In general, the applied decentralization model did not provide greater opportunities for women’s needs and demands to be considered in the design and provision of services. In its evolution, it reinforced the critical shortage of health personnel, particularly in rural areas, compromising the quality of services and their problem-solving capacity. In regards to the rules of access to human resources and the inclusion of the gender approach, the results were the following: • Decentralized health facilities reproduced criteria laid down at the central level for the main programs, giving almost exclusive priority to maternal and child health care. • Innovations were strongly conditioned by the collection methods applied by the decentralized entities. Apart from the ministerial policy specifications, this discouraged large women sectors’ attendance at the services. • Regarding rules of management and gender equality, it was observed that the LHC were an opportunity for the participation of local agents, but this did not include women to the same extent and therefore it was not reflected in an inclusion of their perspectives and demands. In sum, although specific actions that were very important and valuable for the female population’s health were undertaken -such as the elaboration of a Violence Victims Attention Protocol, awareness-raising and training activities in terms of women’s rights and the opening of shelters for pregnant women-, these particular interventions have not been sufficient to deploy a comprehensive gender strategy in health care, nor an equitable allocation of resources. At the end of this research, the national political scene had changed dramatically. The Government that started its term in 2008 implemented the “Life Quality and Health Equity” policy, which perceives health as a human right based on the principles of universality, comprehensiveness, equity and participation. The first measure taken was the gratuitousness of the service provision, removing the previously required tariffs. Women’s human rights were included in the new regulations centered in the promotion of gender equality, acknowledging the existence of different needs of men and women.
Conclusions: Invisibility-visibility of gender inequality at the local level There is very low recognition of gender inequalities at local levels, which contradicts the most optimistic discourses on decentralization, and their predictions of greater democratization, face-toface relations, transparency and security -- a model which women, used to comfortably handling close (physical and symbolic) relationships, could supposedly take advantage of, to increase their chances to participate in the public sphere. On the contrary, analysis shows that, in many cases, decentralization can reproduce situations of subordination (Cos-Montiel, 2006) and lead to the capture of local power by elites that do not recognize or commit to the progress towards gender equity (Beall, J. 2006, Kabeer, N. 2003, Massolo, A. 2005). 26