Bolivia

This study aimed to elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health care in their communities can be improved. [from abstract]

The most common problems related to Health Workers Salaries and Benefits (HWSB) in Bolivia, Peru and Chile are shortage of health workers, disparity of skills, poor distribution of health workers, inadequate working environments and low knowledge about the characteristic of HWSB. This report collects data about these countries, showing that the wages of doctors during the last fifteen years have generally had to increase more than the wages of other workers. [adapted from executive summary]

This book considers the topic of scaling up with a focus on ways to increase the impact of health service innovations that have been tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting, sustainable basis.

Chapter 8 of this book describes an innovative educational approach to capacity building and scaling up reproductive health services in Latin America. It explains how the capacity to provide innovative training was scaled up in public sector reproductive health services in Brazil, Bolivia and Chile. [from introd

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts.

Many NGOs providing reproductive health (RH) services are facing reductions in donor funding, requiring them to generate more of their own resources. Prosalud, CIES and APSAR, Bolivian NGOs, wanted to build skills in costing and market research to support efforts to improve financial sustainability. Staffs attended a one-week workshop, followed by implementation of three operations research (OR) studies designed to reinforce skills and generate information for decisionmaking. The Prosalud and CIES studies included the calculation of unit cost per service; measurement of client willingness to pay (WTP) higher prices for services, and a market segmentation assessment in selected areas where Prosalud clinics are located.

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization.

This comparative study evaluates the implementation of decentralization of health systems in three Latin American countries: Chile, Bolivia, and Colombia. In terms of the relationship between decentralization and system performance in general, the findings support the conclusion that both the die-hard detractors and the fervent advocates for decentralization are wrong. Decentralization appears to be improving some indicators of equity, such as a tendency toward similar per capita expenditures for wealthier and poorer municipalities, and to be associated with increased and more equitable per capita spending on promotion and prevention.