Did Colombia's COVID-19 tracing and isolation strategy fail? An analysis reveals why the PRASS system didn't work as expected.

During the harshest months of the COVID-19 lockdown, Colombia opted for a measure that would allow the economy to reopen without jeopardizing public health: the PRASS program, which stands for Testing, Tracing, and Selective Sustainable Isolation. On paper, it was a logical solution. In practice, it ended up reflecting the structural flaws of the health system and territorial inequality, according to a case study that qualitatively analyzed the program's results.

The so-called PRASS (Practical Social Security System) was created in mid-2020 with an ambitious goal: to break the chains of virus transmission without locking down the entire population. To achieve this, cases needed to be identified, contact traced, and infected individuals isolated in a timely manner. Key components included financial compensation for those who had to self-isolate if they were low-income, and the participation of health insurance companies (EPS), occupational risk insurers, hospitals, and local authorities.

The study was led by researchers from the Center for Sustainable Development Goals at the University of the Andes and the Department of Public Health at the Industrial University of Santander. It is part of the Alliance for the Generation of Evidence on COVID-19, its Response, and Lessons Learned for the Post-Pandemic and Future Epidemics (Ágora). Specifically, the study examined how this strategy actually worked through interviews with 30 key stakeholders—national and regional officials who participated in the program's implementation. The analysis revealed that the PRASS program failed to take off as expected.

In 2021, a study published by Julián Fernández-Niño, director of epidemiology at the Ministry of Health during the pandemic, and his team established that the PRASS could have reduced case fatality by about 48% if it managed to contact, identify, isolate, and diagnose five people for every positive case. But the reality is that only 39.3% of cases had at least one contact, and less than 25% reached the goal of five or more contacts. Or, in other words, the gap between theory and reality was enormous.

“The implementation of the PRASS program revealed social complexities in implementing selective isolation. Our study highlighted the main barriers to program implementation, but we must also highlight facilitators such as coordination between different health sectors: national-territorial, public-private, and private-private. These coordination mechanisms should exist in normal times so that in emergencies, the response is more effective,” explained Sandra Martínez, the study's lead researcher.

Interviews with actors who participated in the program revealed several reasons for its poor performance. One of them, according to their responses, was that sustainable isolation was not a realistic option for those without guaranteed daily income and was designed without fully considering the country's social, economic, and territorial conditions. "The program collided with historical realities that limited its implementation," they concluded after analyzing the interview responses. For example, many people could not self-isolate because they lived in the informal economy—the so-called "rebusque" (scavenging)—or because they shared small spaces with several people.

“Speaking of sustainable isolation when people have to go out and fend for themselves day to day, when they live in very small spaces, where they can't separate themselves […] That was… I would say… an impractical and very unknown epidemiological purism. I think part of the problem was that there was a well-focused response from the areas of epidemiological surveillance, epidemiology, and public health, but with very little coordination with the entire area of social support networks and all of social development […] And that was insufficient, and we realized the inequity that exists, the lack of solidarity, a weak social fabric, which is what we really see in our country,” responded the leader of an EPS that participated in the study.

On the other hand, the PRASS (National Health Service) called for the coordination of actors who, in practice, didn't work together. Some territories managed to coordinate efforts thanks to the leadership of their governors, but in others, "the main department took charge of everything, and it was something that fell to the EPS," said one departmental leader of the PRASS interviewed. The fragmented health system, lacking efficient coordination mechanisms, further complicated matters.

Another important finding the researchers made during the interviews was that the program's teams also faced multiple barriers. In many cases, public health professionals were hired on a service-based basis, with no continuity, delayed payments, and insufficient staff to respond to the crisis.

Added to this was a crucial technical problem: the Segcovid information system, created to track cases and contacts, suffered frequent failures, resulting in data loss, manual record-keeping, and overloading the team. "When the system failed, PRASS failed," several interviewees admitted. Furthermore, these failures affected the delivery of financial compensation to the most needy, one of the program's pillars.

Finally, interviewees highlighted two additional obstacles. First, contact tracing, not only due to the volume of people who needed to be followed, but also because people often didn't answer the phone, didn't want to provide information, or simply didn't trust the system. Second, territorial differences. In rural, dispersed, or resource-poor areas, implementation was much more difficult, and some municipalities had only one or two people in epidemiological surveillance and were unable to establish the necessary operational structure.

The researchers emphasize that, in the future, designing strategies on paper is not enough. Implementing a program like PRASS requires robust epidemiological surveillance, real coordination between stakeholders, functional information systems, and social conditions that make isolation possible, the report concludes. Tracing goals must be adapted to the context and not be identical for a connected city like Bogotá and for a rural border municipality.

“PRASS was a necessary strategy to contain transmission through tracing, isolation, and monitoring. But its implementation proved more complex than anticipated, requiring coordination between health, technology, social protection, local governments, and risk communication, as well as data integration and building citizen trust. Its lessons on governance, interoperability, and social legitimacy will be key for future pandemic responses,” concluded Zulma Cucunubá, director of the Ágora Alliance.

For the next time Colombia faces an epidemic—because it's clear, according to experts, that there will be a next time—the researchers propose strengthening public health from a structural perspective: with solid governance, stable technical teams, and better connectivity. But they also call for consideration of the most vulnerable: without support networks, without trust in the State, and without minimum guarantees, any strategy will once again fall short.

The Alliance for the Generation of Evidence on Covid-19, its Response and Lessons Learned for the Post-Pandemic and Future Epidemics (Ágora) is a research project led by academics from several universities and funded by Minciencias. It seeks to recognize lessons learned that support decision-making in public health and plan effective actions in future health emergencies.

The results of the Agora Alliance, along with key evidence on the pandemic response and lessons for post-pandemic and future epidemics, will be presented on July 25 at an event at the Pontificia Universidad Javeriana, which will also be broadcast online.

Environment and Health Journalist