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Daniel A. Maceira, Ph D and M. Eugenia Barbieri, B A. Health Economics Department, Center for the Study of the State and Society (CEDES), Sánchez de Bustamante 27, Buenos Aires, Argentina, (54-11) 4861-2126, danielmaceira@cedes.org
Objective: The aim of the paper is to evaluate the probability of improving health care indicators at the departmental and municipal level, by analyzing the impact of decentralization and the recent mechanisms of debt relief in Bolivia.
Data: Bolivia constitutes and exceptional case of huge inequalities in income, and geographical and multiracial barriers, with large population groups located in rural areas with strong economic limitations. The decentralization process, born after the 1994 “Popular Participation Law”, showed the intention to redefine the political context, by transferring the management and the control of resources, as well as the responsibilities in the provision of services from the central level to the regional and local jurisdictions.
Methods: The methodology used included intertemporal comparisons and logistic models, built on the data mainly provided by both the 1991 and the 2001 Censuses of Population and Living Conditions.
Results: Results show the limitations of the decentralization process in the allocation of resources to improve the Bolivian health and poverty conditions. In addition, geographical factors (regional variables and urbanity levels) constitute strong limitations that explain not only the evolution of the selected health indicators, but also the impact of the reform.
Policy implications: The paper suggests to the ongoing reform process a series of recomendations to improve the effects of decentralization on the outputs of the national health care system. They are associated to the criteria to coordinate activities at different decentralized levels, as well as a series of indicators to improve resource allocation among municipalities.
Learning Objectives:
Keywords: Urban Health, International Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.