Organizational barriers and equity lessons from decentralization in lac
Download
1 / 19

organizational barriers and equity: lessons from decentralization ... - PowerPoint PPT Presentation


  • 177 Views
  • Updated On :

Organizational Barriers and Equity: Lessons from Decentralization in LAC. Daniel Maceira, Ph.D. [email protected] Center for the Studies of State and Society Buenos Aires, Argentina. LAC Context During the ’80s and ’90s. Highly Volatile Economies,

Related searches for organizational barriers and equity: lessons from decentralization ...

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'organizational barriers and equity: lessons from decentralization ...' - Rita


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Organizational barriers and equity lessons from decentralization in lac l.jpg

Organizational Barriers and Equity:Lessons from Decentralization in LAC

Daniel Maceira, Ph.D.

[email protected]

Center for the Studies of State and Society

Buenos Aires, Argentina


Lac context during the 80s and 90s l.jpg
LAC Context During the ’80s and ’90s

  • Highly Volatile Economies,

  • Profound Gaps in Income Distribution,

  • Implementation of Macroeconomic Adjustment Policies with Negative Effects on Social Sectors (Education and Health),

  • Social Sectors have been subject to a Series of Reforms. Goals: Achieve Social Objectives s.t. Financial Restrictions (WDR93).



Political economy of health care reforms l.jpg
Political Economy of Health Care Reforms

Political Level

Executive Power

  • Ministry of Health

  • Ministry of Finance

    Congress

    Local Governments

    Multilateral Organizations

    International Donors

    Social Security Institutions

    Private Health Care Plans

    Health Providers´ Chambers

    Physicians´ Prof. Organizations

    Health Care Workers

    Drugs & Input Producers

    Patients

    Consumers´ Associations

Goals

Strategies

Actions

Beliefs

International Level

Sectoral Level


Framework organizational barriers l.jpg
Framework: Organizational Barriers

  • Reforms trigger Changes in the Structure of the Sector.

  • Policy Markers should select clear Goals to contrast them against others´Action Plans, identifying potential Partners & designing Mechanisms to align Interests.

  • Decentralization requires:

    • Willingness to Distribute Political & Financial Power.

    • Strong Investments in Management and Social Control at the Local Level.

  • Any reform should forsee a complete Action Plan considering:

    • Spillovers over other sub-sectors (private, social insurance)

    • Cross subsidies to avoid increasing equity gaps.

  • History Matters (federalisms, socialisms, authoritarisms).



Bolivia l.jpg
Bolivia

  • Structural Reform + Health Care Strategy (Maternal&Child Insurance)

  • Law of Municipalities (´85)/ Popular Participation Law (´94):

    • Coparticipation Funds: New rules of Distribution, based on Population at Departament Level.

    • Popular Election of Municipal Authorities.

    • Decentralization of Resources (Broken production function).

    • Social Control (Popular M&E Commitees).

  • Actors:

    • “Neoliberal” reforms (Sanchez de Lozada)

    • New economic and political Stakeholders,

      • Municipalities vs. Departments (Santa Cruz – Tarija),

      • Declining Union´s Political Power (post 1985)

      • Strong influence of Intl. Donors and Multilateral Organizations.

  • Results:

    • HC Coverage Increased,

    • Strong non-planned Subsidies,

    • Empowerment of Local Leaders,

    • Weak effects on equity gap in resource allocation.


Slide8 l.jpg

100%

90%

80%

70%

60%

%Population

%Co-participation, cumulated

50%

%Own Resources, cumulated

%Foreign Aid, cumulated

40%

30%

20%

10%

0%

1st

2nd

3rd

4th

5th

Distribution of Resources, by quintile of UBN

and by Source



Decentralization in bolivia some conclusions l.jpg
Decentralization in Bolivia: constant) and IMR 2001Some Conclusions

  • Administrative/Managerial expertise of major political parties are significant “Quality Shifters” in some Public Policy Outcomes.

  • Urbanity proves to be a relevant issue when planning Health Care Strategies.

  • Financial Resources, as proxy of Decentralization Commitment have a significant, positive and similar effect on Social Outcomes.

  • Local Managerial Capacity has significant and similar effect on Health and Education Outcomes.

  • Community-type variables do not show influence on Social Sectors´Results.


Argentina l.jpg
Argentina constant) and IMR 2001

  • Federalism + Decentralization (late ´80s).

  • Provintial Authorities kept ownership & control of Health Care Resources (human, fiscal, & infrastructure), defining own Public Health Strategies.

  • COFESA: Federal Health Council – Deliverative Body with no enforcement power.

  • 60% of Population covered by Transversal Social Health Insurance Plans.

    • Main Social Security Institution: PAMI (Public insurance for edlery),

    • Unions and Provintial Public Bureaucracies control circa 50% of formal health coverage, divided into 300 social funds:

      • Fragmentation of resources – weak risk pooling mechanisms.

      • Limited solidarity among funds.

      • Provision of care is mainly contracted to Private Providers (no VI financing-provision of care).

  • Therefore:

    • Limited capacity of National Ministry of Health to align interests,

    • Results:

      • Increasing financial gaps in HC among provinces,

      • Inefficiency in Resource Allocation,

      • Crisis 2002: Alignment of National and Provintial Goals helped to support partial reforms (Remediar, Law of Generics) .


Out of pocket in health care by component in by household income quintiles indec egh98 l.jpg
Out-of-pocket in Health Care, by Component (in %), constant) and IMR 2001By Household Income Quintiles (Indec-EGH98)

Health Care Expenditures %

15

7.5

Total

Health Care Services +

Private Insurance

Pharmaceuticals

Q1

Q2

Q3

Q4

Q5

0

1794

190

3204

Household Income




Health care expenditures by source l.jpg
Health Care Expenditures, by Source constant) and IMR 2001


General policy implementation issues l.jpg
General Policy Implementation Issues constant) and IMR 2001

  • Scarce Empirical Literature on Decentralization in LAC.

  • Lack of M&E Mechanisms affects Documentation of Results.

  • Limited Institutional Capacity at Public Level provokes Organizational Constraints in Policy Implementation.

  • National Governments do not coordinate Health Care Strategies with Governors and Municipal Authorities.

  • Rules/Reforms´Main Actions are defined by Actors with strong bargaining power, implying:

    • Financial and Epidemiological Risk Transfers,

    • Poor Equity Indicators, leading to inefficient allocation of resources,

    • High Transaction (administrative, bargaining) Costs,

    • Poorly Effective Reforms,

    • Lack of Sustainable M&E Tools to improve feedback and Sound Advocacy Agenda.


Income expenditures and hc needs l.jpg
Income, Expenditures and HC Needs constant) and IMR 2001


ad