Health Sector Reform in Bolivia : A Decentralization Case Study
Bolivia made progress in health status
and equity in the last decade, thanks to the implementation
of a series of health policies directed primarily at
reducing maternal and infant mortality and controlling
communicable diseases. These policies include the
introduction of a focus on health outcomes in the context of
decentralization, the implementation of a public health
insurance, the strengthening of vertically-financed public
health programs and to a lesser extent, an increase in the
size of the sector's workforce and greater
participation of indigenous peoples for health. This report
analyzes these policies, draws lessons from their
implementation, discusses remaining challenges, and provides
recommendations in the context of the country's latest
policy developments. Findings show that while coverage has
increased in almost all municipalities, significant equity
gaps remain between the rich and the poor, the urban and
rural, and the indigenous and non-indigenous. The analysis
suggests that the Ministry of Health should concentrate on
three key issues: first, maintaining the focus on national
priorities in the context of the new, expanded maternal and
child insurance; second, strengthening efforts to extend
care to poor rural areas; and third, improving the
effectiveness of the system in the context of the new
management model.
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Bibliographic Details
| Main Author: |
World Bank |
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| Language: | English
en_US |
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| Published: |
Washington, DC
2004
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| Subjects: | HEALTH SECTOR,
POLICY REFORM,
HEALTH ISSUES,
DECENTRALIZATION,
FINANCING INSTRUMENTS,
PUBLIC HEALTH EXPENDITURES,
SOCIAL SECURITY BENEFITS,
MANAGEMENT OPERATIONS,
HEALTH INSURANCE PLANS,
GOVERNANCE,
INCENTIVES,
VECTOR BORNE DISEASES,
EPIDEMIOLOGICAL INFORMATION,
INDIGENOUS ACTIVISTS,
POVERTY & HEALTH,
RURAL AREAS ADAPTATION,
ANTENATAL CARE,
CHILDBIRTH,
COMMUNICABLE DISEASES,
COMMUNITIES,
COMMUNITY HEALTH,
COST EFFECTIVENESS,
DEATHS,
DOCTORS,
EPIDEMIOLOGICAL SURVEILLANCE,
EQUIPMENT,
EXTENSION,
FIXED COSTS,
HEALTH CARE,
HEALTH CARE SERVICES,
HEALTH EXPENDITURE,
HEALTH EXPENDITURES,
HEALTH FACILITIES,
HEALTH FINANCING,
HEALTH INDICATORS,
HEALTH INSURANCE,
HEALTH NEEDS,
HEALTH OUTCOMES,
HEALTH POLICIES,
HEALTH PROGRAMS,
HEALTH PROMOTION,
HEALTH REFORM,
HEALTH REFORMS,
HEALTH SERVICES,
HEALTH STATUS,
HEALTH SYSTEM,
HEALTH TARGETS,
HEALTH WORKERS,
HOSPITALS,
HOUSEHOLDS,
HOUSING,
INCOME,
INFANT MORTALITY,
INFANT MORTALITY RATE,
INHABITANTS,
INSTITUTIONALIZATION,
LOCAL HEALTH PLANS,
MALARIA,
MIDWIFES,
MORBIDITY,
MORTALITY,
MOTHERS,
NURSES,
NUTRITION,
OCCUPANCY,
OCCUPANCY RATES,
POPULATION GROUPS,
PREGNANT WOMEN,
PRIMARY CARE,
PRIMARY HEALTH CARE,
PUBLIC HEALTH,
PUBLIC SECTOR,
RURAL AREAS,
SERVICE DELIVERY,
SOCIAL EXCLUSION,
SUSTAINABLE FINANCING,
WORKERS,
WORKING CONDITIONS, |
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| Online Access: | http://documents.worldbank.org/curated/en/2002/01/2971132/health-sector-reform-bolivia-decentralization-case-study
https://hdl.handle.net/10986/15209
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