Local governance dynamics in the Colombian health system: an exploratory cross-sectional study among public health sector officials

Health system governance is essential for effective and equitable healthcare delivery. In Colombia, persistent challenges, including delays, denials, barriers to care, and poor system coordination, suggest weaknesses in local governance. This study aimed to explore local health system governance in Colombia by assessing institutional practices, decision-making processes, and perceptions of public health sector officials. Exploratory cross-sectional study using self-administered online surveys (May–July 2025) with a convenient non-probabilistic sample of 44 health sector officials in stewardship, planning, and oversight roles. Descriptive analyses were performed. While we identified high institutional planning capacity, respondents reported limited decision-making autonomy, external pressures on planning and budget allocation, poor integration of information systems, perceived insufficiency of the benefits package and capitation payment, irregular provider payments, and tariff variability. Findings suggest weak local health system governance in Colombia, highlighting the need to implement a comprehensive reform including strengthened stewardship, information systems integration, adequate financing, and fair provider payments.