health Issues
1. People's need to be listened to Presence of high consumption of alcohol and drugs Child maltreatment and
2. abuse Need for containment and dignified treatment Diagnosis of depression
3. Lack of support for caregivers
4.
5.
6.
Solutions
1. Promote attitudes of tolerance towards migrants.
2. Carry out listening actions to people.
3. Strengthen good disposition at CESFAM, in order to obtain quality care.
4. Coordination with other organizations
5. Be a bridge between those who need and the appropriate entity.
Group No. 4
Mental Health Issues
1. Alcohol and drugs in the population of children, young people and adults.
2. Violation of Rights
3. Drug use and abuse
4. Special educational needs in the school environment
5. Evidence of HIV-AIDS diagnosis in the adult population
6. Need for community education for devices and/or volunteers, participation and support.
7. Lack of dissemination of the Health Network devices in Valparaíso
8. Shortages of economic and human resources at the level of public and local policies.
Solutions
1. Improve professional and volunteer capabilities in mental health.
2. Strengthen networking in the commune of Valparaíso.
3. Promote instances of community and territorial education.

Page20 of 34
ANNEX N°3: SWOT ANALYSIS OF THE ACTIVITY MEETING WITH COMMUNITY
ORGANIZATIONS AND INTERSECTOR OF THE TERRITORY BELONGING TO CESFAM JEAN
AND MARIE THIERRY.

Based on the results obtained in the activity and from the personal perceptions of the
members of the team that carried it out, a SWOT analysis can be configured, that is, of the
strengths, opportunities, weaknesses and threats that this experience has meant.

1 .- Strengths:
• High call for community organizations
• Space of significant connection with organizations
• Coordinated work between organizations and people
• Support and commitment from APS (CESFAM JMT)
• Existing key informants in the community, with a clear vision of mental health in their
territory, availability and critical awareness
• Sensitivity in the community in wanting to group and meet

2 .- Opportunities:
• Instance as input to base projects and planning for JMT and CSMC
• Commune with a political scene that encourages citizen participation
• Results allow space to delve deeper into the problems identified, for attention at the
secondary level.
• Positive instance to replicate in other territories, with support from other CESFAM
• Strengthening active community agents to resolve mental health problems, empowerment
• Collaborative work and connection with the Intersector
• Availability of the JMT team to improve and make their functions more flexible in relation to
the objective community of their territory

3 .- Weaknesses:
• Exercise focused more on adults and older adults, leaving out the children and youth
population of the territory.
• Call as a “duple” and not an institution, under self-care and support

4 .- Threats:
• Organizations with poor replacement generation, disenchantment with participating in
directives. Inactive CDLs.
• Certain distrust due to continuity of results of community activity, generation of high
expectations
• Perception of low connection between health and the community. Appreciated under APS
recognition
ANNEX N° 4: RESULTS OF THE CONVERSATION “HOW DO YOUNG PEOPLE ACCESS
PUBLIC HEALTH?”

The methodology of the meeting aimed to discuss the following thematic areas:

1. Access and use of information about benefits of the Valparaíso San Antonio Health
Service network:

■ What information do you handle about public health benefits or services in

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 Valparaíso?
■ What do they know? How do they know him?
■ What has been the most accessible information channel? How do you evaluate
the content of the information?;

2. Mental health .

■ What does mental health mean to you?

■ What are the mental health problems or problems that you identify in your
environment?

3. Proposals.

■ What do you propose to improve access and use of information about health and mental
health benefits in Valparaíso?
■ How would you facilitate access to the information?

The result of this activity allowed us to develop three categories of analysis, which account
for the process of discussion and drawing conclusions regarding the topic.

1. Access to Public Health for Young People

2. Evaluation of the content of information on Public Health
3. What is Mental Health for Youth

1. Regarding the analysis category Access to Public Health for Young People , it is reflected
that young people have knowledge about the general public health network, they identify the central
hospitals of the commune, the SAPU and SAMU, emergency centers, and clinics. They also know
the mode of access to health, which is accessed for free, correctly differentiating the ISAPRE
system from that of FONASA.

Young people know about CESFAM because health professionals have attended their
different high schools and schools to give some information through talks, and to do health checks,
such as the “healthy young person.” Added to some talks from the Hospital del Salvador,
specifically about volunteering aimed at university students.

Young people recognize that what they know about public health, they know due to the well-
valued “word of mouth” mostly through their relatives who have accessed public health services, or
other adults or peers themselves. And they also report that they have accessed the MINSAL page,
they recognize advertisements about hanta, condom use, and influenza through television and
radio media. They say that this information comes to them as a warning, but they conclude that
person-to-person information is more interesting.

On the other hand, young people agree that there is misinformation about when to go to the
emergency room, nor do they know when to go to a CESFAM. They say “I never get sick,” which
could lead to the conclusion that they relate this care to situations of illness and not prevention.

What professionals who work with young people demand is greater flexibility in the
schedules in which they serve young people, which are not in accordance with their school reality,

Page22 of 34
and greater proximity to educational establishments, an issue on which they agree with young
people.

In addition to this, young people highlight the idea that there are differences between public
and private care. Especially in the waiting time for attention and treatment. They report that the
public health system has few economic resources for the optimal functioning of care, and they have
the opinion that complaints about its quality are unfairly deposited with officials.

Regarding the issue of “treatment”, professionals who work with young people believe that
young people distance themselves from public sector services due to the treatment they receive in
different services. I try to have them described as adult-centered, not taking into account the
different characteristics of this age group, describing it as inhospitable and unfriendly. They agree
that there are no plans designed for young people who would require good treatment and a space
in which they feel safe and confident that respects the confidentiality that their attention requires.

In conclusion regarding the delivery of information, both young people and adults value
experiences that bring health closer to the population, either through talks or conversations with
health professionals who explain to them about specific content for their group or about access to
information. attentions. The space of the joint health and education commission (COMSE) that
exists in many CESFAM is also highly valued, and which allows professionals who work with young
people to have greater accessibility to information and obtain direct benefits for young people.

2. Regarding the Evaluation of the content of the information on Public Health , young
people report that it is not clear, nor is what they get from the MINSAL website. They point out that
the information is insufficient, with unclear steps to follow, such as how to deal with different health
situations, for example, how to do the Elisa test.

They also report that the same system of division into different services and devices slows
down the response to doubts and questions, due to high bureaucratization, which prevents
expeditious and quality access, which ends up distancing people from the correct information.

They report that there is little information on issues specific to young people; They mention
reproduction, prevention of sexually transmitted disease or infection, among others. That is,
insufficient in health care issues.

Young people also mention that doctors are mainly not clear in giving their diagnoses, and
that they often do not understand them because they use many technicalities. This shows that there
would be little information for young people, in which the language is adapted to said population.
Then, the way in which health information is transmitted would raise more concerns than its
content.

Professionals who work with young people think that the information they give through the
media such as television is adequate, as is that in talks, especially if the officials who give them are
empathetic with young people. Regarding this same means of communication, young people also
think that the information delivered by television is clear and appropriate to the times, that is, fast;
This medium, like the Internet, is the most valued means of information.

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 As a last point, professionals who work with young people mention that there is not much
knowledge about other community actors about health, and that in general it is the young people
themselves, their families or officials of educational establishments who must specifically find out
and inform their community. .

3. Regarding the last category of analysis of the activity, What is Mental Health for Young
People , young people relate mental health with a state of psychological well-being that
encompasses all health, general processes, which has to do with emotional tranquility , balance,
stability etc. It is an area that encompasses all health issues, oncology, motherhood, and physical
issues. They mention that the better our mental health is, the more difficult it is for us to get sick: “if
our mental health is bad, there is a greater predisposition to get sick.”

Mental health is also recognized as the area that deals with more and less complex
disorders of the mind. But it is often a taboo topic that is handled poorly and generates
misinformation.

Young people distinguish serious mental health problems from others that are not so
serious. And the serious ones have an associated stigma of violence and aggressiveness, and with
the image that television shows them, especially of people commonly called “crazy.”

They also relate it to diseases that affect health, psychological illnesses, mental problems
and also those that affect the body biologically. Among young people, they are aware of many
mental health illnesses, including anxiety, depression, stress, schizophrenia, bipolar disorder,
bulimia, alcoholism, and self-harm. They also mention childhood traumas, fears and other traumas.

They distinguish that in the elderly there are specific problems such as dementia.

Young people distinguish among their peers: borderline personality disorder, panic attacks,
stress situations, depression, low self-esteem and high levels of anxiety due mainly to the high
academic demands of high schools and schools, added to the pressures to perform well. and
choose a career for your future. Pressure that they perceive from both their teachers and their
families, and that is often naturalized by the adult world.

Among professionals who work with young people, they mention drug use, bullying and
violence in pololeo as common problems, as different forms of violence that relate to the current
state of our society. They distinguish the influence of the adult way of life on the way of life of young
people.

Page24 of 34
ANNEX N°5: RESULTS OF ANALYSIS USING PROBLEM TREE AND PROPOSED SOLUTIONS
OF DGPSM BY GROUP.

Group 1

The topic chosen by the first group was the “Functioning of the mental health network”, which
was subdivided into different subproblems that they called “causes”, each of which had an objective
to meet to solve it.

Sub Problem 1 Social Actor Solution/Goal

Lack of dissemination of the Community Delivery of information at the territorial level, in
health network in the CESFAM and places where people gather.
community.
Participation as mental health monitors.
Grid of the Mass health zone
Service of
health Delivery of information at the territorial level, in
CESFAM and places where people gather.

Training of mental health monitors.

Intersector Improve dissemination through mass and communal
media.

Sub Problem 2 Social Actor Solution/Goal

Lack of training for officials Grid of More transversal and periodic training
on their networks of Service of
manner Health
constant

Sub Problem 3 Social Actor Solution

Lack of communication Intersector Participation and creation of community leaders in
between private and public. health
Community Participation and creation of community leaders in
health

Sub Problem 4 Social Actor Solution

Lack of interest on the part of Community Encourage participation
the user

Sub Problem 5 Social Actor Solution

Lack of use of entities that Intersector Educate the user in their role
provide information such as
OIRS
Group 2

The second group chose the problem “Alcohol and Drug Use.” Although one of the prioritized
topics was the “violation of rights in children and adolescents”, substance consumption was chosen
since it directly intersects, altering the relationship between the adolescents themselves and
coexistence with family.
Among the causes that the group pointed out as associated with the problem are:

Page25 of 34
 • Dysfunctional families, few rules, no values.
• Lack of support from institutions for parenting skills.
• People don't want help
• Lack of professional help for alcoholic parents.
• Little family support.
• Depression
• Lack of interest in information / Myths about drugs.
• Easy access, excess of liquor stores
• Lack of authority control

Problem Social Actor Solution/objectives

Alcohol and drug use Individual/family Favor communication familiar. Spaces
shared.
Parents' commitment to their children, support.

Generate self-care spaces.

Generate confidence in children and young people.

Improve quality of education.

Empathy (in relation to inclusion).

Community

Promote educational events with schools, e.g. JJVV.

Generation of networks and meetings. Prevention fairs.

Require patent restriction policies for sales outlets.

Healthcare system Conduct informative workshops.

Promote psychosocial support programs with

committed professionals.
Intersector Generate learning spaces about drugs and alcohol.
More campaigns.

Committed professionals (support, listening).

Group 3

The third group chooses “Low citizen participation” as the main problem. Among the possible
causes associated with the problem, the following were mentioned:

• Lack of empathy translated into lack of interest, little interest in the other. Lack of
understanding for the other who is not in the same conditions as me.
• Impression that there was participation before, and it has been decreasing over time.
• The value of feeling like a community has been lost.
• Parents do not encourage participation.
• Feeling of oppression by the State.
• Fear of consequences of helping others.

Furthermore, the group participants reflect that it is a multi-causal problem, which goes from

Page26 of 34
the system to the “you to you” relationship.

It is mentioned that despite there being information available and dissemination options and,
despite the “door to door”, people do not come to participate in the different instances. There is talk
that as a society we have lost the sense of tribe. We have lost trust in each other, sharing, relating.
The neighbors don't know each other, they don't talk, the concept of a neighborhood has been lost.
There is a lot of resistance to sharing and relating. There is a feeling that the other is a threat, an
instinct to protect oneself arises and there is a feeling of constant insecurity. All of this leads to
accentuating the sense of loneliness , making it necessary to try to regain the sense of community.

On the other hand, there would be no confidence in our leaders who lead the country, so
young people no longer go to vote and do not take civic duty as important as before.

It is pointed out that the value of feeling like a community has been lost, that parents do not
encourage participation and that they grow up with a more individualistic outlook, unlike older adults,
who had the community value instilled. Before, young people got together in the community to do
activities, now with technology, children and adolescents are stuck together and are not interested in
getting together in the community.

It is important to mention that the group points out that the concept of participation has
changed; today people participate in a different way than before.

Finally, we talk about the right to be recognized and know. The objective of creating a social
fabric is not there; there are many people whose right to inclusion is violated, and they are not given
the right to participate as a social agent.

Page27 of 34
 Solutions Chart:
Problem Social actor Solutions/objectives
Low Stake Individual/Family Encourage family sharing and
Citizen conversation

Education in values
Community To assemble little ones
groups for
educate ourselves.

Health Service Network Education in values and conversation

Set up reception
groups.
Promote the user and health
relationship

Education in values
Intersector Promote the user and health
relationship

Education in values
Group 4

The fourth group chooses the problem “Low citizen participation” as a priority to analyze. In
addition, it establishes a cause-effect sequence associated with the topic, which is reflected in the
following table.

Causes Effects
Distrust Criticisms without foundations
Lack of information Frustration
Little diffusion Discontent/disappointment
passive attitude Loss of public spaces
Individualism Segregation
High workload Fear/insecurity
Lack of leadership Excessive use of technology
Lack of civic education Neglect of spaces
common
Consequences of
dictatorship

Page28 of 34
 Regarding the solutions disaggregated by social actor, the results were the following:
Problem Social actor Solutions/objectives
Low social Individual/family
participation Promote the use of spaces, increase dissemination of
information, expand dissemination areas. Use of various
platforms and media.

Improve infrastructure to facilitate access to public spaces.

Installation of public toilets in more places

Reinstate civic education in schools, as a class independent

of the rest. Promote critical thinking, respect and
participation.

Get involved in community organization of activities and

groups

Increase concern for self-care and self-health awareness

Community Promote the use of spaces, increase dissemination of

information, expand dissemination areas. Use of various
platforms and media.

Improve infrastructure to facilitate access to public spaces.

Installation of public toilets in more places

Increase coordination between entities , resource

mobilization. Strengthen communication
of the networks
institutional and community

Get involved in community organization of activities and

groups

Increase concern for self-care and self-health awareness

Health Service Promote the use of spaces, increase dissemination of

Network information, expand dissemination areas. Use of various
platforms and media.

Improve infrastructure to facilitate access to public spaces.

Installation of public toilets in more places

Increase coordination between entities , resource

mobilization. Strengthen communication
of the networks
institutional and community
Intersector Promote the use of spaces, increase dissemination of
information, expand dissemination areas. Use of various
platforms and media.

Page29 of 34
 Improve infrastructure to facilitate access to public spaces.
Installation of public toilets in more places

Increase coordination between entities, resource

mobilization. Strengthen communication of
the networks
institutional and community

Reinstate civic education in schools, as a class independent

of the rest. Promote respect and participation

Team 5

The problem chosen by the group was the “Violation of the rights of children and
adolescents.”

Problem Social actor Solutions/objectives

Infringement of Individual/ Information and dissemination in each context
rights of family
Strengthen family relationships
children girls and
teenagers change in the paradigm of the passive role of the affected person
strengthen grassroots organizations
desensitization campaigns
internally promote good parenting practices
Community Information and dissemination in each context
Promote inclusive spaces
Promote an integrative view of the associated problems
Strengthen networks and coordination
Training for professionals and social actors, changing the
paradigm of the passive role of the affected person,
strengthening grassroots organizations, desensitization
campaigns, internally promoting good parenting practices.

Grid of Information and dissemination in each context

the
Promote inclusive spaces
Health Service
Promote an integrative view of the associated problems
Strengthen networks and coordination
Training for professionals and social actors
Promote good treatment

Page30 of 34
 Increase the budget for the area,
Democratization of the health system
Change of the paradigm of the passive role of the affected
person
Strengthen grassroots organizations
Desensitization campaigns
Internally promote good parenting practices
Commit to educating and educating ourselves, that professionals
also involve children in their health-disease process and
transparently in a colloquial way. the
diagnoses, indications, etc. That home visits are a basis for
Intersector mental health
Information andcare.
dissemination in each context
Promote inclusive spaces
Promote an integrative view of the associated problems.
Strengthen networks and coordination
Training for professionals and social actors
Promote good treatment
Democratization of the health system
Change of the paradigm of the passive role of the affected
person
Strengthen grassroots organizations
Children's mental health education
Internally promote good parenting practices

Page31 of 34
 LIST OF PARTICIPANTS OF COMMUNITY PRE-DIAGNOSTIC ACTIVITIES
AND PARTICIPATORY DIAGNOSIS OF COMMUNITY MENTAL HEALTH

LIST OF PARTICIPANTS OF “ PLAYA ANCHA COMMUNITY HEALTH NETWORK”

1. “Angel Lighthouse” Kindergarten
2. “Capullito” Kindergarten
3. “Swallow” Kindergarten
4. “Pedro Cariaga” Intercultural School
5. Montedonico School
6. Polytechnic High School A-23 “Alfredo Nazar”
7. Special School “Love and Hope”
8. Pacific School E-271
9. Syrian Arab Republic School
10. United Nations School
11. Cesfam Quebrada Verde
12. Cesfam Black Doors
13. Cesfam Local Council Black Doors
14. Valparaiso Shelter House
15. Clubhouse Community Rehabilitation Organization
16. “Domingo Asún Salazar” Community Mental Health Center

LIST OF PARTICIPANTS OF THE CONVERSATION “YOUTH AND PUBLIC HEALTH IN

VALPARAÍSO, HOW DO YOUNG PEOPLE ACCESS PUBLIC HEALTH?”
1. “Eduardo de la Barra” High School.
2. "Patricio Lynch" School.
3. "Matilde Brandau de Ross" Lyceum.
4. "Equality" Lyceum.
5. "Leonardo Murialdo" High School.
6. Playa Ancha University.
7. "Luis Vives" School.
8. Office for the Protection of the Rights of Children and Adolescents (OPD) of
Valparaíso.
9. Non-Governmental Organization “Galerna”.
10. Educational Reintegration Program (PDE) DEM.
11. Educational Reintegration Program (PDE) 24 hours.
12. Almendral Targeted Prevention Program (PPF).
LIST OF PARTICIPANTS PARTICIPATORY HEALTH DIAGNOSIS OF COMMUNITY MENTAL
HEALTH

Page32 of 34
 1. Users.
2. University students.
3. Congregation of Religious Adorers (Center for Comprehensive Support for
Women).
4. La Matriz Corporation.
5. Office for the Protection of the Rights of Children and Adolescents (OPD) of
Valparaíso
6. JUNAEB - Skills for Life Program.
7. Kindergarten “My Little Port.”
8. “Providencia” Kindergarten.
9. “Florida” Kindergarten.
10. “Ramón Barros Luco” School.
11. “Leonardo Murialdo” School.
12. Educational Reintegration Program (PDE) 24 hours.
13. Almendral Targeted Prevention Program (PPF).
14. Valparaíso Women's Center.
15. Intercultural Facilitator.
16. Rayen Foye Indigenous Association.
17. Calaucan Indigenous Association.
18. New Faces Foundation.
19. More Self-Employed Older Adults Program.
20. Las Cañas Community Center.
21. Cerro la Cruz Community Center.
22. Playa Ancha Cultural Center – Playa Ancha Community Health Network.
23. Plaza Justicia Family Health Center.
24. Directorate of Health Service Valparaíso - San Antonio.
25. Citizen Participation of Health Service Valparaíso - San Antonio.
26. Center for Research and Technological Development.

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