Compitiendo entre sí: adquisición local de equipos de protección personal en un contexto de descentralización y alta desigualdad socioeconómica
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Bajo la influencia del federalismo fiscal y las teorías de la descentralización gubernamental, una parte importante de los sistemas de salud de todo el mundo enfrentaron la pandemia de COVID-19 después de haber sido moldeados o reformados por procesos de transferencia de poderes de los gobiernos centrales a los locales. La adquisición de suministros clave es uno de los componentes que opera de manera descentralizada, lo que obliga a los gobiernos locales a competir entre sí. Este fue el origen de lo que se ha llamado las “guerras de licitaciones” entre gobiernos subnacionales al comienzo de la respuesta a la pandemia. Estas guerras llevaron a políticas de centralización en Estados Unidos, Reino Unido y la Unión Europea. Sin embargo, se sabe menos sobre los casos del sur global. Al analizar la adquisición de Equipos de Protección Personal (EPP) en 320 municipios chilenos encargados de la atención primaria de salud, esta investigación proporciona evidencia de los impactos de la competencia gubernamental horizontal en la capacidad de adquirir suministros clave. En Chile, durante la respuesta a la pandemia de 2020, los municipios más ricos pudieron adquirir más mascarillas por habitante, generándose con ello economías de escala que les permitieron acceder a precios más bajos, a diferencia de aquellos municipios con menores recursos. Los autores apoyan la noción teórica de “concurrencia” como un concepto que añade matices al debate sobre centralización-descentralización. En Chile, por ejemplo, si bien el testeo y la trazabilidad de casos SARS-CoV-2 requerían la descentralización de dichas funciones, las compras de EPP probablemente podrían haberse beneficiado de la centralización de los procesos de adquisición para evitar la reproducción de desigualdades territoriales.
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