Leadership, Management and Sustainability (LMS) Program

Health outcomes vary widely between urban and rural areas and indigenous and non-indigenous populations in Bolivia, the poorest country in South America. Maternal mortality is high and access to modern contraceptive methods is often limited. In the mid-1990s Bolivia embarked on the process of decentralizing health services to help address these inequities. The national government established a universal insurance package for basic health services to be delivered at the municipal level. In January 2003, this insurance program was expanded to cover health services for pregnant women and children under five. While the introduction of health insurance has improved equity and access to health care, it has also greatly increased the responsibilities of municipalities.

RESULTS

Over the past 5 years LMS has strengthened the institutional capacity of Centro de Investigación, Educación, y Servicios (CIES), Bolivia’s International Planned Parenthood Foundation. LMS’s assistance has resulted in a stronger organizational image and position of CIES in the marketplace, improved organizational systems, and achieved a 60% rate of financial sustainability.

CIES successfully decentralized management functions and processes to 8 regional offices. Annual operating plans, control manuals and financial, human resources and procurement systems were developed and implemented.
A web-based management dashboard is now used to track key performance and financial indicators on a monthly basis by senior management.
Four CIES regional offices completed the Business Planning for Health program, and three received capacity building grants to enable these regions to begin implementing their business plans.
A total of 65 senior leaders have been trained in leadership and management practices.

EXPERIENCE IN COUNTRY

Support to Centro de Investigación, Educación, y Servicios (CIES)

The USAID/Bolivia Mission requested that LMS provide organizational strengthening assistance to CIES (the Center for Investigation, Education, and Services), the International Planned Parenthood Foundation (IPPF) affiliate in Bolivia, to increase its rate of financial sustainability from under 50% to 85%. CIES is highly dependent on funding from USAID and IPPF. Founded in 1987, CIES is an NGO providing reproductive health services in nine clinics throughout Bolivia.

CIES is working toward decentralization, increased market analysis capacity, diversification of clinic services, and improved human resource systems. LMS technical assistance focuses on the areas of strategic planning, marketing, business planning/proposal development, and human resource management. LMS has worked with CIES to implement several tools to strengthen the organization and improve its financial sustainability including the LMS Work Climate Assessment, MSH’s Cost Revenue Analysis (CORE), the Business Planning for Health program, a human resource manual and training program. LMS has also supported a series of workshops for the CIES staff to enhance leadership skills incorporating areas of change management, negotiation, strategic thinking, and motivation. These tools and workshops have promoted CIES to update its mission, structure and strategies in a new strategic plan for 2007–2011.

Business Planning with APROSAR

APROSAR is a community-focused organization that works with indigenous populations. Since it first participated in the Business Planning for Health (BPH) program in 2002 under the M&L Program, it has written and received funding for nine business plans. As of March 2006, APROSAR has received $149,223 from Dutch and Belgian donors, Fundación Inter Américana, and Louvain Développement as well as $120,000 for a tenth business plan which is pending approval from the Fundación Aliplano. Funded business plans address various health priorities in the communities APROSAR serves including: extension of primary health care services through a mobile program; improving services provided by community health promoters; equipping an outpatient dental clinic; clean water projects in three municipalities; advanced training for community nurses; and developing human resources for community health programs in Sur Carangas province of the Department of Oruro.