Project: BUILDING CAPACITY FOR HEALTHCARE REFORM IN BOLIVIA

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ProjectBUILDING CAPACITY FOR HEALTH-CARE REFORM
IN BOLIVIA
Canadian Society for International Health CSIH
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Purpose To support the MHSS in building
Bolivias new health-care system via the
implementation of the SHP management model at the
local/regional level.

• Proposals
• Promote the formulation and application of
  regulatory instruments (standards) for
  health-care sector institutions at the
  local/regional level, based on the new legal
  framework of the MHSS.
• Strengthen institutional and social management
  capacity in health care at the health-care
  district level.
• Strengthen and build on the management capacity
  of service networks at the local level within the
  framework of the new care model (FCH y BHI).
• Systemize the management model validated at the
  local level and promote its institutionalization
  in the DHS, as well as its extension and
  implementation at the national level.

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Strategic guidelines for technical assistance
Technical assistance for the institutionaliza- ti
on of the decentralized and participatory SHP
management model at the DHS level, and its
nation-wide dissemination.
Technical advice for the implementation of SHP
management in the pilot Districts of SL y GY.
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Background

• Cooperation agreements between Bolivia and
  Canada.
• Structural reform by the Bolivian government.
• Health-care reform proposal SHP
• Relevant Canadian experiences with health-care.

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Principles and overall approach of the Project
Systematic, multi-sector approach to analyzing
problems and solutions.
Gradual expansion based on sucessful experiences
locally, nationally and in Canada
Consultation, coordination and cooperation
between institutions and sectors.
Strategic planning and strategic result-based
management
Health-Care Reform STRATEGIC HEALTH PLAN SHP
Iterative work
LOCAL SHP in pilot Districts
Decentralization and Popular Participation Institu
tional capacity-building Cross-cultural and with
gender equality
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Socio-cultural and economic context
Intention Improve health care Improve the quality
of life
Urban sector
Rural sector Equal care with respect to urban
services
SHP local/regional
Players Government institutions Civil
society Private society Health-care sector
Processes Training Organization Systemization Inst
itutionalization
Local needs and demands Decentralization and
Participation Legal uniformization
Management Social control Coverage,
Accessibility, Quality and Human warmth
Health-Care Reform Process
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The Projects approach and how its strategies fit
together
Formulation and application of standards
Multi-sector, pan-institutional approach
Institutional health-care management
Training for the new management model
Training for the new care model
Cultural and gender equality
systemization Institutionalization
CB
Global management
Service network management
Social management in health-care
Decentralization Participation Sustainability
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Gradual extension of basic health insurance to
make it universal. Consolidation of the Basic
Health Package (Illness - Nutrition - Promotion
and Mother-Child Insurance)
Basic Health Insurance Community Health
and Epidemiological shield
Equity
Quality
PES
Healthy Municipalities
New management model
Coverage

• Descentralization
• Popular Participation
• Institutional efficiency and effectiveness

• Human safety
• Social justice
• Organization and participation
• Recreation and culture
• Solidarity

• Proper nutrition
• Good hygiene habits.
• Water and sewers
• Healthy, safe housing
• Access to services

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Building Capacity for Health-Care Reform
Steps
1. Organization and Prep. 2. Implementation 3.
Systemization

• Location
• DHS
• Tarija Beni
• Districts
• San Lorenzo
• Guayaramerin

Constants Gender and cultural equality
Canadian and Bolivian technical assistance
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Insitutional management Social management Manageme
nt of standards Network management
International Plan Caritas UNICEF PROSIN
Provision of services BHI FCH

Management 25060 25233
SHP
CSIH
72 provisions of service by SBS 24 PHC programs
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HYPOTHESIS The SHP will only be implemented
properly at the local level if the District and
key institutions have global management capacity
Strategic goal of the District Improve the health
of the population
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LOCAL SPHERE
Civic Space Mobilization Participation Control
Cultural space (Values, practices)
Local society of the SL and GY Districts Communiti
es and neighbourhoods
Capacity-building (local/regional long-term
vision, synergy, joint efforts, contribution
Implementation of theSHP with the new management
and care model
Key institutions DISTRICTS, TOWNS, GRASSROOTS
ORG, NGOs
Individuals and families
Level of health and quality of life
Individual and family capacities (self-esteem,
identity, civic reflection, participation,
mobilization, contribution, etc.
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Levels of impact of the Project
Validation of the SHP management model at the
local level - Institutional management - Social
management - Management of PHC Network
Normative capacity of local SHP management
Central level MHSS General Director of Health
Services General Director of Epidemiology
Strategic space
Institutionalization of the SHP, decentralization
and participation
Regional level DHS
Tactical space
Institutional capacity-building.Management
leadership capacity. Result-based management,
negotiation, consultation, IEC, equity and
sustainability.
Local level Health Districts
Operational space
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Step 3 Systemization and institutionalization
Step 1 Organization and preparation
Step 2 Implementation
FCH
BHI
Ensures institutionali-zation and dissemination
Generates the conditions
Guarantees the quality of SHP and AOP
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STEP 1
Update of the Districts organizational-functional
structure.
1.1.
Joint efforts of the PPP of the Districts SHP.
1.2.
Overall diagnosis of the District.
1.3.
Participatory elaboration of the Districts SHP.
1.4.
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Step 2
Participatory elaboration of the management AOP
2.1.
Participatory carrying out of the AOP
2.2.
Participatory evaluation and follow-up of the AOP
2.3.
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Step 3
Systemization of Project training by steps and
sub-projects
3.1.
Systemization of the SHPs management model in
the District
3.2.
Institutionaliza-tion of the local management
model in the DSH
3.3.