Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia

Area of Science:

• Public Health
• International Development
• Health Policy

Background:

• Bolivia faces significant health challenges, including poor indicators and high child mortality from communicable diseases and malnutrition.
• The Integrated Primary Health Care Project (PROISS) aimed to enhance primary healthcare in major Bolivian municipalities.
• The project was a substantial investment, co-financed by the World Bank and executed by the Ministry of Health.

Purpose of the Study:

• To analyze the factors contributing to the success and subsequent decline of the PROISS project.
• To extract lessons for project managers and international agencies involved in social sector project implementation.
• To critically assess the long-term sustainability of externally financed health projects in recipient nations.

Main Methods:

• A case study approach examining the three distinct phases of the PROISS project (1990-1997).
• Analysis of project implementation, including periods of conflict, improvement, and decline.
• Qualitative exploration of contributing factors to project outcomes.

Main Results:

• The project experienced a period of significant improvement in health service coverage and quality (Phase 2).
• However, the project faced challenges leading to its decline in later stages (Phase 3).
• Factors influencing these shifts included internal conflicts and external funding dynamics.

Conclusions:

• Externally financed projects may struggle to achieve sustainable impact on national health sectors.
• Lessons learned emphasize the need for careful planning, adaptive management, and consideration of long-term sustainability in international health initiatives.
• The PROISS case highlights the complexities of implementing and sustaining large-scale health projects in resource-limited settings.