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Nuevo marco técnico para la gestión territorial integral de la salud pública en Colombia – Resolución 1597 de 2025
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Con la Resolución 1597 de 2025, el Ministerio de Salud y Protección Social establece un nuevo marco técnico y normativo para la gestión territorial integral de la salud pública en Colombia. La norma, que articula el Plan Decenal de Salud Pública 2022–2031 con la estrategia de Atención Primaria en Salud (APS), transforma el Plan de Atención Básica en el nuevo Plan de Salud Pública de Intervenciones Colectivas (PIC) y traza responsabilidades claras a departamentos, municipios y prestadores. La gestión pública en salud, bajo este nuevo esquema, será más intersectorial, territorializada, culturalmente adecuada y rigurosamente evaluada.
Gestión integral con enfoque territorial, diferencial y basado en APS
La Resolución se sustenta en principios constitucionales y legales que reconocen la salud como derecho fundamental (Ley 1751 de 2015, Constitución Política, Leyes 715/2001 y 1122/2007). A partir de este marco, define conceptos técnicos clave como la Gestión Territorial Integral de la Salud Pública, la cual abarca planes, programas y estrategias dirigidas a garantizar el derecho a la salud e incidir en determinantes sociales, económicos, ambientales y culturales, incluyendo el cambio climático y la paz territorial.
El documento también actualiza la definición de la Atención Primaria en Salud (APS) como estrategia que integra salud pública, promoción, prevención, diagnóstico, tratamiento, rehabilitación y cuidados paliativos. La atención debe ser integral, continua y orientada por Equipos Básicos de Salud en todos los niveles de complejidad. Asimismo, el enfoque diferencial, étnico, territorial y poblacional, se incorpora de manera transversal, alineado con los capítulos del PDSP para pueblos indígenas, afrodescendientes, víctimas y otras poblaciones.
Doce procesos clave para la gestión en salud pública
El nuevo modelo técnico de gestión se estructura en doce procesos transversales que deben ser liderados y ejecutados por entidades territoriales:
- Planeación integral en salud: formulación, implementación y evaluación del Plan Territorial de Salud.
- Gestión del conocimiento: identificación de necesidades, producción y difusión de saberes.
- Cuidado integral de la salud: desde la promoción hasta los cuidados paliativos, articulado en redes RIITS.
- Direccionamiento de políticas públicas: adaptación de estrategias a contextos y necesidades locales.
- Coordinación intersectorial y transectorial: vinculación de múltiples sectores para incidir en determinantes sociales.
- Participación social y comunitaria: organización, control y vigilancia del sistema desde la ciudadanía.
- Desarrollo de capacidades: fortalecimiento institucional y comunitario para el desarrollo en salud.
- Gestión del trabajo digno y decente: condiciones laborales adecuadas para el talento humano en salud.
- Vigilancia en salud pública: recopilación, análisis y difusión de datos para prevenir y controlar enfermedades.
- Inspección, vigilancia y control (IVC): cumplimiento de normativas sanitarias.
- Gestión de medicamentos e insumos: planificación, compra y uso racional de recursos.
- Monitoreo y evaluación: medición periódica de resultados, calidad y eficiencia administrativa.
Todos estos procesos deben realizarse en articulación con los Equipos Básicos de Salud, actores comunitarios, sectores no sanitarios y redes integrales e integradas territoriales.
PIC: eje operativo de la intervención colectiva en salud pública
El nuevo Plan de Salud Pública de Intervenciones Colectivas (PIC) sustituye al antiguo Plan de Atención Básica y es ahora el instrumento central de acción en los entornos cotidianos. Su formulación parte del análisis de situación de salud (ASIS), los acuerdos intersectoriales y las concertaciones comunitarias. Cada entidad territorial debe contratar la ejecución del PIC con ESE o instituciones equivalentes, priorizando la continuidad de las acciones mediante contratos que operen hasta el 31 de marzo del año siguiente.
Cuando no exista una ESE en el municipio, este podrá ejecutar directamente las acciones que no requieran habilitación o contratar con la ESE más cercana. También se habilita, de manera excepcional, la contratación con universidades u ONG para enfermedades transmitidas por vectores o zoonosis, siempre que no haya capacidad técnica local.
Se prohíbe expresamente la subcontratación de actividades, salvo apoyo logístico, y se promueve la conformación de alianzas entre municipios para intervenciones regionales. El seguimiento técnico-financiero será mensual a nivel territorial y trimestral desde el Ministerio. Los resultados podrán influir en la evaluación de eficiencia administrativa y la asignación de recursos futuros.
Recursos, responsabilidades y evaluación de la gestión territorial
La resolución detalla el uso autorizado de los recursos de la Subcuenta de Salud Pública Colectiva del Sistema General de Participaciones (SGP), limitando su aplicación exclusivamente a acciones de salud pública. Se prohíbe destinarlos a actividades ajenas como compra de alimentos, pago de personal financiado por la UPC, adquisición de dispositivos para discapacidad o impresión de material sin impacto sanitario.
También establece que los recursos no comprometidos de vigencias anteriores se destinarán prioritariamente a actividades de inmunización, enfermedades transmisibles y control de vectores en municipios de categorías 5 y 6, contribuyendo a financiar el funcionamiento de los Equipos Básicos de Salud.
Las responsabilidades están claramente diferenciadas:
- Departamentos y distritos: implementar procesos de gestión, formular y ejecutar el PIC, asegurar la ejecución del 100% de recursos del SGP, asistir a municipios de categorías inferiores y evaluar la adecuación sociocultural de las acciones.
- Municipios: adaptar las intervenciones a contextos locales y grupos poblacionales, garantizar la ejecución técnica y financiera del PIC, y adquirir insumos para control de vectores en municipios de categorías 1 a especial.
- Entidades contratadas para el PIC: garantizar talento humano, condiciones técnicas de ejecución, rendición de cuentas y articulación comunitaria, así como operar con cuentas exclusivas para los recursos públicos.
El seguimiento y evaluación se realizará por componentes: financiero (ejecución del 100% del SGP), administrativo (continuidad del PIC y perfiles adecuados), técnico (coherencia con ASIS y planes), resultados en salud (metas del PDSP y PTS) y atributos de calidad (oportunidad, seguridad, continuidad, coordinación, adaptabilidad y cuidado humanizado).
Régimen de transición y articulación con comunidades étnicas
Es clave mencionar que la Resolución 1597 de 2025 establece un régimen transitorio para ajustar los contratos del PIC en curso o celebrar nuevos en un plazo máximo de 60 días. Además, enfatiza la participación activa de comunidades étnicas, conforme a los capítulos diferenciales del Plan Decenal de Salud Pública y la Resolución 1964 de 2024, que define el enfoque étnico para poblaciones negras, afrocolombianas, raizales y palenqueras.
También se reconocen los lineamientos del Sistema Indígena de Salud Propia e Intercultural (SISPI), que debe integrarse mediante diálogo, consulta previa y concertación, particularmente en la formulación y ejecución del PIC. Se permite contratar actividades comunitarias específicas con organizaciones de base sin ánimo de lucro, priorizando temas como salud sexual y reproductiva o consumo de SPA.
Descargue la resolución completa aquí:
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