To be effective, it demands redesigning public services to make them genuine health services, and not as these are today due to the hegemony of the Flexner focus on recovery and rehabilitation. In addition, it encourages the development of participatory structures and mechanisms to empower civil society, and become state in the Gramsci's light.
Efectivizarla requiere reorientar los servicios públicos tornándolos genuinamente de salud y no como son ahora para la enfermedad debido a la hegemonía del enfoque flexneriano recuperativo rehabilitador; además conlleva desarrollar estructuras y mecanismos participativos que permita a la sociedad civil empoderarse y tornarse Estado bajo el enfoque gramsiano.