Download Health Sector Reform in Bolivia: A Decentralization Case by World Bank PDF

By World Bank

Bolivia has made major development in overall healthiness prestige and fairness within the final decade, a result of implementation of a sequence of wellbeing and fitness guidelines directed basically at decreasing maternal and little one mortality and controlling communicable illnesses. those guidelines comprise the advent of a spotlight on future health results within the context of decentralization, the implementation of public medical health insurance, the strengthening of vertically-financed public well-being courses and to a lesser volume, a rise within the measurement of the sector's crew and larger participation of indigenous peoples. healthiness quarter Reform in Bolivia analyzes those rules, attracts classes from their implementation, discusses ultimate demanding situations, and offers suggestions within the context of the country's most recent coverage advancements. Findings convey that whereas insurance has elevated in just about all municipalities, major fairness gaps stay among the wealthy and the bad, the city and rural, and the indigenous and non-indigenous. The research means that 3 key matters have to be addressed: - holding the focal point on nationwide priorities within the context of the newly improved maternal and baby assurance; - Strengthening efforts to increase care to terrible rural parts; and - bettering the effectiveness of the method within the context of the recent administration version.

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Extra info for Health Sector Reform in Bolivia: A Decentralization Case Study (World Bank Country Study)

Sample text

One of these is the “Mancomunidad,” a voluntary association of municipalities within a set judicial framework, for a specific purpose. However, past experience with setting up these formal mancomunidades around a given health network (see Box 1) suggests that it is a time-consuming and relatively complex process. On the other hand, the functioning of a multi-municipal DILOS could be made effective through the “Transitory Municipal Unions,” a more informal version of the mancomunidades. To ensure follow up of health goals set in the PAs and the Local Health Plans, the monitoring and evaluation function should be institutionalized within the MOH and the SEDES.

In addition, by law, the Health Insurance Funds must contribute 5 percent of their total income to the national government as a subsidy for public health interventions. 16 However, the Health Insurance Funds don’t always fully meet this commitment and similarly, the national government does not always pay the contributions it owes the Cajas, as a public employer. 67 Source: SNIS 2001. 16. Year 2000, including all public Health Insurance Funds (Cajas). 8 Public Exp. 4 Source: Based on INE 1999 (MECOVI) and Cárdenas (2000).

Finally, the remaining 2 percent come from the Social Investment Fund (FPS) and other public entities. 15 Between 1990 and 1994, MOH expenditures experienced rapid growth; but between 1994 and 1998, which coincided with the country’s decentralization, MOH spending dropped again in real terms, practically to its 1991 level. 1). As a result, central public health expenditures reached US$100 million in 2001. 14. Encuesta de Hogares MECOVI 2000. 15. The analysis does not include the pensions to widows of the Chaco war, which were paid by the MOH at the beginning of the 1990s.

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