República de Bolivia Ministerio de Salud y Deportes 1 Bolivia: Child Survival with Dignity Dr. Álvaro Muñoz-Reyes Navarro Minister of Health and Sports London, December 2005

República de Bolivia Ministerio de Salud y Deportes 2 Overview of the presentation 1.The state of child health in Bolivia 2.Response of the health system Removing financial barriers to access Increasing coverage through neonatal and Community IMCI Building national and local alliances for sustainability 3.Implications for health policies

República de Bolivia Ministerio de Salud y Deportes 3 Trends in Child Mortality in Bolivia Source: DHS 1989,1994,1996,2003 MDG 4, Objective 5 The state of child health in Bolivia

República de Bolivia Ministerio de Salud y Deportes 4 National Insurance for Motherhood, Infancy and Childhood (SNMN) May 1996 Basic Health Insurance 31 December 1998 Evolution of the Public Health Insurance Model to SUMI Maternal and Child Universal Health Insurance 21 November Beginning with SBS (1998), the IMCI strategy was completely incorporated Response of the health system

República de Bolivia Ministerio de Salud y Deportes 5 The importance of an effective legal framework  State and Local Governments with greater social responsibility and financial resources  Greater efficiency and efficacy in management  Redistribution of public revenues  Greater participation and control by social stakeholders Law of Popular Participation Hydrocarbon Tax Law of Administrative Decentralization Law of SUMI Law of National Dialogue

República de Bolivia Ministerio de Salud y Deportes 6 Financing of SUMI 100% National Revenues National Customs and Internal Taxes SUMI 90% 10% 8% 2% Investment Municipalities National Liability Fund - Dialogue Account Direct Taxes on Hydrocarbons Complementary Resources Source: Bolivia MOH

República de Bolivia Ministerio de Salud y Deportes 7 Maternal and Child Universal Health Insurance (SUMI) Is a State Policy created to reduce the morbidity and mortality of mothers and children Improves access and eliminates economic barriers to health services Is the main prioritized policy of the Ministry of Health and Sports Is a component of the Bolivian Poverty Reduction Strategy Is the principal means to reach the MDG objectives in health

República de Bolivia Ministerio de Salud y Deportes 8 SUMI coverage according to place of residence, Bolivia Urban Population: 62.4% Source: Bolivia MOH 2005

República de Bolivia Ministerio de Salud y Deportes 9 Health System Community Context Community Dialogue Collective Action Individual Change Social Change Impact Conceptual elements in Community - IMCI Application of key practices in the care of the child and the newborn SUMI

República de Bolivia Ministerio de Salud y Deportes 10 Strategic action lines in Community-IMCI Families and the community apply the key practices in the care of the child and the newborn Engagement of social agents Community mobilization and surveillance Development of alliances within and between sectors Home visits Strengthening the link between the community and health facilities

República de Bolivia Ministerio de Salud y Deportes 11 Results from the Community- IMCI component Achieved the participation and empowerment of social agents in the promotion of key practices Strengthened the link between health facilities and the community Stimulated intersectoral efforts A focus only on Community Health Workers (CHW) is not sufficient to improve family practices Source: Red Cross, PAHO/WHO. Community IMCI Evaluation Plan International Bolivia, BASICSII. 2002

República de Bolivia Ministerio de Salud y Deportes 12 Neonatal Community-IMCI: Selected Results Source: Save the Children/SNL, 2004

República de Bolivia Ministerio de Salud y Deportes 13 The alliances in support of children and newborn Education- Neighborhood Groups- Community health workers- Municipalities-Mothers’ Clubs NGOs, other local organizations Central and Departmental Levels Local Level Community IMCI and Newborn MOH- PAHO/WHO-UNICEF- USAID:PROCOSI (Network of NGOs) and PROSIN/USAID - Red Cross - Plan International National Alliance for the Community IMCI scale-up The First Lady's Office-MOH-Other ministries- NGOs-Cooperating Agencies-Women’s organizations MOH- bilateral and multilateral cooperating agencies Inter-Agency Coordination Committee Inter-Institutional Council of Safe Motherhood

República de Bolivia Ministerio de Salud y Deportes 14 The alliances in support of children and newborns have facilitated: Mobilization of human and economic resources Synergy of efforts and harmonization of interventions Greater possibility of sustaining the key interventions Incorporation of new social agents and other sectors Promotion of local development

República de Bolivia Ministerio de Salud y Deportes 15 Implications for health policy Access –Elimination of economic barriers improves access to healthcare –Prioritization of excluded population groups (indigenous, rural area habitants and others) Coverage –One must seek to improve the quality of care in order to increase utilization of services –Strategies should be oriented toward user (client) satisfaction and focused on intercultural, gender or generational perspectives –Policies should prioritize interventions in favor of neonatal health integrated with maternal health Sustainability –Alliances should be in harmony with national policies of health –SUMI should motivate greater social participation Boys and Girls Have the Right to a Life….a Life with Dignity