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Background of the Study the Republic of Bolivia Is a Landlocked Country

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Background of the Study the Republic of Bolivia Is a Landlocked Country 1INTRODUCTION (1) Background of the Study The Republic of Bolivia is a landlocked country located between 10 degrees and 23 degrees South, has an area of 1,098,581km2 (3 times as large as Japan) with a population of 8,137,000 (1999), and is also known as one of the poorest countries in Latin America. Bolivia continues to promote popular participation and decentralization laws, as it maintains its policies on free economy. The Bolivian government has launched “5-year National Plan = Action Plan (1997-2002)” with the purpose to alleviate poverty. In the medical and public health sector, it aims to reduce by half under-five mortality rate and maternal mortality rate, addressing policies on a) introduction of Basic Health Insurance, b) improvement of nutritional status, c) infectious disease control (e.g., Chagas' disease, malaria, tuberculosis). Beni Department occupies 213,000km2, 20% of the nation’s total land, and has approximately 365,000 people (2001 Census) that account for the second lowest population density in the country. The annual population growth rate in Beni is rather high at 3.16%, while that of the urban areas is 5.19%, and the rural areas 0.43%, showing a remarkable trend of migration from rural areas to urban centers. Three major illnesses in Beni are ARI, malaria and diarrhea. Three major causes of death are heart disease, diarrhea and pneumonia. Diarrhea, ARI and malnutrition account for high infant mortality rate. Maternal mortality rate is also high, though the rate of rural areas is twice as high as that of urban areas. Major causes of maternal mortality are hemorrhage, eclampsia and unsafe abortion. In Beni prefecture, along with the central government and municipal government, donors such as USAID, UNICEF, CIDA, WHO/PAHO, UNFPA and NGOs, are implementing health sector projects. There is still no comprehensive department and/or district health plan. Coordination among donors will be expected in planning and project implementation. In response to the request of the Government of the Republic of Bolivia, the Government of Japan decided to conduct the Study on Enhancement of District Health System for Beni Prefecture in the Republic of Bolivia. The Japan International Cooperation Agency (JICA) dispatched a preparatory study team in January 2001 and Scope of Work (S/W) for the Study was signed on 25th January 2001. The Study Team (JST) has been dispatched by JICA to Beni department from the end of June 2001 to start the activities of the Study. (2) Objectives of the Study 1) To formulate a Master Plan on the enhancement of district health system for Beni Prefecture for the target year 2010, and to formulate priority program(s) identified in the Master Plan, which will be able to contribute to the development of the health decentralization process; 2) To pursue technology transfer to the counterpart personnel in the course of the Study. (3)Study Area Beni Department. 1 - 1 (4)Study Approach 1) Phase I Study a. Analysis of the existing conditions of socio-economic background and demand for and supply of health services b. Formulation of Master Plan on the district health system and stagewise implementation plan c. Selection and identification of the priority programs for the Pilot Study in Phase II 2) Phase II Study Development of the priority programs through the implementation and monitoring of the Pilot Study. The Study Team has conducted the Phase I survey and formulated the Master Plan including identification of the Pilot Study in December 2001 and submitted the Interim Report (IT/R) to the Bolivian side. In February 2002, the Study Team commenced the Phase II of the Study, focusing mainly on the startup of the Pilot Study described in the IT/R. Progress Report was submitted to the counterpart agency, Beni Prefecture by the end of February on the progress and results of the field survey. In the Phase II survey, the first and second monitoring of the Pilot Study were carried out between January and December 2002, based on the understanding among the Prefectual Government, municipal governments, SEDES, OTBs, donors, NGOs and other agencies concerned. The Final Report consists of the Main report, Appendices and Annexes. Tables/ figures, list of 1 - 2 collected data, minutes of meetings and records of meetings are compiled into Appendices. Questionnaires for monitoring of Pilot Study, results of training/ education for 2 hospitals in Trinidad, results of education/ training for 2 CSs and medical boat, own evaluation report on Pilot Study, results of water quality survey and detail data of facilities and medical equipment on Pilot Study are included in Annexes. 1 - 3 2 COORDINATION AND PARTICIPATORY APPROACH 2COORDINATION AND PARTICIPANTORY APPROACH 2.1 Explanation and Discussion on the Inception Report (IC/R) After protocol visits to the Ministry of Finance and Ministry of Health and Social Provision (MSPS) and several donors such as WHO/PAHO, USAID and CIDA, the JST explained and discussed on IC/R with the Prefect and his staff of the Beni department. The Minutes of Meeting on IC/R, affixed in Appendices, was signed on July 3, 2001 between the JST and the Bolivian side, Prefecture, Ministry of Finance and MSPS after some clarification of its contents. Based upon the IC/R, technical activities have been implemented by the JST with the Bolivian counterparts. 2.2 Workshop on the IC/R (1) Date and Place Province Preparatory meeting Workshop Vaca Diez Guayaramerin: 9th July Guayaramerin: 10th July Riberalta: 11th July Riberalta: 11th July Mamoré 16th July 17th July Cercado 6th July 13th July Moxos 18th July 19th July (2) Objectives 1) To explain and to exchange opinions on the Inception Report. 2) To clarify the selection criteria of OTB/ communities for the study in detail of the health supply and demand and to propose the designated OTB/ communities for the selection in each province by the participants. Table 2.1 shows details of selected communities for the Survey. (3) Discussion Points and Comments 1) Limited human resources and accessibility and availability problems of the health services. 2) Importance of the use of the participatory methods. 3) The criterion that the Law of Decentralization and Popular Participation need to strengthen prevails. 4) To focus the efforts in the reduction of the poverty in the indigenous groups and dispersed rural communities. 5) Inadequate health infrastructure and basic services. 6) Counterpart fund availability for the Pilot Study. (4)Workshop Results and Preliminary Conclusions 1) Explanation of the IC/R. 2) Activities that have taken place during the first month in Bolivia and the results of these activities. 3) Confirmation of the counterpart participation and preparation of the local fund for their participation. 4) Coordination improvement among agencies concerned in Trinidad. It has had a good progress with mutual trust and an active environment. 2 - 1 2.3 Adhoc Committee (1) Date and Place Date: September 2001 Place: Prefectural Government of Beni, Trinidad (2) Participants Table 2.2 lists the participants. (3) Objectives 1) Explanation and discussion on Inception Report. 2) Promotion of coordination among agencies concerned. (4) Discussion Points and Comments 1) Requirement of coordination among agencies concerned. 2) Prefecture Action Plan: 10 years plan. 3) Hospital Materno Infantil (Maternal and Child Hospital): equipment requirement but no assessment and review of the D/S and past experience of O&M. 4) NGOs: no activities in urban areas but for rural areas. 5) Training requirement for CS in the surrounding areas of Trinidad. 6) O&M cost: No coordination between hospitals and municipal government. 7) Limitation of human and financial resources. 8) Importance of institutional and organizational plan in M/P. 9) Pilot Study for supply and demand side of health services. 2.4 General Committee Meeting (Adhoc) (1) Date and Place Date: 14th September 2001 Place: Trinidad (2) Participants Refer to Table 2.3. (3) Objectives 1) Explanation and discussion on Inception Report. 2) Promotion of coordination among agencies concerned. (4) Discussion Points and Comments 1) Explanation of strategies of the Study, health condition and system in a coverage area by the JICA Study Team. 2) Expressing effort and possible support to the activity of the JICA Study Team by participants. 2.5 Meeting with MSPS (1) Date and Place Date: 27th September 2001 2 - 2 Place: MSPS, La Paz (2) Participants Refer to Table 2.4. (3) Objectives Explanation and discussion on the progress of the Study at MSPS in La Paz. (4) Discussion Points and Comments 1) Difficult situation of Beni in terms of decentralization and popular participation. Confusion of the HIPC system. 2) Promotion of PRSP for poverty alleviation. 3) Donor coordination. 4) Health Master Plan prepared by IDB in 1990. 5) Prevalence of POA. 6) ITEM allocation. 7) DUF activities. 8) Hospital integration in Beni. 9) Unsettled personnel system in SEDES. 10) Gaps between intent and the reality in MSPS. 2.6 Meeting with the Prefecture and Relevant Parties (1) Date and Place Date: 2nd October 2001 Place: Trinidad (2) Participants Refer to Table 2.5. (3) Discussion Points and Comments 1) Establishment of Steering Committee and Technical Committee as an autonomous body. 2) Selection, human/financial resource allocation and implementation of Pilot Study. 3) Radio communication in the rainy season between hospitals and auxiliary nurses. 4) ITEM allocation and HIPC funds. 5) Plan and check of POA by relevant agencies. 6) Reform of Management for the Hospital German Busch and the Hospital Materno Infantil. 2.7 Preliminary meeting for the Steering Committee (1) Date and Place Date: 13th November 2001 Place: Prefectural Government of Beni, Trinidad (2) Participants See Table 2.6. 2 - 3 (3) Objectives: Discussion and regulation of Steering Committee 1) Comment on the Draft document on Pilot Study.
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