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Difficulties hit Bolivia's programme for pregnant women
World Report
Difficulties hit Bolivia’s programme for pregnant women Anastasia Moloney reports on the progress and difficulties faced by Bolivia’s cash transfer programme for pregnant women, which was launched by the nation’s president in March last year.
www.thelancet.com Vol 375 June 5, 2010
mortality. For that to happen, it will be important to overcome the administrative bottlenecks that have been affecting the scheme so far”, said Jaime Nadal, the UN Population Fund’s (UNFPA) representative in Bolivia. In recent months, Bolivia’s local press have draw attention to difficulties facing the programme, including the firing of some 20 officials (some of whom were national directors) in what has become a highly sensitive and politically charged issue.
“...although the cash transfer programme has encouraged pregnant women to see a doctor...there are substantial difficulties in its implementation.” Long waiting hours in clinics, technical glitches, bottlenecks in signing up to the programmme, and month-long delays in receiving payments, are common complaints voiced by women. Some 60 000 women who have signed up are not getting paid because they do not have a child birth certificate—a prerequisite for receiving cash payments, according to local press. “There is awareness about the problems in implementing the bono, like challenges in infrastructure, human resources, monitoring, and quality assurance, and they have been identified”, said Ivette Sandino, chief of health and nutrition at UNICEF in Bolivia. “There has been progress made in improving the mechanisms in giving out the vouchers but it is still not 100%”, she added. Bolivia was recently singled out among a handful of countries that “have been achieving accelerated progress” in reducing maternal mortality rates, according to research
by the University of Washington’s Institute for Health Metrics and Evaluation published in The Lancet. But whether Bolivia can maintain this trend and to what extent cash transfer programmes can build on previous progress and sustain a decline in maternal mortality rates, particularly in rural areas where rates are roughly double the national average, is so far not clear. “It is too early to measure the impact of the stipend as it was introduced in March, 2009. While one could and should monitor process indicators, we would need at least 5 years—if not more—to measure this programme’s impact on maternal and child mortality rates”, said UNFPA’s Nadal. Additionally, UNICEF’s Sardino says: “There needs to be a better monitoring and evaluation system to measure the progress made in reducing maternal mortality rates, and so that this information is available on a timely basis to influence decision making, programme implementation and policy development.” “The lack of data at the moment means it is difficult to know and get a picture of the situation.”
For The Lancet paper on maternal mortality see Lancet 2010; 375: 1609–23
Anastasia Moloney
The printed journal includes an image merely for illustration Some women in the cash transfer programme have experienced long waits at clinics
1955
Ron Giling/Lineair/Still Pictures
1 year after Bolivia introduced a social programme to reduce the country’s high maternal and child mortality rates, hundreds of thousands of women and children have benefited from the initiative but an array of teething problems, logistical bottlenecks, and a lack of resources continue to mar its progress and prevent its widespread implementation. The conditional cash transfer programme known as the Juana Azurduy stipend, offers cash payments totalling US$260 to pregnant women paid in instalments on condition they attend regular prenatal and postnatal check ups until their child is 2 years, and have a skilled attendant present during birth. Bolivia’s health ministry hopes the initiative, which is a signature policy of the leftist government of Evo Morales and a declared state priority, will reduce maternal mortality rates by roughly half by 2015. With 290 maternal deaths per 100 000 livebirths in 2009, according to government data, Bolivia has one of the highest rates in the Americas. Last year, nearly 350 000 women received cash payments, says the government, whereas the number of pregnant women visiting clinics on any day, particularly in and around the capital La Paz, has more than quadrupled. But although the cash transfer programme has encouraged pregnant women to see a doctor and prevent potential pregnancy-related complications, there are substantial difficulties in its implementation. “The Juana Azurduy [conditional cash transfer scheme], combined with the implementation of the SAFCI Health Delivery Model, could bring about some positive change in the indicators mentioned above, including maternal
Difficulties hit Bolivia’s programme for pregnant women Anastasia Moloney reports on the progress and difficulties faced by Bolivia’s cash transfer programme for pregnant women, which was launched by the nation’s president in March last year.
www.thelancet.com Vol 375 June 5, 2010
mortality. For that to happen, it will be important to overcome the administrative bottlenecks that have been affecting the scheme so far”, said Jaime Nadal, the UN Population Fund’s (UNFPA) representative in Bolivia. In recent months, Bolivia’s local press have draw attention to difficulties facing the programme, including the firing of some 20 officials (some of whom were national directors) in what has become a highly sensitive and politically charged issue.
“...although the cash transfer programme has encouraged pregnant women to see a doctor...there are substantial difficulties in its implementation.” Long waiting hours in clinics, technical glitches, bottlenecks in signing up to the programmme, and month-long delays in receiving payments, are common complaints voiced by women. Some 60 000 women who have signed up are not getting paid because they do not have a child birth certificate—a prerequisite for receiving cash payments, according to local press. “There is awareness about the problems in implementing the bono, like challenges in infrastructure, human resources, monitoring, and quality assurance, and they have been identified”, said Ivette Sandino, chief of health and nutrition at UNICEF in Bolivia. “There has been progress made in improving the mechanisms in giving out the vouchers but it is still not 100%”, she added. Bolivia was recently singled out among a handful of countries that “have been achieving accelerated progress” in reducing maternal mortality rates, according to research
by the University of Washington’s Institute for Health Metrics and Evaluation published in The Lancet. But whether Bolivia can maintain this trend and to what extent cash transfer programmes can build on previous progress and sustain a decline in maternal mortality rates, particularly in rural areas where rates are roughly double the national average, is so far not clear. “It is too early to measure the impact of the stipend as it was introduced in March, 2009. While one could and should monitor process indicators, we would need at least 5 years—if not more—to measure this programme’s impact on maternal and child mortality rates”, said UNFPA’s Nadal. Additionally, UNICEF’s Sardino says: “There needs to be a better monitoring and evaluation system to measure the progress made in reducing maternal mortality rates, and so that this information is available on a timely basis to influence decision making, programme implementation and policy development.” “The lack of data at the moment means it is difficult to know and get a picture of the situation.”
For The Lancet paper on maternal mortality see Lancet 2010; 375: 1609–23
Anastasia Moloney
The printed journal includes an image merely for illustration Some women in the cash transfer programme have experienced long waits at clinics
1955
Ron Giling/Lineair/Still Pictures
1 year after Bolivia introduced a social programme to reduce the country’s high maternal and child mortality rates, hundreds of thousands of women and children have benefited from the initiative but an array of teething problems, logistical bottlenecks, and a lack of resources continue to mar its progress and prevent its widespread implementation. The conditional cash transfer programme known as the Juana Azurduy stipend, offers cash payments totalling US$260 to pregnant women paid in instalments on condition they attend regular prenatal and postnatal check ups until their child is 2 years, and have a skilled attendant present during birth. Bolivia’s health ministry hopes the initiative, which is a signature policy of the leftist government of Evo Morales and a declared state priority, will reduce maternal mortality rates by roughly half by 2015. With 290 maternal deaths per 100 000 livebirths in 2009, according to government data, Bolivia has one of the highest rates in the Americas. Last year, nearly 350 000 women received cash payments, says the government, whereas the number of pregnant women visiting clinics on any day, particularly in and around the capital La Paz, has more than quadrupled. But although the cash transfer programme has encouraged pregnant women to see a doctor and prevent potential pregnancy-related complications, there are substantial difficulties in its implementation. “The Juana Azurduy [conditional cash transfer scheme], combined with the implementation of the SAFCI Health Delivery Model, could bring about some positive change in the indicators mentioned above, including maternal