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  1. 1. Project: BUILDING CAPACITY FOR HEALTH-CARE REFORM IN BOLIVIA Canadian Society for International Health CSIH
  2. 2. Purpose: To support the MHSS in building Bolivia’s new health-care system via the implementation of the SHP management model at the local/regional level. <ul><li>Proposals: </li></ul><ul><li>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 . </li></ul><ul><li>Strengthen institutional and social management capacity in health care at the health-care district level. </li></ul><ul><li>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). </li></ul><ul><li>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. </li></ul>
  3. 3. Strategic guidelines for technical assistance Technical assistance for the institutionaliza- tion 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.
  4. 4. Background <ul><li>Cooperation agreements between Bolivia and Canada. </li></ul><ul><li>Structural reform by the Bolivian government. </li></ul><ul><li>Health-care reform proposal: SHP </li></ul><ul><li>Relevant Canadian experiences with health-care. </li></ul>
  5. 5. Principles and overall approach of the Project Health-Care Reform STRATEGIC HEALTH PLAN SHP LOCAL SHP in pilot Districts Decentralization and Popular Participation Institutional capacity-building Cross-cultural and with gender equality Iterative work Gradual expansion based on sucessful experiences locally, nationally and in Canada Systematic, multi-sector approach to analyzing problems and solutions. Consultation, coordination and cooperation between institutions and sectors. Strategic planning and strategic result-based management
  6. 6. Socio-cultural and economic context Health-Care Reform Process Urban sector Rural sector Equal care with respect to urban services SHP local/regional Intention Improve health care Improve the quality of life Local needs and demands Decentralization and Participation Legal uniformization Management Social control Coverage, Accessibility, Quality and Human warmth Processes Training Organization Systemization Institutionalization Players Government institutions Civil society Private society Health-care sector
  7. 7. The Project’s approach and how its strategies fit together Training for the new management model Training for the new care model Formulation and application of standards Institutional health-care management Service network management Social management in health-care Cultural and gender equality CB systemization Institutionalization Decentralization Participation Sustainability Multi-sector, pan-institutional approach Global management
  8. 8. PES Basic Health Insurance Community Health and Epidemiological shield New management model Healthy Municipalities <ul><li>Proper nutrition </li></ul><ul><li>Good hygiene habits. </li></ul><ul><li>Water and sewers </li></ul><ul><li>Healthy, safe housing </li></ul><ul><li>Access to services </li></ul>Gradual extension of basic health insurance to make it universal. Consolidation of the Basic Health Package (Illness - Nutrition - Promotion and Mother-Child Insurance) <ul><li>Descentralization </li></ul><ul><li>Popular Participation </li></ul><ul><li>Institutional efficiency and effectiveness </li></ul>Quality Coverage Equity <ul><li>Human safety </li></ul><ul><li>Social justice </li></ul><ul><li>Organization and participation </li></ul><ul><li>Recreation and culture </li></ul><ul><li>Solidarity </li></ul>
  9. 9. “ Building Capacity for Health-Care Reform” <ul><li>Location </li></ul><ul><li>DHS: </li></ul><ul><li>Tarija Beni </li></ul><ul><li>Districts: </li></ul><ul><li>San Lorenzo </li></ul><ul><li>Guayaramerin </li></ul>Steps 1. Organization and Prep. 2. Implementation 3. Systemization Canadian and Bolivian technical assistance Constants: Gender and cultural equality
  10. 10. SHP Provision of services BHI FCH Management 25060 25233 72 provisions of service by SBS 24 PHC programs Insitutional management Social management Management of standards Network management CSIH International Plan Caritas UNICEF PROSIN
  11. 11. 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 Strategic goal of the Project Institutional capacity-building for the Health-Care Network Improve the District’s management capacity
  12. 12. LOCAL SPHERE Civic Space Mobilization Participation Control Implementation of theSHP with the new management and care model Level of health and quality of life Cultural space (Values, practices) Capacity-building (local/regional long-term vision, synergy, joint efforts, contribution Individual and family capacities (self-esteem, identity, civic reflection, participation, mobilization, contribution, etc. Local society of the SL and GY Districts Communities and neighbourhoods Key institutions DISTRICTS, TOWNS, GRASSROOTS ORG, NGOs Individuals and families
  13. 13. Levels of impact of the Project Validation of the SHP management model at the local level - Institutional management - Social management - Management of PHC Network Strategic space Tactical space Operational space Normative capacity of local SHP management Institutionalization of the SHP, decentralization and participation Institutional capacity-building.Management leadership capacity. Result-based management, negotiation, consultation, IEC, equity and sustainability. Central level MHSS General Director of Health Services General Director of Epidemiology Regional level DHS Local level Health Districts
  14. 14. Step 3 Systemization and institutionalization Step 1 Organization and preparation Step 2 Implementation Generates the conditions Guarantees the quality of SHP and AOP BHI FCH Ensures institutionali-zation and dissemination
  15. 15. STEP 1 Update of the District’s organizational-functional structure. Joint efforts of the PPP of the District’s SHP. Overall diagnosis of the District. Participatory elaboration of the District’s SHP. 1.1. 1.2. 1.3. 1.4.
  16. 16. Step 2 2.1. Participatory elaboration of the management AOP 2.2. 2.3. Participatory carrying out of the AOP Participatory evaluation and follow-up of the AOP
  17. 17. Step 3 Systemization of Project training by steps and sub-projects Systemization of the SHP’s management model in the District Institutionaliza-tion of the local management model in the DSH 3.1. 3.2. 3.3.