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BOLIVIA
>> Regional Overview >> Bolivia Overview Activity Data Sheet
PROGRAM: BOLIVIA
TITLE AND NUMBER: Improved Health of the Bolivian Population, 511-003
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $13,300,000 (DA), $6,248,000 (CSD), $6,182,000 (PL 480)
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: $5,080,000 (DA) $14,000,000 (DA), $6,400,000 (CSD), $11,820,000 (PL 480)
STATUS: Continuing
INITIAL OBLIGATION: FY 1996 ESTIMATED COMPLETION DATE: FY 2004Summary: The Strategic Objective seeks to raise the quality of life among Bolivia's poor through improved health, as measured by both survival (infant, child, and maternal mortality) and the quality of that survival (child nutrition status, birth intervals, and disease). Principal results are strengthened health knowledge and practices; improved coverage and quality of health services; and a more participatory and decentralized health system. Ultimate customers are low-income Bolivians, who are at greatest risk of untimely death and low quality of life. The program impacts about 70% of Bolivia's approximately eight million people.
Child Survival and Disease (CSD) and P.L. 480 Title II funds are used to strengthen immunization; institutionalize integrated prevention and management of childhood illnesses in medical facilities and communities; promote breastfeeding, proper weaning, and intake of micronutrients; improve maternal health services; control such infectious diseases as malaria, tuberculosis, yellow fever, leishmaniasis, dengue, and chagas; and slow HIV/AIDS transmission. Development Assistance (DA) funds are used to strengthen family planning and wider reproductive health (prenatal care, maternity care, and sexually-transmitted diseases) and to fund population research and demographic analysis.
Key Results: Public sector health services gained strength over the year, and new policy directions point to further decentralization of health services. Assistance at childbirth by trained attendants (CSD; DA; Title II) measures service coverage and quality, and serves as a proxy for maternal mortality. Institutional births increased from 52% to 55% of all births in 2000, and are on target. Although assisted births have increased by 72% since 1995, this data maybe underreported. USAID support is key to strengthening obstetrical services with activities in five of Bolivia's nine departments.
Couple-years of protection (CYP), an estimate of protection provided to couples by contraceptive methods, indicate people's improved practices and can reflect women's well being (DA funds). After two years of slow growth, CYP grew by 15% in 2000, to 269,052, or 107% of the target. The three-month injectable contraceptive almost doubled its share, from 6% to 11% of all CYPs. The economic crisis is hurting non-governmental organizations (NGOs), which charge for contraceptives; their portion of CYPs fell from 25% in 1999 to 21% in 2000. In contrast, the public sector, which provides contraceptives free of charge, increased its share from 47% in 1999 to 50% in 2000. Social marketing sales maintained their 29% share of CYPs. USAID supports family planning through contraceptive supply, logistics assistance, and the provision of training and client education.
The extent to which targeted children receive the third dose of DPT vaccine (or its equivalent) (CSD; Title II) measures service coverage and quality annually and is a proxy for infant mortality. In 2000, vaccination coverage in USAID target areas rose from 62% in 1999 to 73%, well above the target of 65%. The measles epidemic of 1998-99 was halted, with USAID playing a significant role in collaboration with other donors and the Government of Bolivia (GOB).
The number of municipalities that provide cost-sharing contributions (CSD; DA; Title II) shows the annual level of local ownership of health activities, reflecting participation and decentralization. In 2000, 114 municipalities (95% of the target) provided this contribution to USAID-funded NGOs, either in currency or in kind. This covers 36% of Bolivia's 314 municipalities.
Performance and Prospects: USAID is the major donor in the areas of: family planning, wider maternal health, immunization and NGO support; while attribution cannot be exclusive, USAID's role is pivotal in all four areas. The Title II program showed reductions in chronic malnutrition this year. In one program area, 36% of children under five years of age are currently malnourished, against 52% in 1996. Malnutrition of children under-five across program areas was decreased from 53% to 50%, still a positive sign, given the negative economic situation.
USAID is undertaking a mid-course program assessment. Full partner participation has provided invaluable customer feedback in evaluating activities and diagnosing areas warranting additional support. Areas that may require additional support include coordination mechanisms within the public sector and between the public sector and NGOs, municipalization of health services, social mobilization for health, as well as more traditional needs in human resources, services and sustainability.
With the caveats of an inauspicious economic climate and the uncertainties that accompany an impending election year, signs are good that performance will continue at least apace and perhaps at an even stronger rate. As illustrated below, work in health is leveraging technical and financial resources by working in close partnership across national and technical lines and is making gains in sustainability.
The infectious disease initiative, launched in 1999, strengthened regional cooperation. Since August 1999, USAID health teams in Bolivia, Brazil and Peru, together with national counterparts, have coordinated 15 regional activities that manifest the dynamic synergies and mutual rewards of cooperation. Examples are an assessment of Bolivia's immunization program; development of regional strategies for malaria, dengue, and yellow fever; measles eradication; cross-border actions to slow HIV transmission; and technical assistance in epidemiological surveillance and vector-borne disease research.
A key GOB commitment emanating from the national dialogue was increased decentralization of the health system. This may imply elimination of the current structure of 96 health districts and the formation of mancomunidades (federations of municipalities) to optimize resources targeted for health. USAID is building synergies within its program. The Democracy team is working with the Health team on a joint effort to support municipalization of health services in targeted municipalities. Likewise, the Health team is working with the Counter-narcotics team to expand health activities in the Yungas as part of an alternative development program to reduce coca cultivation.
There have been three notable advances in achieving sustainability within the health sector. Policy dialog has resulted in the GOB's financing positions in HIV/AIDS, the Social Security Institute and the demographic analysis unit. Second, to reduce future in-service training needs, significant gains have been made in reforming undergraduate curricula in reproductive health, tuberculosis, integrated management of childhood illnesses, and epidemiology. Finally, the NGO ProSalud completed its expansion phase by opening its 34th center, and modernized its by-laws.
USAID will use CSD ($6,248,000 in FY 2001 and $6,400,000 in FY 2002) and P.L. 480 Title II funds ($6,182,000 in FY 2001 and $11,820,000 in FY 2002) to strengthen immunizations; institutionalize integrated prevention and management of childhood illnesses in medical facilities and communities; promote breastfeeding, proper weaning and intake of micronutrients; improve maternal health services; control such infectious diseases as malaria, tuberculosis, yellow fever, leishmaniasis, dengue, and chagas; and slow HIV/AIDS transmission. DA funds ($13,300,000 in FY 2001 and $14,000,000 in FY 2002) are used to strengthen family planning and wider reproductive health (prenatal care, maternity care and sexually-transmitted diseases) and to fund population research and demographic analysis.
Possible Adjustments to Plans: A workshop with partners identified areas meriting further investment or modification, including a further reduction in the number of cooperating agencies in order to solidify program focus, as well as expanding the scope of work of some in-country partners.
Other Donor Programs: USAID is taking the lead on enhancing coordination among bilateral agencies. Bilateral assistance donors include: Great Britain (reproductive health and infectious diseases); Spain (management training); Belgium (tropical disease research); Canada (health management and water/sanitation); Germany (reproductive and adolescent health and integrated management of childhood diseases); and Japan (infrastructure and equipment, much of it for the Social Security Institute). With respect to multilateral assistance, the Inter-American Development Bank supports the Epidemiological Shield (infectious diseases) program and the World Bank supports the basic health insurance program and nutrition.
Principal Contractors, Grantees, or Agencies: U.S. partners include four PVO cooperating sponsors of Title II (Food for the Hungry International, Project Concern International, Adventist Development Relief Agency, and CARE); 11 cooperating agencies that provide technical assistance to partners; and Population Services International for social marketing and client education. Other partners include the Ministry of Health for a multi-faceted activity with national scope and in priority health districts; Bolivian NGOs ProSalud and the Center for Education, Investigation and Services, both with service delivery networks; and the local Federation of Coordinated Programs for Integrated Health, through which activities of 24 NGOs in child survival, reproductive health, and infectious diseases are funded.
Bolivia 511-003
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: Percent of births attended by trained birth attendants in Bolivia in a given calendar year. 43 47 52 55 55 58 60 Indicator 2: Percent of infants under age 1 who received the third dose of DPT in USAID-assisted activity sites in a given calendar year. NA 45 62 73 65 68 70 Indicator 3: Total number of couple-years of protection (CYPs) provided by USAID-assisted activities in a given calendar year 233,562 223,756 232,329 269,052 250,718 259,026 271,977 Indicator 4: Number of municipal governments with formal agreements with USAID-assisted partners that have provided a cash or in-kind counterpart contribution. 65 59 111 114 120 95 90 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent National Health Information System (NHIS): no. of births attended; National Statistical Institute (INE) projections: no. of expected births. Number of births attended by a health worker trained in obstetrics (i.e., physicians, nurses, nurse auxiliaries and midwives)/total number of expected births x 100. Births may be in health facilities or homes. Note: Indicators has been changed since the FY 2001 Budget Justification to better measure program performance. Indicator 2: IR Percent USAID/Bolivia's Information Monitoring Tool, National Health Information System Number of infants under age 1 (0-11 months) who received the 3rd dose of DPT vaccine before their first birthday/ Total no. of children under age 1 in USAID-assisted activity sites in rural areas x 100. Note: Indicators have been changed since the FY 2001 Budget Justification to better measure program performance. Note: Indicator has been changed since the FY 2001 Budget Justification to better measure program performance. Indicator 3: IR Number National Health Information System, Information Monitoring Tool, Commodity Management Tool The estimated protection provided to couples by contraceptive methods obtained from USAID-assisted family planning services during a one-year period. Methods include condoms, oral contraceptives, IUDs, vaginal tablets, injectables and voluntary surgical contraception. Natural methods will be included as of 2002, with baseline in 2001, after relevant training is completed this year. Indicator 4: IR Municipal government USAID/Bolivia's Information Monitoring Tool. This indicator is not cumulative. This indicator demonstrates direct USAID support to local government units, which under the Popular Participation Law (PPL) are responsible for the administration of health care services at the local level. It shows the extent to which municipal governments and USAID-funded NGO health care providers are responding to incentives created by the PPL to establish public and private partnerships in pursuit of improved health. It also shows the willingness of municipal governments to complement USAID resources with counterpart contributions, in efforts to provide better health services to their populations. These joint agreements point to local responsibility for health, shared participation by responsible parties and greater chances for sustainability of the activities in the aftermath of USAID funding. Note: Indicator has been changed since the FY 2001 Budget Justification to better measure program performance. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 91,958 DA 77,901 DA 14,057 DA 45,387 CSD 36,641 CSD 8,746 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 12,390 DA 13,011 DA 7,583 CSD 8,541 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 104,348 DA 90,912 DA 13,436 DA 52,970 CSD 45,182 CSD 7,788 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds* 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 13,300 DA 6,248 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 13,300 DA 6,248 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 14,000 DA 25,000 DA 156,648 DA 6,400 CSD 12,800 CSD 78,418 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
