Repblica de Bolivia Ministerio de Salud y Deportes

República de Bolivia Ministerio de Salud y Deportes Bolivia: Child Survival with Dignity Dr. Álvaro Muñoz-Reyes Navarro Minister of Health and Sports London, December 2005 1

República de Bolivia Ministerio de Salud y Deportes Overview of the presentation 1. The state of child health in Bolivia 2. Response of the health system 3. • Removing financial barriers to access • Increasing coverage through neonatal and Community IMCI • Building national and local alliances for sustainability Implications for health policies 2

República de Bolivia Ministerio de Salud y Deportes The state of child health in Bolivia Trends in Child Mortality in Bolivia MDG 4, Objective 5 Source: DHS 1989, 1994, 1996, 2003 3

República de Bolivia Ministerio de Salud y Deportes Response of the health system Evolution of the Public Health Insurance Model to SUMI National Insurance for Motherhood, Infancy and Childhood (SNMN) May 1996 Basic Health Insurance 31 December 1998 Maternal and Child Universal Health Insurance 21 November 2002 2005 1996 Beginning with SBS (1998), the IMCI strategy was completely incorporated 4

República de Bolivia Ministerio de Salud y Deportes The importance of an effective legal framework Law of Administrative Decentralization Hydrocarbon Tax Law of Popular Law of National Participation Dialogue Ø State and Local Governments with greater social responsibility and financial resources Ø Greater efficiency and efficacy in management Ø Redistribution of public revenues Law of SUMI Ø Greater participation and control by social stakeholders 5

República de Bolivia Ministerio de Salud y Deportes Financing of SUMI 100% National Revenues National Customs and Internal Taxes Municipalities 2% 90% Investment Complementary Resources 10% SUMI 8% Source: Bolivia MOH • National Liability Fund -Dialogue Account 2000 • Direct Taxes on Hydrocarbons 6

República de Bolivia Ministerio de Salud y Deportes Maternal and Child Universal Health Insurance (SUMI) • Is a State Policy created to reduce the morbidity and mortality of mothers and children • Improves access and eliminates economic barriers to health services • Is the main prioritized policy of the Ministry of Health and Sports • Is a component of the Bolivian Poverty Reduction Strategy • Is the principal means to reach the MDG objectives in health 7

República de Bolivia Ministerio de Salud y Deportes SUMI coverage according to place of residence, Bolivia - 2004 Urban Population: 62. 4% Source: Bolivia MOH 2005 8

República de Bolivia Ministerio de Salud y Deportes Conceptual elements in Community - IMCI Community Context Community Dialogue Health System Individual Change Collective Action Impact SUMI Social Change Application of key practices in the care of the child and the newborn 9

Strategic action lines in Community-IMCI República de Bolivia Ministerio de Salud y Deportes Strengthening the link between the community and health facilities Development of alliances within and between sectors Engagement of social agents Families and the community apply the key practices in the care of the child and the newborn Home visits Community mobilization and surveillance 10

República de Bolivia Ministerio de Salud y Deportes Results from the Community. IMCI component • Achieved the participation and empowerment of social agents in the promotion of key practices • Strengthened the link between health facilities and the community • Stimulated intersectoral efforts A focus only on Community Health Workers (CHW) is not sufficient to improve family practices Source: Red Cross, PAHO/WHO. Community IMCI Evaluation. 2005. Plan International Bolivia, BASICSII. 2002 11

República de Bolivia Ministerio de Salud y Deportes Neonatal Community-IMCI: Selected Results Source: Save the Children/SNL, 2004 12

República de Bolivia Ministerio de Salud y Deportes The alliances in support of children and newborn Inter-Agency Coordination Committee MOH- bilateral and multilateral cooperating agencies National Alliance for the Community IMCI scale-up MOH- PAHO/WHO-UNICEFUSAID: PROCOSI (Network of NGOs) and PROSIN/USAID - Red Cross - Plan International Inter-Institutional Council of Safe Motherhood The First Lady's Office-MOH-Other ministries. NGOs-Cooperating Agencies-Women’s organizations Community IMCI and Newborn Education- Neighborhood Groups. Community health workers. Municipalities-Mothers’ Clubs NGOs, other local organizations Central and Departmental Levels Local Level 13

República de Bolivia Ministerio de Salud y Deportes The alliances in support of children and newborns have facilitated: • Mobilization of human and economic resources • Synergy of efforts and harmonization of interventions • Greater possibility of sustaining the key interventions • Incorporation of new social agents and other sectors • Promotion of local development 14

República de Bolivia Ministerio de Salud y Deportes • Implications for health policy Access – Elimination of economic barriers improves access to healthcare – Prioritization of excluded population groups (indigenous, rural area habitants and others) • Coverage – One must seek to improve the quality of care in order to increase utilization of services – Strategies should be oriented toward user (client) satisfaction and focused on intercultural, gender or generational perspectives – Policies should prioritize interventions in favor of neonatal health integrated with maternal health • Sustainability – Alliances should be in harmony with national policies of health – SUMI should motivate greater social participation Boys and Girls Have the Right to a Life…. a Life with Dignity 15

República de Bolivia Ministerio de Salud y Deportes Thank You 16