1 / 14

Programatic Support for Health Reform in Bolivia:

Programatic Support for Health Reform in Bolivia:. Achievements of APL1 and challenges of APL2. Contents. Historical Context and decentralization Objectives and Instruments of Reform Management Agreements Public Insurance Achievements of APL1 Challenges of APL2. Historical Context.

wanda-lowe
Download Presentation

Programatic Support for Health Reform in Bolivia:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Programatic Support for Health Reform in Bolivia: Achievements of APL1 and challenges of APL2

  2. Contents • Historical Context and decentralization • Objectives and Instruments of Reform • Management Agreements • Public Insurance • Achievements of APL1 • Challenges of APL2

  3. Historical Context • Unsatisfactory health indicators considering the level of income and education • 1980s: Hyperinflation and stabilization hit the public health sector • Late 1980s: Traditional investments in hospitals • Early 1990s: SIF, rotating fund for drugs, NGOs

  4. Decentralization • 1994 Legislation: Tax co-participation in proportion to population • Decentralization “by factors”: Infrastructure and investment to the municipality, employees to the prefecture • Unclear responsibilities by government level led to significant decrease in financing and coverage

  5. Objectives Reduction in maternal and infant mortality Prevention of endemic diseases Instruments Clarify objectives and responsibilities with performance contracts Provide incentives to providers with Basic Health Insurance Objectives and Instruments of the Health Reform and the APL

  6. Management Agreements and Performance Indicators • The country and the donors: HIPC, CDF, PRSP • DCA includes Performance Indicators remedy • The regions and the central government • Key features : few variables and periodic revisions

  7. Objectives of SBS • Reduce the cost barriers for users • Improve incentives for providers • Ensure a basic package of benefits • Assign responsibilities by jurisdiction • Introduce competition with private sector

  8. SBS Operation • Created in 1996, expanded in 1999 -- $20m/year • Financing assured by earmarking coparticipation revenues -- better distributed than infrastructure/personnel • Fee for service - good for information systems and control • Includes reimbursements and incentives • Little community/user participation

  9. Achievements: Institutional Births

  10. Achievements: Child Coverage Vaccinations Coverage Coverage Year Year

  11. Achievements: Equity in Births Coverage Municipality Quintile by GDP

  12. APL1: Achievements • Created a results-oriented culture • Improved the provision of public health services where these services exist • Met APL1/APL2 triggers: • Performance Indicators met 7/8 targets a year ahead of schedule • 4 institutional innovations: PAs, SBS, IMCI/MBP, EPI • Disbursements

  13. APL2 • Retain parameters of APL1: PI, DO, structure of components • Further strengthen emphasis on results/evaluation • Expand to next logical stage – Reach out to underserved regions • Focus on sustainability – SBS, immunizations, new health teams

  14. APL and Public Expenditures • APL1 (US$25m) leveraged US$80m of SBS and US$50m of immunization program • Influenced HIPC2 – targets and use of savings • APL2 ($35m) will now attempt to influence central government payroll expenditures (US$100m/year)

More Related