USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY2005-FY2009 December 2010 This publication was produced for review by the United States Agency for International Development. It was prepared by Deborah Caro through the Global Health Technical Assistance Project. USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY2005-FY2009 DISCLAIMER The authors‘ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. This document (Report No. 10-1-161) is available in printed or online versions. Online documents can be located in the GH Tech web site library at www.ghtechproject.com/resources. Documents are also made available through the Development Experience Clearing House (www.dec.org). Additional information can be obtained from: The Global Health Technical Assistance Project 1250 Eye St., NW, Suite 1100 Washington, DC 20005 Tel: (202) 521-1900 Fax: (202) 521-1901 [email protected] This document was submitted by The QED Group, LLC, with CAMRIS International and Social & Scientific Systems, Inc., to the United States Agency for International Development under USAID Contract No. GHS-I-00-05-00005-00. 4 USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY05-09 ACKNOWLEDGMENTS The Team would like to express their deep gratitude and appreciation to all of the USAID partner organizations that helped us to understand the intricacies of the program and all the changes it went through during its tenure. We also owe an enormous debt to the healthcare workers, community members, and the municipal and community leaders who answered our questions tirelessly and helped us to understand the new political and health context in Bolivia. The USAID Health Team was an enormous help during the entire process of producing the portfolio review and strategy. We also are extremely grateful to the Ministry of Health and SEDES officials who received us openly and worked with us to understand the program, the history of events, and the intricacies of the new policies. We were extremely grateful for the full collaboration we received at all levels. Special thanks goes to Alicia Dinerstein for guiding the process, envisioning why and how it should be done, and persevering through multiple drafts. Our great desire is that all Bolivians will vivir bien as a result of realizing their rights to access high quality culturally and gender sensitive healthcare. USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY05-09 i CONTENTS ACRONYMS ...................................................................................................................................................................... iv EXECUTIVE SUMMARY ................................................................................................................................................ vii Structure of the Report .................................................................................................................................................. vii Methodology ..................................................................................................................................................................... vii Overview of the Strategy .............................................................................................................................................. viii Findings ................................................................................................................................................................................ x BACKGROUND AND CONTEXT .............................................................................................................................. 1 Objectives of the Portfolio Review ................................................................................................................................ 1 Structure of the Report .................................................................................................................................................... 2 THE USAID HEALTH STRATEGY ................................................................................................................................ 4 Major Bolivian Health Policies Supported by USAID Activities ............................................................................... 6 The Portfolio and Key Implementing Partners ............................................................................................................ 7 The Rural Health Strategy and Its Implementing Organizations .............................................................................. 7 Rural Strategy Activities and Implementing Partners 2004-2009 ............................................................................ 9 Other Strategic Activities and Implementing Partners ............................................................................................ 13 Other Strategic Health Activities and Implementing 2005-2009 ........................................................................... 14 ASSESSMENT BY INTERMEDIATE RESULT (IR) ..................................................................................................... 16 IR 1: Increased Ability of Individuals, Families and Communities to Take Action to Improve Health .......... 16 IR 1.1- Improve Health Practive by Promoting Healthy Practices ........................................................................ 19 IR 1.2- Increase Access to Products that Promote Health and Help to Prevent Illness .................................. 24 IR 1.3- Increase the Capacity of Communities to Develop Effective Organizations to Support Local Health Services .............................................................................................................................................................................. 26 IR 2: Expanded Delivery Of Quality, High-Impact Health Services Through Health Networks .................... 35 IR 2.1- Improve the Provision of Clinical Services .................................................................................................... 38 IR 2.2- Improve the Provision of Community Health Services .............................................................................. 40 IR 2.3- Improve the Quality of Health Services According to National Norms, Protocols, and User Satisfaction......................................................................................................................................................................... 42 Summary of IR2 Findings ................................................................................................................................................ 46 IR 3: Strengthened Institutional Capacity for Health Care Management and Sustainability ............................ 47 IR 3.1- Increase the Capacity of the Public and Private Health Services for Results-Based Management in Select Municipalities……………………..…...............................................................................................................50 IR 3.2- Increase the Financial Sustainability of Public and Private Health Services ........................... ………...54 Summary of IR 3 Findings ............................................................................................................................................... 55 PROGRAM ANALYSIS: ACHIEVEMENT OF THE STRATEGIC OBJECTIVE ................................................... 57 LESSONS LEARNED AND RECOMMENDATIONS FOR NEXT STRATEGY ................................................ 60 ii USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY05-09 APPENDICES APPENDIX A. SCOPE OF WORK .................................................................................................... 62 APPENDIX B. PERSONS CONTACTED ......................................................................................... 77 APPENDIX C. LEVELS AND FUNCTIONS OF THE BOLIVIAN HEALTH SYSTEM…….. 87 APPENDIX D. USAID ACTIVITIES FOR HEALTH STRATEGY 2005-2010 ............................. 91 APPENDIX E. IMPLEMENTATION TIMELINE OF RURAL STRATEGY .................................. 98 APPENDIX F. REFERENCES ............................................................................................................... 99 USAID/BOLIVIA: HEALTH STRATEGY PORTFOLIO REVIEW FY05-09 iii ACRONYMS ACS Agente Comunitario de Salud/ Community Health Agent AIEPI (IMCI) Atención Integral a las Enfermedades Prevalentes de la Infancia/Integrated Management of Childhood Illness ALS Autoridad Local de Salud/Local Health Authority AO Activity Objective (formerly SO, or Strategic Objective) CAI Comités de Análisis de Información/Information Analysis Committees CARE Cooperative for Assistance andRelief Everywhere CDC Centers for Disease Control and Prevention CDVIR Centros Departamentales de Vigilancia y Referencia de ITS/SIDA/Departmental Centers for Surveillance and Referral of HIV/AIDS and STIs CEASS Central de Almacenamiento de Suministros de Salud/ Central Depository for Health Supplies CHP Proyecto de Salud Comunitario (de PROCOSI)/Community Health Project (CHP) CLS Comité Local de Salud/Local Health Committee CSP Country Strategic Plan CSRA Consejo de Salud Rural Andino DAIA Disponibilidad Asegurada de Insumos Anticonceptivos/Contraceptive Security DILOS Directorio Local de Salud/Local Health Directorate DIU Dispositivo intrauterino/Intrauterine Device (IUD) EAPC Estrategia de Acción Participativa Comunitaria/Strategy for Particatory