Bolivia: a mid-course assessment of the National Mother Child Health Insurance Program.

This article presents a mid-course assessment on the National Mother Child Health (MCH) Insurance Program in Bolivia. Since the initiation of the MCH insurance program in 1996, the government anticipated the reduction of maternal and child mortality through provision of essential medical care for reproductive women, newborns and children under 5 years old. The program addresses priority health needs such as birth and antenatal care, acute respiratory illness, and diarrhea. The evaluation was conducted through interviews, information reviews, and surveys among 31 hospitals, health centers, and heath posts in 12 municipalities of Bolivia. Changes in the utilization of services, financial sustainability, and institutional capacity were observed as a result of insurance reform. In conclusion, this evaluation suggests some modifications in the program, including alteration of basic payment rates of the insurance program, creation of an administrative unit to manage program operations, and examination of problem areas such as subsidized transportation, reimbursement rates, shortage of working capital, and personnel incentives.