Monitoring, documentary traceability, and territorial governance in public health

A comparative analysis of the MCCS Strategy in three municipalities of Antofagasta, Chile

Abstract

Obesity poses an epidemiological and social challenge in Chile, linked to social and territorial determinants that go beyond individual responsibility. In this context, local governments play a strategic role in health promotion by intervening in environments and living conditions. This article critically analyzes the implementation of the Healthy Municipalities, Communes, and Communities Strategy (MCCS, by its Spanish acronym) in Antofagasta, Calama, and Tocopilla, Chile, during the 2019–2021 and 2022–2024 cycles, from the perspective of territorial governance, institutional monitoring, and documentary traceability, with the aim of identifying barriers, facilitators, and patterns of local performance. A qualitative approach with a descriptive-comparative design was employed, based on the documentary analysis of 86 official records, including municipal plans, monitoring reports, agreements, resolutions, and regulatory guidelines, organized by municipality and period. The analysis considered dimensions of technical, financial, community, regulatory, and intersectoral governance, as well as the effect of the critical 2019–2024 context on continuity, coordination, and implementation capacity. The results showed divergent trajectories. Antofagasta exhibits a persistent gap between planning and implementation, with under-execution of funds, technical discontinuity, and weak local coordination. Calama demonstrates organizational learning and institutional consolidation, with high implementation rates, territorial outcomes, and intersectoral strengthening. Tocopilla exhibits intermediate performance, with administrative continuity, though with less evaluative and intersectoral development. It is concluded that technical continuity, information management, and monitoring traceability influence the sustainability of the strategy and territorial equity.