De-Fragmenting and De-Segmenting the Bolivian Health System: Progress and Challenges of a New Health Policy

This presentation analyses the transformation of health services undertaken by the current Bolivian socialist government since 2006 and assesses their impact on the health care delivery system to date. From the author working knowledge, both as independent researcher (two published articles) and as MoH high-level consultant, progress and challenges of the new health policy are assessed in order to improve knowledge on new tendencies in policy design.

Bolivia scores lower than any other Latin American country in health and related equity indica­tors. We analyze the main health sector related factors conditioning this situation during the 1986-2006 health sector reforms and, using a policy documents/official reports review and interviews with decision-makers, we present the main characteristics and critically examine the outputs and outcomes produced so far by the new health policy: The Family and Community Intercultural Health.

Within a segmented and fragmented health system, accessibility and quality of care suffers. While accepting that Bolivian health care delivery still presents these features, we present and analyse, on criteria linked to health system integration, the progresses towards the development of a “Single Health System” (Sistema Único de Salud), the health care delivery model mandated by the new Bolivian Political Constitution.

We discuss issues such as Comprehensive and universal care vs selective and targeted programmes, public health services' restriction of access to basic packages, sector decentralization pathways, modalities of financing, patient affiliation, monitoring and service delivery, income and risk cross-subsidies and stan­dardization of quality and cost of care delivery.

Finally we assess the major challenges for the implementation and sustainability of the new health care delivery model and health policy in terms of social, political and economic viability and technical public health feasibility.

279 words