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Decentralization and Integration of the Supply System in Bolivia

This article discusses the health reform in Bolivia and the need for decentralization and integration of the supply system. It highlights the achievements, challenges, and success factors of the logistics system in improving the distribution of sexual and reproductive health supplies. The article also emphasizes the importance of community involvement and a common vision for comprehensive healthcare.

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Decentralization and Integration of the Supply System in Bolivia

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  1. Pando Beni La Paz Cochabamba Santa Cruz Oruro Potosí Chuquisaca Tarija Decentralization and Integration of the Supply System in BoliviaHow to Protect Sexual and Reproductive Health Supplies Oscar Viscarra Zuna, MD,MPH 25 October 2007

  2. Justification for Health Reform in Bolivia Bolivia initiated its health reform based on the need to change their political system and processes. This initiative recognized and promoted community involvement. The needs of indigenous communities, rural and urban, were included within the legal, political and economic framework. It sought to improve the quality of life of Bolivian women and men, with a more equitable distribution and better administration of public resources.

  3. Changes in Government Strategy Source: Adapted by Carmen Helena Vergara of UNICEF (1998), for the CPPS Pilot Project (2001)[

  4. Health Reform in Bolivia: DESCENTRALIZATION INTEGRATION 1994: Initiated under the Law of Popular Participation (resources to 311 municipalities) 1995: Proclamation of Administrative Decentralization Law 1996: Maternal Child Health insurance 1998- 2002: Basic Health Insurance • 6.4% of tax co-participation under Ministerial Resolution • 96 benefits for pregnancy, children under 5, and general population, includes contraception + Cervical Cancer + STI • Technical programming based on cost effectiveness 1989 – 1996 Implementation of logistics management information system for contraceptives in NGOs and Ministry of Health 1999: Inclusion of the Logistics System within curricula for universities, pharmacist schools, technical nursing schools, and assistant nursing schools • Health personnel begin to record data on consumption of essential drugs, as part of the information system

  5. Health Reform in Bolivia: 2002:Universal Maternal and Child Health Insurance: • 10% of resources of tax co-participation. • National Law (SUMI) • 96 services focused on pregnant women and children under five. 2005: Expanded Universal Maternal and Child Health Insurance. DECENTRALIZATION INTEGRATION • 2002: Single National Supply • System (SNUS) • Based upon the • Contraceptive logistics • Management system 2006: Universal Health Insurance Men, women and children

  6. Roles of the Decentralized Administrative Levels in Bolivia Service Provider: Local Level-Municipalities Health establishments, public sector services + social security + voluntarily enrolled private services. Purchaser of Services: Municipal Level Municipalities with resources from tax co-participation. Regulator: Departmental Level Local health directories (DILOS), comprised of Mayor’s representative, municipal and community representatives (oversight committee) + social control.

  7. Sustainable Financing 100% NATIONAL REVENUE National Customs and Internal Taxes Public Universities National Government Investment – Public Salaries Municipalities S UM I 10% of National Revenues go to the financing of the SUMI 10% 90% SUMI: Universal Maternal Infant Insurance

  8. Evolution of the Logistics System During Decentralization

  9. Evolution of the Logistics System During Decentralization

  10. Effects of Health Reforms on CS • Although the SUMI guarantees funds, local capacity to implement is weak • FP as a priority and political commitment are low • Decision-making for budget allocation, product and provider selection done by/at municipalities and service delivery points • Service delivery statistics/data are only managed/known at local level • There is no national strategy or common vision

  11. Achievements of the Logistics System in Health Reform • Logistics system institutionalized in university and nursing/biochemical school curricula • Under national law, sexual and reproductive health supplies, including contraceptives, are in the public insurance system • Single National Supply System (SNUS) implemented under presidential decree • Standardized information system for all essential drugs and supplies

  12. Success Factors • Some functions of the logistics cycle should remain centralized (ex.): standardization, information system, procurement, and quality control. • Regular monitoring of the logistics system is key to ensuring its efficiency, effectiveness, and transparency. • Prioritizing the logistics management information system in times of health reform. • During the process of integration, information systems must be computerized.

  13. Pending challenges • Achievement of political and technical sustainability (logistics system) • Work with municipal governments to advocate for procurement of contraceptives (bulk procurement) • Improve local capacity for supply chain management • Real-time data on availability of contraceptives at all levels of the health system • Create a common vision for CS

  14. Thank you for your attention

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