Health outcomes vary widely between urban and rural areas and indigenous and non-indigenous populations in Bolivia, the poorest country in South America. Maternal mortality is high and access to modern contraceptive methods is often limited. In the mid-1990s Bolivia embarked on the process of decentralizing health services to help address these inequities. The national government established a universal insurance package for basic health services to be delivered at the municipal level. In January 2003, this insurance program was expanded to cover health services for pregnant women and children under five. While the introduction of health insurance has improved equity and access to health care, it has also greatly increased the responsibilities of municipalities.

EXPERIENCE IN COUNTRY

• Support to Centro de Investigación, Educación, y Servicios (CIES)
• Business Planning with APROSAR 

Support to Centro de Investigación, Educación, y Servicios (CIES)

The USAID/Bolivia Mission requested that LMS provide organizational strengthening assistance to CIES (the Center for Investigation, Education, and Services), the International Planned Parenthood Foundation (IPPF) affiliate in Bolivia, to increase its rate of financial sustainability from just under 50% to 85%. CIES is highly dependent on funding from USAID and IPPF. Founded in 1987, CIES provides reproductive health services through 9 clinics/health centers located in 8 of the 9 departments of the country. LMS technical assistance focuses on the areas of strategic planning, marketing, business planning/proposal development, and human resources management.

Business Planning with APROSAR

APROSAR is a community-focused organization that works with indigenous populations. Since it first participated in the Business Planning for Health (BPH) program in 2002 under the M&L Program, it has written and received funding for nine business plans. As of March 2006, APROSAR has received $149,223 from Dutch and Belgian donors, Fundación Inter Américana, and Louvain Développement. $120,000 for a tenth business plan is pending approval from the Fundación Aliplano. Funded business plans address various health priorities in the communities APROSAR serves including: extension of primary health care services through a mobile program; improving services provided by community health promoters; equipping an outpatient dental clinic; clean water projects in three municipalities; advanced training for community nurses; and developing human resources for community health programs in Sur Carangas province of the Department of Oruro.