By World Bank

Bolivia has made major development in overall healthiness prestige and fairness within the final decade, a result of implementation of a chain of future health regulations directed essentially at lowering maternal and baby mortality and controlling communicable ailments. those rules comprise the creation of a spotlight on health and wellbeing 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 quantity, a rise within the dimension of the sector's crew and larger participation of indigenous peoples. overall healthiness area Reform in Bolivia analyzes those regulations, attracts classes from their implementation, discusses ultimate demanding situations, and gives innovations within the context of the country's most recent coverage advancements. Findings exhibit that whereas assurance has elevated in just about all municipalities, major fairness gaps stay among the wealthy and the terrible, the city and rural, and the indigenous and non-indigenous. The research means that 3 key concerns must be addressed: - conserving the point of interest on nationwide priorities within the context of the newly extended maternal and baby assurance; - Strengthening efforts to increase care to negative rural parts; and - enhancing the effectiveness of the process within the context of the hot administration version.

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

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To do so, it developed instruments to focus activities at the departmental and local level on the national priorities and increase accountability of all actors within the system. This included the setting of annual national targets in priority indicators, which were inserted in the government’s commitments with the international cooperation (World Bank, HIPC, and PRS). To make sure that this shift in focus would become effective throughout the system, the MOH started signing annual performance agreements with each SEDES that set regional targets in priority indicators and clarified the responsibilities of each government level.

1 for the list of indicators included in the PAs). They establish the “terms of reference” of the Regional Health Authorities and are evaluated semi-annually by the MOH. Results The new focus on health outputs strengthened the accountability within the system and directed efforts towards the national priorities. The MOH met practically all the targets agreed upon with 17. One of the innovations of this project was that it included the health targets into the legal agreement of the loan to condition year to year disbursements.

The large municipalities, however, most of whom were politically opposed to the government coalition parties, strongly opposed decentralization, fearing that it would bring them additional responsibilities without the necessary accompanying resources. They were backed by the unions and most professional organizations who saw in decentralization a weakening of their central bargaining power. As a result, the health sector was never fully decentralized to municipal governments. Since 1994, the responsibility for the management of human resources lies with the MOH’s regional administrations.

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