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  1. Local health services : some lessons from their evolution in Bolivia.

    Article - En anglais

    For a decade, numerous projects in Bolivia have tried to put in practice the concept of local health systems.

    But, so far, no significant changes have been made and local health services still are the'poor relation'of the system.

    The main components of the projects-expansion of health facilities, training of health personnel and institutional decentralization-were not designed to respond to the complexity of the problems encountered.

    Decentralization was implemented at the level of health districts but not accompanied by redefinition of functions at the central level, and challenged by civil servants'attempts to save their jobs.

    While training activities did introduce new methods and subjects, they were too often reduced to short workshops or seminars.

    Health facilities were built without regard for their significance beyond health care.

    A strategic approach is needed to adapt the planning process to the degree of liberty allowed by society.

    Mots-clés Pascal : Service santé, Echelon local, Bolivie, Amérique du Sud, Amérique, Décentralisation, Personnel sanitaire, Stratégie, Evolution

    Mots-clés Pascal anglais : Health service, Local scope, Bolivia, South America, America, Decentralization, Health staff, Strategy, Evolution

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0307071

    Code Inist : 002B30A01B. Création : 15/07/1997.