TABLE OF CONTENTS -- Abstract -- Acknowledgments -- Acronyms and Abbreviations -- Executive Summary -- 1. Health Outcomes and Coverage in the Context of Decentralization -- 2. Financing and Use of Services -- Public Health Expenditures -- Social Security and Cross-Subsidies -- Distributional Impact of Health Expenditures -- 3. Clarifying Targets and Accountability in the Context of Decentralization -- Decentralization -- National Commitments and Performance Agreements -- Deepening the Focus on Results in the Context of the New Management Framework -- 4. Public Health Insurance and Equity -- Design and Basic Characteristics of the Public Health Insurance in Bolivia -- The Package of Services, User Empowerment and Targeting -- Financing of Public Health Insurance-Relationship between Municipalities and the Central Government and Associated Incentives -- Public Health Insurance and Equity -- Administration of the Insurance and Incentives Embedded in the Payment Mechanism -- Conclusions -- 5. The Epidemiological Shield -- Communicable and Vector-Borne Diseases in Bolivia -- Epidemiological Shield Programs -- 6. Human Resources for Health in Bolivia -- Background Information -- Main Findings -- Discussion -- Recommendations -- 7. Indigenous Empowerment and an Intercultural Approach to Health -- The Indigenous Population, Poverty and Health -- Organization and Political Participation of Indigenous Populations for Health -- Partial Answers to Indigenous Health Needs -- Recent Progress on Indigenous Health Indicators and Pending Challenges -- Recommendations -- 8. Conclusions and Recommendations -- Maintaining the Focus on National Priorities in the Context of the SUMI -- Strengthening Efforts to Extend Care to Poor Rural Areas and Indigenous People -- Improving the Effectiveness of the Decentralized System in the Context of the New Management Model.

Annex A. National Health Accounts, 2000 -- Annex B. Equity and Coverage of Priority Health Services -- Annex C. Determinants of Use of Health Services in Bolivia -- References -- TABLES -- 1.1: Comparative Indicators: Latin America -- 1.2: Maternal Mortality Rate, by Geographic Region (maternal deaths per 100,000 live births) -- 1.3: Maternal Mortality Rate and Use of SBS Services, by Regions (maternal deaths per 100,000 live births) -- 1.4: Trends in Economic Growth and Infant Mortality Rate (percentages, annual average) -- 2.1: National Health Expenditures 2000 -- 2.2: Public Health Expenditures (excludes Social Security) -- 2.3: Bed Occupancy Rates and Average Lengths of Stay (2001) -- 3.1: Performance Indicators included in Regional Performance Agreements 1999, 2000 and 2001 -- 3.2: National Commitments for Health -- 3.3: Ranking of Departments by Performance -- 4.1: The Evolution of Public Health Insurance in Bolivia -- 4.2: Municipal SBS Surpluses vs. Socioeconomic Indicators -- 6.1: MOH HRH per 100,000 inhabitants (Primary and Secondary Level of Care) -- 6.2: Number of Networks in Surplus or Shortage -- 6.3: Number of Networks with Surplus/Shortages of Doctors -- 6.4: Allocation of HIPC Staff -- 6.5: Composition of MOH Wage Bill 2001 -- 6.6: Summary of Incentives Framework for HRH -- 6.7: Recommended Short and Long-Run Distribution of Selected HRH Management Tasks Between Different Levels of Government -- 7.1: Health Indicators-Indigenous and Non-Indigenous Populations -- 7.2: Coverage of Skilled Birth Attendance, by Population -- B.1: Selected Maternal and Child Health Indicators, 1994-1998 -- B.2: Municipal Health Indicators by Municipal Poverty Level, 1996-2001 -- C.1: Determinants of Use of Health Services -- C.2: Health Indicators 2001 -- C.3: Health Indicators 2000 -- FIGURES.

1.1 Coverage of Skilled Birth Attendance and Antenatal Care 1994-2002 -- 1.2 Coverage of DPT3, Pneumonias and Acute Diarrheal Diseases 1994-2002 -- 1.3 Percentage of Births Attended by Skilled Personnel -- 1.4 MMR vs Skilled Birth Attendance Year 2000 -- 1.5 Skilled Birth Attendance by Income Quintile-2001 -- 2.1 Central Public Health Expenditures 1990-2001 -- 2.2 Health Expenditure per Capita by Income Quintiles 1999 -- 4.1 Financing of the Public Health Insurance -- 5.1 Evolution of Malaria Cases and Parasitic Index, 1991-2002 -- 5.2 TB: Symptomatics, Detection Smears and Positives (1991-2001) -- 6.1 Professional Nurses and GDP per Capita Latin American Countries 1999 -- 6.2 Staffing Levels vs. Requirements MOH First and Second Level Facilities -- 6.3 Staffing Levels vs. Requirements Based on ideal No. of 1st/2nd Level Facilities -- 6.4 Average HRH Shortage by type of Network -- BOX -- 1. Pilot Experiences of Three Health Service Networks with Different Management Models -- 2. The Public Health Insurance and the National Programs.