This article analyses the incorporation of the concept of fiscal sustainability in Colombian legislation. This has been framed within the global trends of third generation reforms, in which the role of the Congress of the Republic in defining fiscal priorities and goals has been relegated. These have been subordinated to global evaluation schemes, generating incentives for compliance with creditors, without involving processes of social stability or concentration of wealth. Reforms have involved constitutional amendments and three regulatory phases: The first, with the incorporation of transparency and dissemination mechanisms; the second, with the implementation of the fiscal rule; and the third, with the post-pandemic adaptation that makes the rule more flexible but generates greater technocratic control, which implies that the self-imposed restrictions have been dynamic. However, they have become disconnected from the purposes of the social rule of law and the endorsement of the social contract, due to the constant fiscal restriction on governmental actions materialized in public policies.

Guarantee the right to health is one of the biggest challenges for the Colombian state and one of the biggest causes of social conflict. Although systems and protection mechanisms have been created, those have not been sufficient to meet the access to that right. However, with the decentralization process, powers have been delegated to local authorities which perform additional activities to what has been stipulated in the sectorial minimum requirements defined by the Ministry of Health and Social Protection, in response to the vision of thein habitants of a territory about a problem. The initiatives that have been undertaken in some cases are innovative as those expand the services or define new mechanisms of action to achieve greater effectiveness in the activities and public health projects. The aim of this paper is to propose a scheme of analysis in public health from a temporary socio-territorial approach, which is addressed from instruments of territorial and sectorial planning, identifying commonalities, gaps, continuity and ruptures between these, based on the determinants of health by the World Health Organization (WHO).