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La Organización de los Servicios de Salud en el Departamento Norte de Santander, venía desarrollándose desde la década de los cincuenta bajo la modalidad de Dirección Departamental de Salud, entidad de origen central, dependiente del Ministerio de Salud, presidida por un Director, quien era nombrado por el Ministro del ramo, sin hacer parte del Gabinete Departamental, con autonomía e independencia del Gobernador. La financiación dependía totalmente de la Nación.

Para el desempeño de las funciones atinentes a la prestación de servicios, existían las zonas Sanitarias de Cúcuta, Pamplona, Ocaña y Gramalote. En este esquema, que se mantuvo hasta 1974, básicamente existía una planta de personal mínima compuesta por el Director, tres Médicos que se encargaban de labores técnicas, tres Asistentes Administrativos que fungían a su vez como secretarias y diez funcionarios de nivel medio que se encargaban de funciones operativas, entre ellas las de realizar acciones de prevención.

Desde el año 1975 y en concordancia con los Decretos 350 y 056 se le dio vida jurídica al Sistema Nacional de Salud, teniendo como fin el ordenamiento del Sector Salud a través de la implementación de un enfoque sistemático y la definición y organización de niveles de complejidad.

En Norte de Santander se creó, mediante la figura de contrato de integración tripartito (Ministerio, Gobernación y la Beneficencia) el Servicio Seccional de Salud, como órgano de dirección del Sistema de Salud a nivel departamental, dependiendo administrativamente del Departamento y técnica y normativamente del Ministerio de Salud, debiendo adoptar, adecuar y desarrollar para el cumplimiento de las políticas, planes y programas nacionales, las formulaciones que al respecto le fueran formuladas por el mismo. Bajo estas condiciones (enfoque sistemático y organización por niveles de complejidad) se estructuró el Servicio Seccional de Salud, pensando siempre en desarrollar la prestación del servicio en condiciones de eficiencia y eficacia, de tal manera que el impacto de las condiciones se tradujera en un mejoramiento continuo de las condiciones de salud de los Norte Santandereanos. 

Como características importantes del Ente se pueden mencionar que la Dirección estaba en manos de una Junta Seccional de Salud y de un Jefe de Servicio; la estructura orgánica contemplaba tres divisiones (Atención Médica, Saneamiento Ambiental y Administración), cada una de ellas con sus respectivas secciones y grupos, de acuerdo a sus necesidades. Se crearon las Unidades Regionales de Salud (Cúcuta, Pamplona y Ocaña), de las cuales dependía la asesoría técnica y el seguimiento de las actividades a realizar en los demás organismos de salud. Así mismo, se dio a la tarea de realizar el funcionamiento de centros y puestos de salud y desarrollar el esquema de atención en ellos, pero reservándose el manejo centralizado de los recursos de financiamiento. Para esta etapa y conforme a la estructura adoptada y a las funciones asignadas, la planta de personal creció en un porcentaje bastante significativo hasta llegar a 190 funcionarios en el nivel departamental, pero sin que ese incremento se reflejara en resultados que permitieran un buen desarrollo del sector.

Con el transcurrir de los años se hizo evidente que todo el funcionamiento del sistema giraba alrededor del Servicio Seccional de Salud y que era muy escasa la asunción de competencias de asesoría, vigilancia y control por parte de las Unidades Regionales, creándose una dependencia casi total de los diferentes organismos. A mediados de la década de los Noventa, en Norte de Santander era patente que los resultados no correspondían a las expectativas que se tenían y que el enfoque sistemático que se busco desarrollar, por varios motivos no lograba articular sus diversos componentes. Entre las causas de esta situación se pueden mencionar: prácticas de salud que hacían énfasis en lo curativo dejando al lado los aspectos de prevención de los eventos nosológicos, el escaso reconocimiento y participación de los municipios en la planificación de las acciones, debido a ello al marcado centralismo existente. Pero los problemas que se detectaban en Norte de Santander eran comunes al resto del Territorio Nacional y el Gobierno Nacional estaba trabajando en una propuesta que permitiera enfrentar estas situaciones.

Es por ello que en los años 1990- 1994, se plantea como objetivo fundamental elevar el nivel de salud de la población de menores ingresos económicos, y se empieza a hablar de un nuevo sistema de atención sustentado en esquemas de Seguridad Social de Salud, subsidios a la demanda y, criterios de equidad y de redistribución social. Surge entonces la Ley 10 de 1990, por el cual se reorganiza el Sistema Nacional de Salud, descentralizando la administración de los servicios y colocándolos en manos de gobernadores y alcaldes. En esta ley se incluyeron mecanismos globales para modernizar y reorganizar el Sistema. Sin embargo, aun cuando habían claridad de los objetivos a perseguir, la ley se quedo corta en cuanto al señalamiento de los recursos para ejecutar las acciones, es decir, no se contó con el adecuado soporte financiero que permitiera a las autoridades departamentales y municipales asumir la responsabilidad.

No obstante, a partir de la expedición de la ley 10 de 1990 el Servicio Seccional de Salud de Norte de Santander inicia el proceso de descentralización abocándose a la elaboración de una serie de trabajos relacionados con el análisis y la planeación sectorial, dando origen al Plan Sectorial de Salud 1991- 1994; así mismo, se preparo, sustento y logró la aprobación de la ordenanza No. 036 de enero de 1991, mediante la cual se creo el Instituto de los Servicios de Salud de Norte de Santander “NORSALUD”, como un Instituto descentralizado del orden Departamental con personería jurídica, autonomía administrativa y patrimonio independiente, adscrito a la gobernación del Departamento, con domicilio en la ciudad de Cúcuta, pero con radio de acción en el territorio del Departamento. Por razones de diversa índole NORSALUD no tuvo ningún desarrollo, es más, solo contaba con un funcionario (El Director, quien es nombrado por el Gobernador y encargado de las funciones de Jefe del Servicio de Salud). Los demás, hacían parte de la nómina del Servicio Seccional de Salud. Con base en la situación existente y la normatividad vigente se decidió la conformación de una nueva entidad y fue así como se aprobó mediante ordenanza 039 de Septiembre de 1996 el Departamento Administrativo de Salud de Norte de Santander, con nueva estructura orgánica y manual de funciones de acuerdo a competencias.

Al respecto se destaca el conflicto jurídico que existe para la puesta en marcha del Departamento Administrativo el cual no comenzó a funcionar según la estructura orgánica dispuesta, ni se modificó la planta de cargos. Posteriormente se expidió la ordenanza 008 del 10 de Febrero de 1997, que en esencia guarda las características principales de la ordenanza 039, modifica algunos puntos relacionados con las funciones del Departamento Administrativo, la estructura orgánica y los requisitos de la denominación para el Director de la Institución. La ordenanza 013 del 7 de Mayo de 1997, amplia el término especificado en el articulo decimotercero de la ordenanza 039, para la definición de la planta de personal del Departamento Administrativo hasta el 31 de agosto de 1997. La ordenanza 035 del 29 de Agosto de 1997, amplia el término de la ordenanza 013 hasta el 30 de Junio de 1998 para la definición de la planta de personal, previo estudio elaborado por el equipo técnico del Servicio de Salud.

Es de anotar que esta entidad tampoco tuvo ningún desarrollo. Mediante el decreto 000041 expedido por el Gobernador del Departamento el 6 de Enero de 1999, se creó la Secretaria Departamental de Salud, en cumplimiento de los requisitos del Sistema de Seguridad Social en Salud. Mediante acta se asignaron a la Secretaria de Salud del Departamento las funciones que en virtud del contrato de reestructuración venia desempeñando el Servicio Seccional de Salud, mientras se suscribe el convenio de descentralización con el Ministerio, bajo la dependencia técnica y administrativa de este último, conforme a las políticas y planes nacionales de salud que señale para estos efectos. Mediante el decreto 000699 se deroga el Decreto No. 000041 del 6 de enero de 1999 y se fija la estructura de la Secretaria de Salud, se establecen sus funciones generales y las de sus dependencias y se dictan otras disposiciones. Finalmente el 18 de Julio de 2003, la Asamblea del Departamento expide la Ordenanza 018 mediante la cual se crea el INSTITUTO DEPARTAMENTAL DE SALUD DE NORTE DE SANTANDER, como un establecimiento público del orden departamental, con personería jurídica, patrimonio propio, autonomía administrativa y financiera, ente que funciona plenamente en la actualidad.

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