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Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia
1University of Texas-Houston, School of Public Health, El Paso, Texas, USA. nhomedes@utep.edu
Insights
Bolivia's Integrated Primary Health Care Project (PROISS) showed initial success in improving health services but ultimately declined. External funding challenges question the sustainability of such projects in developing countries.
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.
Abstract:
Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries.