Health Care Decentralization in Paraguay

Total Page:16

File Type:pdf, Size:1020Kb

Health Care Decentralization in Paraguay HEALTH CARE DECENTRALIZATION IN PARAGUAY: EVALUATION OF IMPACT ON COST, EFFICIENCY, BASIC QUALITY, AND EQUITY Baseline Report MEASURE Evaluation Technical Report Series, No. 4 Gustavo Angeles John F. Stewart Rubén Gaete Dominic Mancini Antonio Trujillo Christina I. Fowler The technical report series is made possible by support from USAID under the terms of Cooperative Agreement HRN-A-00-97-00018-00. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID. December 1999 Printed on recycled paper Other Titles in the Technical Report Series No. 1. Uganda Delivery of Improved Services for Health (DISH) Evaluation Surveys 1997. Path- finder International and MEASURE Evaluation. March 1999. No. 2. Zambia Sexual Behaviour Survey 1998 with Selected Findings from the Quality of STD Services Assessment. Central Statistics Office (Republic of Zambia) and MEASURE Evaluation. April 1999. No. 3. Does Contraceptive Discontinuation Matter? Quality of Care and Fertility Consequences. Ann K. Blanc, Siân Curtis, Trevor Croft. November 1999. ISBN: 978-0-9842585-0-5 Recommended Citation: Gustavo Angeles, John F. Stewart, Rubén Gaete, Dominic Mancini, Antonio Trujillo, Christina I. Fowler. Health Care Decentralization in Paraguay: Evaluation of Impact on Cost, Efficiency, Basic Quality, and Equity. Baseline Report. MEASURE Evaluation Technical Report Series No. 4. Carolina Population Center, University of North Carolina at Chapel Hill. December 1999. Acknowledgements We would like to acknowledge the cooperation and generous support of numerous individuals and organiza- tions that made the first phase of this study possible. We express our gratitude to the staff of 143 health facilities who cooperated with the research team to collect facility and staff data. We thank the 1,261 facility clients and the 2,150 women of reproductive age who provided information about their experiences with the health system, their health, and the health of household members. Without their cooperation and patience this study would not be possible. We thank also the regional health directors from Central, Cordillera and Misiones for their cooperation during the fieldwork. The USAID Mission in Paraguay, which commissioned and supported the implementation of the baseline study, deserves special mention. We recognize and appreciate the cooperation of the following individuals: F. Wayne Tate (USAID/Paraguay Mission Director); Gerald Barth (Deputy Mission Director); Osvaldo Benítez (former Health Officer), Todd Sorenson (Democracy Officer); and Enrique Villalba (Program and Finance Officer). We also thank Barbara Kennedy, former USAID/Paraguay Mission Director, for her cooperation. The technical, operational and field support of Paraguayan organizations were critical to all aspects of the study, from the initial conceptualization of the project to the collection and analysis of the data. We would also like to recognize the staff of PRODEP (Proyecto de Descentralización en Paraguay), especially Arturo Urrutia (PRODEP Director) and Carlos Mario Ramirez (PRODEP Health Consultant) who recognized the importance of assessing the impact of decentralization. We would like to thank CIRD (Centro de Información y Recursos para el Desarrollo) and its director, Agustín Carrizosa, for the use of CIRD facilities during the organization and implementation of the health facility fieldwork. This field support greatly facilitated the data collection effort. Agustín also provided valuable comments to the preliminary version of this report. At CEPEP (Centro Paraguayo de Estudios de Población), we acknowledge the important efforts of Cynthia Prieto (CEPEP Executive Director) and Mercedes Melian (CEPEP Research Director) in assisting the research team to incorporate the modules required for this study into the larger ENSMI 98 household survey. We also thank Leo Morris and Paul Stupp (both at the Centers for Disease Control and Prevention) for their valuable technical assistance in the development of the household questionnaire, the oversampling of the study areas and in the implementation of the household survey. Furthermore, we appreciate the efforts of ICA (Instituto de Comunicación y Arte) staff and Enrique Chase (ICA Executive Director) for successfully carrying out the client exit survey. We also value the efforts of ICA interviewers who conducted the facility surveys in a competent way. In North Carolina, we drew upon the technical resources of the Carolina Population Center. Amy Ong Tsui (Director of the Carolina Population Center and former Project Director of MEASURE Evaluation) and David Guilkey (Senior Technical Advisor, MEASURE Evaluation) provided valuable technical assistance at the inception of this study and during all of its phases. We also thank Ties Boerma (Director of MEASURE Evaluation) for continuing the support to this study, and the members of MEASURE’s Technical Advisory Group for careful comments to the study proposal. The maps displaying the spatial relationships are the excellent work of Steve McGregor and John Spencer of the Carolina Population Center's Spatial Analysis Unit. Joy Fishel (Research Assistance, MEASURE Evaluation) provided valuable research and report preparation assistance. Brandon Howard (Information Officer, MEASURE Evaluation) played a key role in both the layout and production of the report. Last but not least, we acknowledge the careful and skilled translation work by Ruy Burgos. USAID/Paraguay and the MEASURE Evaluation Project, through its Cooperative Agreement with USAID/Washington, provided funding for this study. Acknowledgements i CONTENTS Acknowledgements........................................................................................................................................ i Executive Summary.................................................................................................................................... vii 1. Introduction........................................................................................................................................... 1 1.1. Background ....................................................................................................................................... 1 1.2. Overview of Evaluation Study........................................................................................................... 2 1.3. Overview of Baseline Indicators Report............................................................................................ 2 2. Country Background............................................................................................................................. 3 2.1. Geographic Characteristics................................................................................................................ 3 2.2. Socio-Demographic Profile ............................................................................................................... 3 2.3. Health Profile .................................................................................................................................... 3 2.4. Economic & Political Profile............................................................................................................. 4 2.5. Health Care System in Paraguay ....................................................................................................... 4 2.5.1. Policy ........................................................................................................................................ 4 2.5.2. Organization & Infrastructure ................................................................................................... 5 2.5.3. Health Expenditure & Financing .............................................................................................. 5 3. Health Reform: Decentralization of Basic Health Services................................................................... 7 3.1. Background ....................................................................................................................................... 7 3.2. Evolution of Health Reform Initiative ............................................................................................... 7 3.2.1. Phase 1: Deconcentration.......................................................................................................... 7 3.2.2. Phase 2: Decentralization.......................................................................................................... 7 3.3. Implementing the Decentralization.................................................................................................... 8 3.3.1 Roles of the Principal Actors .................................................................................................... 8 3.4. Progress of Decentralization Process................................................................................................. 9 4. Evaluation Plan................................................................................................................................... 11 4.1. Study Objectives ............................................................................................................................. 11 4.2. Study Design ................................................................................................................................... 11 4.3. Sample Selection ............................................................................................................................
Recommended publications
  • Health Care Decentralization in Paraguay
    HEALTH CARE DECENTRALIZATION IN PARAGUAY: EVALUATION OF IMPACT ON COST, EFFICIENCY, BASIC QUALITY, AND EQUITY Baseline Report MEASURE Evaluation Technical Report Series, No. 4 Gustavo Angeles John F. Stewart Rubén Gaete Dominic Mancini Antonio Trujillo Christina I. Fowler The technical report series is made possible by support from USAID under the terms of Cooperative Agreement HRN-A-00-97-00018-00. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID. December 1999 Printed on recycled paper Other Titles in the Technical Report Series No. 1. Uganda Delivery of Improved Services for Health (DISH) Evaluation Surveys 1997. Path- finder International and MEASURE Evaluation. March 1999. No. 2. Zambia Sexual Behaviour Survey 1998 with Selected Findings from the Quality of STD Services Assessment. Central Statistics Office (Republic of Zambia) and MEASURE Evaluation. April 1999. No. 3. Does Contraceptive Discontinuation Matter? Quality of Care and Fertility Consequences. Ann K. Blanc, Siân Curtis, Trevor Croft. November 1999. Recommended Citation: Gustavo Angeles, John F. Stewart, Rubén Gaete, Dominic Mancini, Antonio Trujillo, Christina I. Fowler. Health Care Decentralization in Paraguay: Evaluation of Impact on Cost, Efficiency, Basic Quality, and Equity. Baseline Report. MEASURE Evaluation Technical Report Series No. 4. Carolina Population Center, University of North Carolina at Chapel Hill. December 1999. Acknowledgements We would like to acknowledge the cooperation and generous support of numerous individuals and organiza- tions that made the first phase of this study possible. We express our gratitude to the staff of 143 health facilities who cooperated with the research team to collect facility and staff data.
    [Show full text]
  • Paraguay Presentation-Panel3
    Disaster Risk Reduction in Paraguay A model using Sendai Framework for Disaster Risk Reduction 2015 - 2030 Dr. Raúl Latorre. General Director of Health Services Steps to follow • Priority 1: Understanding disaster risk. • Priority 2: Strengthening disaster risk governance to manage disaster risk. • Priority 3: Investing in disaster risk reduction for resilience. • Priority 4: Enhancing disaster preparedness for effective response and to “Build Back Better”in recovery, rehabilitation and reconstruction. Priority 1: Understanding disaster risk Ciudad de Alberdi. Ñeembucú, Paraguay National Public Health Emergency (NPHE): FLOODS PARAGUAY. Hundred years of history • According to forecast El Niño will continue, reaching its maximum intensity in January and lasted until Jun this year. • The behavior is similar to the years 1997-1998 Child (very strong phenomenon). • Departments and districts affected by flooding. Paraguay. 2016 • Concepción • San Pedro • Cordillera • Guairá • Misiones • Alto Paraná • Central • Ñeembucú • Pte. Hayes • Asunción Distribution of diseases, Flood- Paraguay, Dec 2015 event 5-Feb-2016 Sifilis 0 Accidentes con animales ponsoñosos 0 N=6.005 Agresiones por animales 0 Enfermedades transmitidas por alimentos (ETA) 1 Transtornos mentales 1 Neumonias 1 Enfermedades febril eruptivas 1 Accidentes en tránsito terrestre 1 Neumonias Graves 1 Otros sintomas 3 Otras enfermedades cronica 4 Sx febril agudo 4 DM 4 Lesiones por causas externas 7 Diarreas 8 Enfermedades tipo influenza (ETI) 9 Lesiones en piel 10 HTA 21 IRAS No Neumonias 24 0 5 10 15 20 25 30 (%) Porcentaje de enfermedades Fuente: Planilla de enfermedades DGVS al 05/02/2015 Priority 2: Strengthening disaster risk governance to manage disaster risk Emergency committee: Health Ministery INSTITUTIONAL AND RESPONSE INTERSECTORIAL In the date 18.12.2015 the MSP and BS issues Component institutional managers Resolution S.
    [Show full text]
  • General Assembly Distr.: General 17 November 2015 English Original: Spanish
    United Nations A/HRC/WG.6/24/PRY/1 General Assembly Distr.: General 17 November 2015 English Original: Spanish Human Rights Council Working Group on the Universal Periodic Review Twenty-fourth session 18-29 January 2016 National report submitted in accordance with paragraph 5 of the annex to Human Rights Council resolution 16/21* Paraguay __________________ * The present document has been reproduced as received. Its content does not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations. GE.15-20155 (E) 011215 011215 *1520155* A/HRC/WG.6/24/PRY/1 I. Introduction 1. The Republic of Paraguay hereby submits its second national report under the universal periodic review (UPR), in which it provides a description of the main steps forward, the achievements made and challenges faced in promoting and protecting human rights in Paraguay. The report provides information on the follow-up to the recommendations received under the first reporting cycle (124 of which were received and accepted), in the light of which it is important to bear in mind the mid -term report submitted in September 2014, (recommendation No. 86.) which testified to the country’s commitment to and confidence in this evaluation mechanism. 2. Paraguay is a State governed by the rule of law whose democracy is founded on recognition for human dignity. Government authority is exercised through the three branches of government located in Asunción, the capital of the Republic; its system of government is based on the separation of powers, a balance between them, coordination and mutual oversight, as established in the 1992 Constitution.
    [Show full text]
  • Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma As a Public Health Problem in the Americas
    Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas Lima, August 1-3 2018 Report 1 Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas Lima, August 1-3, 2018 Report Washington, D.C. 2019 p Also published in Spanish and Portuguese Quinta Reunión de Gerentes de los Programas Nacionales para la Eliminación del Tracoma como Problema de Salud Pública de las Américas. (Lima, 1 al 3 de agosto de 2018). OPS/CDE/19-011 Quinta reunião de gestores dos programas nacionais para a eliminação do tracoma como problema de saúde pública das Américas. (Lima, 1 a 3 de agosto de 2018). OPAS/CDE/19-011 Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas. (Lima, August 1-3 2018) PAHO/CDE/19-011 © Pan American Health Organization 2019 All rights reserved. Publications of the Pan American Health Organization (PAHO) are available at www. paho.org. Requests for permission to reproduce or translate PAHO Publications should be addressed to the Publications Program through the website (www.paho.org/permissions). Suggested citation. Pan American Health Organization. Fifth Regional Meeting of Managers of National Programs for the Elimination of Trachoma as a Public Health Problem in the Americas. (Lima, August 1-3 2018). Washington, D.C.: PAHO; 2019. Cataloguing-in-Publication (CIP) data. CIP data are available at http://iris.paho.org. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.
    [Show full text]
  • Emergency Plan of Action (Epoa) Paraguay: Floods
    Emergency Plan of Action (EPoA) Paraguay: Floods DREF N° MDRPY020 Operation start date: 18 May 2019 Expected timeframe: 3 months Date of issue: 21 May 2019 Operation end date: 18 August 2019 DREF allocated: CHF 288,311 Swiss francs (CHF) Total number of people affected: 310,595 people Number of people to be assisted: 4,700 people (62,119 families) Host National Society presence: Paraguayan Red Cross (PRC) has 11 branches, 10 sub-branches in Central Department, 1000 volunteers and 15 staff members. Red Cross Red Crescent Movement partners actively involved in the operation: International Committee of the Red Cross (ICRC), International Federation of Red Cross and Red Crescent Societies (IFRC) and Swiss Red Cross. Other partner organizations actively involved in the operation: National Emergency Secretariat (SEN), Ministry of Public Health and Social Welfare (MSPBS), Ministry for Childhood, Ministry of the Interior, Departmental Directorates, Municipalities, UNICEF, Pan-American Health Organization (PAHO). <Click here for the DREF budget, here for the map of affected areas and here for the contact information > A. Situation analysis Description of the disaster On 10 May, a new storm that brought with it intense rains, large hailstones and up to 80- km/hr. winds affected the entire country, doubling or tripling monthly rainfall averages. This especially affected the department of Ñeembucú, which received around 250 mm throughout the day, causing river levels to increase by 15cm in 24 hours. In Asunción, the Paraguay River rose between 10 and 17 centimetres in a few hours. On 13 May, Congress asked the Executive Branch1 to declare an emergency in Ñeembucú department and to extend the emergency declaration for 90 days in the departments of Central, Misiones, Itapúa, Guairá, San Pedro and the capital city of Asunción, which were issued in March and April.
    [Show full text]
  • Diet of Melanophryniscus Paraguayensis (Anura: Bufonidae): an Endemic Species to Paraguay
    Herpetological Conservation and Biology 16(2):251–258. Submitted: 5 October 2020; Accepted: 3 May 2021; Published 31 August 2021. DIET OF MELANOPHRYNISCUS PARAGUAYENSIS (ANURA: BUFONIDAE): AN ENDEMIC SPECIES TO PARAGUAY KARINA NÚÑEZ1,3, MARTA DURÉ2, GRISELDA ZÁRATE1, FÁTIMA ORTIZ1, AND MEDES MENDOZA1 1Universidad Nacional de Asunción, Facultad de Ciencias Exactas y Naturales, Departamento de Biología, Colección Zoológica, San Lorenzo, Paraguay 2Centro de Ecología Aplicada del Litoral, Consejo Nacional de Investigaciones Científicas y Técnicas (CECOAL, CONICET-UNNE)/ Facultad de Ciencias Exactas y Naturales y Agrimensura (FACENA-UNNE), Corrientes, Argentina 3Corresponding author, e-mail: [email protected] Abstract.—Melanophryniscus paraguayensis (no common name) is an endemic toad of the central grasslands in the eastern region of Paraguay. Details about its natural history are poorly understood and it is categorized nationally as Vulnerable. This work describes the diet composition of this species and the relationship between toad body size and the number and volume of prey consumed. We analyzed the stomach content of 162 individuals, using the stomach flushing technique, after measuring and weighing them. For each prey category, we calculated the volume, number, and frequency of occurrence, and we estimated the relative importance index (IRI) with these data. We also estimated the standardized Shannon Diversity Index and Levins Niche Breadth Index for prey categories, and we analyzed the correlation between size of the anurans and prey size. Seventy-six individuals had identifiable content, which consisted of 1,357 prey classified into 16 categories, mostly at the order level. Ants and mites were the prey taxa with the greatest contribution in number and frequency and represent the most important prey based on IRI.
    [Show full text]
  • REPUBLIC of PARAGUAY US$500,000,000 4.700% Bonds Due 2027
    OFFERING MEMORANDUM REPUBLIC OF PARAGUAY US$500,000,000 4.700% Bonds due 2027 We are offering US$500,000,000 aggregate principal amount of 4.700% bonds due 2027 (the “Bonds”) of the Republic of Paraguay (the “Republic” or “Paraguay”) that will bear interest on their outstanding principal amount from the date of issuance, expected to be March 27, 2017 (the “Settlement Date”), at a rate of 4.700%, payable semi-annually in arrears on March 27 and September 27 of each year (each, an “Interest Payment Date”), commencing on September 27, 2017 and ending on March 27, 2027 (the “Maturity Date”). The Bonds constitute and will constitute direct, general, unconditional and unsubordinated External Debt (as defined herein) of the Republic for which the full faith and credit of the Republic is pledged. The Bonds rank and will rank without any preference among themselves and equally with all other unsubordinated External Debt of the Republic. It is understood that this provision shall not be construed so as to require the Republic to make payments under the Bonds ratably with payments being made under any other External Debt. The Bonds will contain provisions, commonly known as “collective action clauses.” Under these provisions, which differ from the terms of our external debt issued prior to March 31, 2016, we may amend the payment provisions of any series of debt securities issued under the indenture (including the Bonds) and other reserved matters listed in the indenture with the consent of the holders of: (1) with respect to a single series of
    [Show full text]
  • REPUBLIC of PARAGUAY 5.400% Bonds Due 2050
    OFFERING MEMORANDUM US$500,000,000 REPUBLIC OF PARAGUAY 5.400% Bonds due 2050 We are offering US$500,000,000 aggregate principal amount of 5.400% bonds due 2050 (the “Bonds”) of the Republic of Paraguay (the “Republic” or “Paraguay”) that will bear interest on their outstanding principal amount from the date of issuance, expected to be February 7, 2019 (the “Settlement Date”), at a rate of 5.400%, payable semi-annually in arrears on March 30 and September 30 of each year (each, an “Interest Payment Date”), commencing on September 30, 2019 and ending on March 30, 2050 (the “Maturity Date”). Principal on the Bonds will be repaid in three installments on March 30, 2048, March 30, 2049 and at maturity. See “Description of the Bonds—General—Basic Terms.” The Republic may redeem the Bonds, in whole or in part, at any time or from time to time prior to the date that is six months prior to the scheduled maturity of the Bonds (“Par Call Date”), by paying the greater of 100% of the principal amount of the Bonds being redeemed and a “make-whole” amount, in each case, plus accrued and unpaid interest. Beginning on the Par Call Date, the Republic may redeem the Bonds in whole or in part, at any time or from time to time, at the Republic’s option at a redemption price equal to 100% of the principal amount of the Bonds to be redeemed, plus accrued and unpaid interest, if any, on the principal amount of the Bonds being redeemed to the date of redemption.
    [Show full text]
  • ECORFAN-Republic of Paraguay
    Volume 1, Issue 1 – July – December-2015 E C O R Journal-Republic of Paraguay F ISSN-On line: 2414-4827 A N ® ECORFAN Indexing Academic Google ECORFAN-Republic of Paraguay ECORFAN- Republic of Paraguay Directory ECORFAN Journal-Republic of Paraguay, Volume 1, Issue 1, July-December 2015, is a CEO journal edited semestral by ECORFAN. Alberdi N°105 almost Rivarola Captain, C.P. 2060, Ciudad RAMOS-ESCAMILLA, María, PhD. de Luque, Central Department, Paraguay.Postcode:11500WEB:www.ecorfan.org/ CAO republicofparaguay/,[email protected]. Editor in Chief: RAMOS-ESCAMILLA, María. ISSN- CENTENO-ROA, Ramona, MsC. On line: 2414-4827.Responsible for the latest update of this number ECORFAN Computer Director of the Journal Unit.Escamilla BOUCHÁN-IMELDA, Luna SOTO-VLADIMIR, Alberdi N°105 almost PERALTA-CASTRO, Enrique, MsC. Rivarola Captain, C.P. 2060, Ciudad de Luque, Central Department, Paraguay. Postcode:11500 Institutional Relations last updated December 31, 2015. ESPINOZA-GÓMEZ, Éric, MsC. The opinions expressed by the authors do not necessarily reflect the views of the editor of the Editing Logistics publication. IGLESIAS SUAREZ- Fernando, BsC. It is strictly forbidden to reproduce any part of the contents and images of the publication Designer Edition without permission of the National Directorate of Intellectual Property. SERRUDO GONZALES- Javier, BsC. Editorial Board VAZQUES-NOGUERA, José, PhD. Universidad Nacional de Asunción, Paraguay BLANCO-BORJAS, Dolly, PhD. Universidad Nacional Autónoma de Mexico, Mexico GUILLEN-MONDRAGÓN, Irene Juana, PhD. Universidad Autónoma Metropolitana, Mexico GIRÓN, Alicia, PhD. Universidad Nacional Autónoma de México, Mexico PEREZ-AQUINO, Fátima, MsC. Instituto Paraguayo del Indígena, Paraguay MANHANELLI, Caio, MsC. Universidade Federal de São Carlos, Brazil CANDIDO-GONZALES, Bogarin, BsC.
    [Show full text]
  • Epoa) Paraguay Floods
    Page | 1 Emergency Plan of Action (EPoA) Paraguay Floods APPEAL Operation n° MDRPY016; GLIDE no. FL-2014-000007- PRY Date of issue: 10 July 2014 Date of disaster: 9 June 2014 Operation manager: Felipe Del Cid Point of contact: Luis Diaz de Bedoya, president of the Paraguayan Red Cross Operation start date: 9 June 2014 Expected timeframe: 12 months Overall operation budget: 1,815,467 Swiss francs Number of people affected: 46,272 families (231,360 Number of people to be assisted: 22,500 people people) (4,500 families) Host National Society: Paraguayan Red Cross Red Cross Red Crescent Movement partners actively involved in the operation: International Committee of the Red Cross (ICRC), Finnish Red Cross and Swiss Red Cross Other partner organizations actively involved in the operation: National Emergency Secretariat [Secretaría de Emergencia Nacional- SEN], Agencies of the United Nations, USAID Office of Foreign Disaster Assistance (OFDA), Oxfam A. Situation analysis Description of the disaster According to the situation report of the Ministry of Emergency of Paraguay on 5 July 2014, the intense rains in Paraguay, which started in March 2014, have been unusually intense for the season, leading to severe floods in rural communities and urban areas. The effects have continued to be felt with the flooding from the rapidly rising Paraná river and Paraguay river. To date, 46,272 families (231,360 people) from five departments in the country have been affected by the flooding and require humanitarian support. The Asunción Municipality declared a state of emergency and the National Emergency Secretariat has requested support from the Paraguayan Red Cross in terms of water and sanitation and the deployment of additional shelter support.
    [Show full text]
  • Leveraging Paraguay's Hydropower for Sustainable Economic Development
    Leveraging Paraguay’s Hydropower for Sustainable Economic Development Final Report1 Director of the Earth Institute: Jeffrey Sachs Director of CCSI: Lisa Sachs Lead authors: Perrine Toledano and Nicolas Maennling With Support from: Jose Acero, Sébastien Carreau, Charlotte Gauthier and Paloma Ruiz November 2013 1 The views in this report are that of the Research Team and the Research Team alone and do not reflect the views of any supporting institution. 1 The Columbia Center on Sustainable Investment (CCSI), a joint center of Columbia Law School and the Earth Institute at Columbia University, is the only applied research center and forum dedicated to the study, practice and discussion of sustainable international investment. Our mission is to develop and disseminate practical approaches and solutions, as well as to analyze topical policy-oriented issues, in order to maximize the impact of international investment for sustainable development. The Center undertakes its mission through interdisciplinary research, advisory projects, multi-stakeholder dialogue, educational programs, and the development of resources and tools. For more information, visit us at www.ccsi.columbia.edu. Acknowledgements We would like to thank Fabrizio Franco and Lorena Mersan for their legal contributions to the report, Jacky Mandelbaum and Sophie Thomashausen for their thorough review, and Ignacio Urrutia for his political economy insights and hospitality during our visit to Asunción. We would also like to thank the following Institutions and Organizations that
    [Show full text]
  • Electoral Observation Mission in Paraguay 1998
    Electoral Observation Mission in Paraguay 1998 Unit for the Promotion of Democracy General Secretariat Organization of American States Subject to Revision and not for Release to General Public Pending Consideration by Permanent Council. Table of Contents Executive Summary .....................................................................................................................4 PART I General Context of the Electoral Observation Mission............................................................8 1. Background information on Paraguay.......................................................................................9 PART II The Electoral Observation Mission..........................................................................................11 1. Origin and mandate of the Mission..........................................................................................12 2. Start and functioning of the Mission........................................................................................14 PART III Institutional Framework.............................................................................................................16 1. Electoral Justice System.........................................................................................................17 2. Political parties.......................................................................................................................19 3. The Press ..............................................................................................................................21
    [Show full text]