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The latter is reported administrative context, not evidence that the formal design was achieved.", "tags": [], "territory": "Bolivia (Plurinational State of), SUS public-service network; rural and indigenous illustrations", "title": "Formal SUS levels and health-network design", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/images/Descarga/SUS/Instructivo_guia_completo_001_SUS_2019.pdf" }, { "kind": "source_reference", "source": "Primary Health Care in Rural Areas and Indigenous Communities of Bolivia", "url": "https://cdn.who.int/media/docs/default-source/documents/gender/phc-for-indigenous-people-of-bolivia.pdf" }, { "kind": "source_reference", "source": "Histórico: Gobierno y directores acuerdan optimizar la atención en hospitales de tercer nivel con equipamiento, personal y SUS", "url": "https://www.minsalud.gob.bo/8153-historico-gobierno-y-directores-acuerdan-optimizar-la-atencion-en-hospitales-de-tercer-nivel-con-equipamiento-personal-y-sus" } ] }, { "analytical_mapping": { "mapping_basis": "observed_from_a_mixed-methods_study_with_a_la_paz_qualitative_case_study", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:BOL:delivery-referrals:la-paz-observed-referral-and-private-alternative-boundary", "source_projection_ids": [ "country-improvement-source:BOL:agafitei-sus-access-study-2023" ], "support_state": "candidate_supported", "target_slot": "la-paz-case-study-referral-and-counter-referral-boundary", "target_view": "referrals", "typed_fields": { "observed_case_context": "interview accounts described coordination and counter-referral difficulties between first and second levels", "private_alternative": "the study reports some users or staff described private care when public specialist access was difficult", "scope_boundary": "interviews in one municipality do not estimate national referral completion, bypass or private-sector utilization", "study_design": "national household-survey analysis plus 2021 interviews in La Paz" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Agafitei GA. Revista Latinoamericana de Desarrollo Económico. 2023;39:35-76, physical pages 31 to 35.", "country_ids": [ "BOL" ], "coverage_domains": [ "facility_data", "hospital_organization", "market_structure", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "Physical pages 31 to 35, Access to SUS healthcare services: a case study of La Paz." }, "material_id": "material:6d51a17b3e85841d764e73bc", "notes": [ "Keep interview accounts, national survey results and the private-care alternative distinct; do not calculate national rates from this case study." ], "origin": "candidate-analytical-mappings", "period": "National surveys 2017-2019; La Paz interviews during 2021; article published 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "5625b6a4d882f8e4f1691176ddfff93f7fc99c8be043cae715901736f8e9ba7c", "response_sha256": "5625b6a4d882f8e4f1691176ddfff93f7fc99c8be043cae715901736f8e9ba7c" }, "statement": "A mixed-methods study reports La Paz interview accounts of coordination and counter-referral difficulties between first and second levels, with some descriptions of private alternatives. These are site-specific observations, not a national flow estimate or a causal effect of SUS.", "tags": [], "territory": "La Paz municipality, Bolivia (Plurinational State of); national survey component separately bounded", "title": "La Paz referral and private-alternative observations", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://lajed.ucb.edu.bo/a/article/download/278/486" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_who_management-level_material_a_dated_system-study_and_a_ministry_public-sector-account", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:BOL:actors-functions:national-department-municipal-architecture", "source_projection_ids": [ "country-improvement-source:BOL:who-indigenous-phc-networks", "country-improvement-source:BOL:agafitei-sus-access-study-2023", "country-improvement-source:BOL:ministry-concurrent-responsibilities-2025" ], "support_state": "candidate_supported", "target_slot": "national-department-municipal-health-network-architecture", "target_view": "functions", "typed_fields": { "2025_public_account": "a Ministry report describes concurrent national, departmental and municipal responsibilities in the public SUS context", "departmental_level": "SEDES is shown as the departmental health-service level", "municipal_level": "municipalities are shown at the local administration level", "national_level": "Ministry of Health is shown as the national management level", "operational_boundary": "health networks, services and community organizations are operational components", "scope_boundary": "the sources do not establish an identical management arrangement for every sector or locality" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "WHO, Primary Health Care in Rural Areas and Indigenous Communities of Bolivia, pages 2 to 3; Agafitei 2023, pages 16 to 17; Ministerio de Salud y Deportes, Directora del SUS, 16 May 2025.", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "authoritative_review", "governance", "government_responsibilities", "hospital_organization", "networks", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "WHO physical pages 2 to 3, Health System Management Levels; Agafitei physical pages 16 to 17, Bolivian health system; Ministry web section Directora del SUS, 16 May 2025." }, "material_id": "material:8a66777ebb723562700dd6c7", "notes": [ "Do not turn the illustrated public-network hierarchy into an ownership or management claim for social security, private or traditional providers." ], "origin": "candidate-analytical-mappings", "period": "WHO material available 2021; system description in a 2023 study using earlier evidence; Ministry report dated 16 May 2025", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315", "response_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315" }, "statement": "The candidate map distinguishes the Ministry at national level, SEDES at departmental level and municipalities at local level, with health networks and services operating below these levels. A 2025 Ministry account also describes concurrent responsibilities in the public SUS context. Neither source set assigns every provider sector to one chain of authority.", "tags": [], "territory": "Bolivia (Plurinational State of), with rural and indigenous-network illustrations and a public-SUS Ministry account", "title": "National, departmental and municipal health-network levels", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://cdn.who.int/media/docs/default-source/documents/gender/phc-for-indigenous-people-of-bolivia.pdf" }, { "kind": "source_reference", "source": "The Bolivian Universal Health System and Effective Access to Healthcare: A Diagnosis", "url": "https://lajed.ucb.edu.bo/a/article/download/278/486" }, { "kind": "source_reference", "source": "Directora del SUS: la salud es una competencia compartida entre el Gobierno nacional y las entidades territoriales", "url": "https://www.minsalud.gob.bo/8630-directora-del-sus-la-salud-es-una-competencia-compartida-entre-el-gobierno-nacional-y-las-entidades-territoriales" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_grey_who_benefit-package_profile_and_research_literature", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:BOL:relationships-networks:public-social-security-private-sector-boundaries", "source_projection_ids": [ "country-improvement-source:BOL:who-health-benefit-package-2020-2021", "country-improvement-source:BOL:agafitei-sus-access-study-2023" ], "support_state": "candidate_supported", "target_slot": "sus-social-security-and-private-coverage-boundaries", "target_view": "public-private", "typed_fields": { "ownership_boundary": "coverage and network descriptions do not establish ownership, quality or use of each provider", "private_boundary": "WHO reports voluntary private coverage", "social_security_boundary": "short-term social-security cajas are reported with their own provider networks", "sus_public_boundary": "WHO reports public coverage for people without another coverage type" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "WHO Health Benefit Package Country Profile, physical page 1; Agafitei 2023, physical pages 16 to 18.", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "authoritative_review", "decision_rights", "governance", "market_structure", "networks", "ownership" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "WHO physical page 1, HBP features and processes; Agafitei physical pages 16 to 18, Bolivian health system." }, "material_id": "material:82a3df041aef6cceb0068e7e", "notes": [ "Do not recast social-security network statements as SUS purchasing or private-provider ownership claims." ], "origin": "candidate-analytical-mappings", "period": "WHO survey responses 2020-2021; study published 2023 using earlier system evidence", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "770b1978a782de9c54c848138269ca8a23cfaae64117d53dbe9b471330e82dd5", "page_count": 3, "response_sha256": "770b1978a782de9c54c848138269ca8a23cfaae64117d53dbe9b471330e82dd5" }, "statement": "WHO reports a public subsector, short-term social-security cajas with their own provider networks, and voluntary private coverage. The mapping keeps SUS, social security and private arrangements separate; it does not claim that their populations, providers or care routes are mutually exclusive in practice.", "tags": [], "territory": "Bolivia (Plurinational State of)", "title": "Public, social-security and private sector boundaries", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://cdn.who.int/media/docs/default-source/health-economics/hbp-country-profiles-2020-21/hbp-country_area-profile_bolivia-%28plurinational-state-of%29.pdf" }, { "kind": "source_reference", "source": "The Bolivian Universal Health System and Effective Access to Healthcare: A Diagnosis", "url": "https://lajed.ucb.edu.bo/a/article/download/278/486" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_ministry_sus_implementation_guide_cross_checked_against_grey_who_survey_profile", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:BOL:decision-autonomy:sus-formal-benefit-and-entry-rules", "source_projection_ids": [ "country-improvement-source:BOL:sus-implementation-guide-2019", "country-improvement-source:BOL:who-health-benefit-package-2020-2021" ], "support_state": "candidate_supported", "target_slot": "sus-formal-benefit-package-and-level-of-care-rules", "target_view": "decisions", "typed_fields": { "autonomy_boundary": "neither source measures facility discretion or actual access at each level", "formal_sus_rule": "the Ministry guide sets SUS implementation and levels-of-care arrangements", "national_role": "the Ministry is named in WHO survey responses as an actor in benefit-package discussions", "service_boundary": "the WHO profile reports package conditions and 2020-2021 responses" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes, Guía instructiva para la implementación del SUS, 2019, pages 5, 11 and 18; WHO Health Benefit Package Country Profile, page 1.", "country_ids": [ "BOL" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "hospital_organization", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Ministry guide physical pages 5, 11 and 18, Redes de Salud and Niveles de atención; WHO profile physical page 1, HBP features and processes." }, "material_id": "material:e17cda0b14dd3098b61533ac", "notes": [ "Keep formal rules separate from reported availability, utilization and referral completion." ], "origin": "candidate-analytical-mappings", "period": "formal guide issued 2019; WHO survey responses 2020-2021", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c", "page_count": 29, "response_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c" }, "statement": "The Ministry's 2019 guide supports a formal SUS implementation mapping, while WHO reports the Ministry's role in benefit-package discussions. These sources do not establish that a given service was available, free or used at every facility.", "tags": [], "territory": "Bolivia (Plurinational State of), SUS public-service network", "title": "SUS formal benefit and level-of-care rules", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/images/Descarga/SUS/Instructivo_guia_completo_001_SUS_2019.pdf" }, { "kind": "source_reference", "source": "Bolivia (Plurinational State of): Health Benefit Package Country Profile", "url": "https://cdn.who.int/media/docs/default-source/health-economics/hbp-country-profiles-2020-21/hbp-country_area-profile_bolivia-%28plurinational-state-of%29.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_ministry_implementation_guide_cross_checked_against_paho_profile_and_who_country-reporting", "mapping_group": "time_and_reform", "mapping_id": "candidate-mapping:BOL:time-reform:sus-2019-formal-launch-and-profiled-context", "source_projection_ids": [ "country-improvement-source:BOL:sus-implementation-guide-2019", "country-improvement-source:BOL:paho-country-profile-2024", "country-improvement-source:BOL:who-sus-coverage-country-story-2020" ], "support_state": "candidate_supported", "target_slot": "sus-2019-formal-launch-and-subsequent-profile-context", "target_view": "reforms", "typed_fields": { "2019_formal_event": "the Ministry issued the SUS implementation guide in 2019", "2019_reported_launch": "PAHO reports SUS launch from February 2019", "2024_profile_boundary": "the PAHO profile contains indicators with stated source years", "effect_boundary": "formal launch and later institutional reporting do not establish the reform's causal effects", "who_2020_report": "WHO's 2020 country story reports 2019 reforms and its support for policy formulation and implementation planning" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes, Guía instructiva para la implementación del SUS, 2019; WHO, Universal health access and coverage, a reference for the world, 2020; PAHO, Perfil de País: Bolivia, 2024.", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "authoritative_review", "decision_rights", "facility_data", "governance", "government_responsibilities", "hospital_organization", "networks", "primary_care", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "Ministry guide physical page 1, title; WHO country-story sections Bolivia country story and Universal health access and coverage; PAHO web sections Perfil de País and Situación de salud." }, "material_id": "material:f79e60153d81b639023e84ad", "notes": [ "Do not convert a launch date or profile indicator into a national implementation-effect claim." ], "origin": "candidate-analytical-mappings", "period": "formal guide 2019; WHO country story for the 2020 mid-term review; PAHO profile published 15 September 2024 with indicator-specific source years", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c", "page_count": 29, "response_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c" }, "statement": "The candidate timeline records the 2019 Ministry implementation guide, PAHO's reported February 2019 SUS launch, and WHO's subsequent institutional account of 2019 policy formulation and implementation planning, followed by a 2024 country profile. It does not attribute later indicator patterns to SUS or establish uniform implementation across departments and municipalities.", "tags": [], "territory": "Bolivia (Plurinational State of)", "title": "SUS launch and subsequent profile context", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://hia.paho.org/es/perfiles-de-pais/bolivia" }, { "kind": "source_reference", "source": "Guía instructiva para la implementación del Sistema Único de Salud", "url": "https://www.minsalud.gob.bo/images/Descarga/SUS/Instructivo_guia_completo_001_SUS_2019.pdf" }, { "kind": "source_reference", "source": "Universal health access and coverage, a reference for the world", "url": "https://www.who.int/about/accountability/results/who-results-report-2020-mtr/country-story/2020/universal-health-access-and-coverage-a-reference-for-the-world" } ] }, { "analytical_mapping": { "mapping_basis": "reported_from_official_who_indigenous_phc_material_and_grey_who_sector-profile", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:BOL:actors-functions:traditional-sector-and-public-private-boundary", "source_projection_ids": [ "country-improvement-source:BOL:who-indigenous-phc-networks", "country-improvement-source:BOL:who-health-benefit-package-2020-2021" ], "support_state": "candidate_supported", "target_slot": "traditional-sector-intercultural-and-public-private-boundary", "target_view": "public-private", "typed_fields": { "intercultural_context": "WHO describes SAFCI and indigenous-community health-network work", "social_security_private_boundary": "WHO separately reports short-term social-security cajas and voluntary private coverage", "sus_boundary": "WHO separately reports the public subsector and SUS implementation context", "traditional_boundary": "the available sources do not establish a national financing, licensing, referral or utilization map for traditional practitioners" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "WHO, Primary Health Care in Rural Areas and Indigenous Communities of Bolivia, pages 3 to 6; WHO Health Benefit Package Country Profile, page 1.", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "governance", "market_structure", "networks", "ownership", "patient_flows", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "WHO indigenous PHC material physical pages 3 to 6, Indigenous Health Network and SAFCI context; WHO HBP profile physical page 1, sector description." }, "material_id": "material:01b79fc151dd6bf7bd84689d", "notes": [ "Do not equate intercultural policy context with verified traditional-service coverage, referral volume, private provision or social-security contracting." ], "origin": "candidate-analytical-mappings", "period": "WHO rural and indigenous material available 2021; WHO benefit-package survey responses 2020-2021", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315", "response_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315" }, "statement": "The sources support separate analytical treatment of indigenous community-network context, SUS public services, short-term social security and voluntary private coverage. They do not provide a national traditional-practitioner financing, licensing or referral map, so no such linkage is asserted.", "tags": [], "territory": "Bolivia (Plurinational State of), with rural and indigenous-community examples", "title": "Traditional-sector, public, social-security and private boundaries", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://cdn.who.int/media/docs/default-source/documents/gender/phc-for-indigenous-people-of-bolivia.pdf" }, { "kind": "source_reference", "source": "Bolivia (Plurinational State of): Health Benefit Package Country Profile", "url": "https://cdn.who.int/media/docs/default-source/health-economics/hbp-country-profiles-2020-21/hbp-country_area-profile_bolivia-%28plurinational-state-of%29.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization. Bolivia (Plurinational State of): Health Benefit Package Country Profile. WHO Global Survey on HTA and Health Benefit Packages, 2020-2021. https://cdn.who.int/media/docs/default-source/health-economics/hbp-country-profiles-2020-21/hbp-country_area-profile_bolivia-%28plurinational-state-of%29.pdf", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "facility_data", "governance", "hospital_organization", "market_structure", "networks", "ownership", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "Each box has its own network of providers", "institution": "World Health Organization", "locator": { "locator_type": "pdf_page_anchor", "section": "HBP features and processes", "source_word_anchor": "Each box has its own network of providers", "source_word_count": 8 }, "material_id": "material:87d2c270537551e1da4197d0", "notes": [ "Keep SUS, short-term social security and voluntary private coverage as separate reported sectors." ], "origin": "country-evidence-improvement-sources", "period": "WHO survey responses for 2020-2021", "publication_date": null, "publication_year": 2021, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "770b1978a782de9c54c848138269ca8a23cfaae64117d53dbe9b471330e82dd5", "page_count": 3, "response_sha256": "770b1978a782de9c54c848138269ca8a23cfaae64117d53dbe9b471330e82dd5" }, "statement": "WHO reports a public subsector for people without other coverage, short-term social-security cajas with their own provider networks, and voluntary private coverage. The profile reports survey information and does not establish current enrolment, contracting or use for every fund or provider.", "tags": [], "territory": "Bolivia (Plurinational State of), public subsector, short-term social security and voluntary private coverage", "title": "Bolivia (Plurinational State of): Health Benefit Package Country Profile", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://cdn.who.int/media/docs/default-source/health-economics/hbp-country-profiles-2020-21/hbp-country_area-profile_bolivia-%28plurinational-state-of%29.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes. Directora del SUS: la salud es una competencia compartida entre el Gobierno nacional y las entidades territoriales. 16 May 2025. https://www.minsalud.gob.bo/8630-directora-del-sus-la-salud-es-una-competencia-compartida-entre-el-gobierno-nacional-y-las-entidades-territoriales", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "observed_referral", "ownership", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "la salud es una competencia compartida", "institution": "Ministerio de Salud y Deportes, Estado Plurinacional de Bolivia", "locator": { "locator_type": "web_section_anchor", "source_word_anchor": "la salud es una competencia compartida", "source_word_count": 6 }, "material_id": "material:9e22b3e5f394c2973ed41c0e", "notes": [ "Treat the facility ownership, financing and referral descriptions as a Ministry account limited to the public SUS context." ], "origin": "country-evidence-improvement-sources", "period": "Ministry news report, 16 May 2025", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "ca147fed61d9c7b5133cfe259c1e512dc1dc3a40f0b553116ec8bb29aedfecc0" }, "statement": "The Ministry's SUS director reports concurrent national, departmental and municipal responsibilities, including departmental ownership of third-level hospitals and municipal financing of first- and second-level facilities. The report also describes referral problems in some departments, but it is not an independent national performance audit.", "tags": [], "territory": "Bolivia (Plurinational State of), public SUS facilities; examples discuss Santa Cruz", "title": "Directora del SUS: la salud es una competencia compartida entre el Gobierno nacional y las entidades territoriales", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/8630-directora-del-sus-la-salud-es-una-competencia-compartida-entre-el-gobierno-nacional-y-las-entidades-territoriales" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes. Guía instructiva para la implementación del Sistema Único de Salud. 2019. https://www.minsalud.gob.bo/images/Descarga/SUS/Instructivo_guia_completo_001_SUS_2019.pdf", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "networks", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Sistema Único de Salud", "institution": "Ministerio de Salud y Deportes, Estado Plurinacional de Bolivia", "locator": { "locator_type": "pdf_title_and_sections", "source_word_anchor": "Sistema Único de Salud", "source_word_count": 4 }, "material_id": "material:3fe270d68b45a3851f8c5321", "notes": [ "Treat the guide as a 2019 formal framework, not as an implementation audit." ], "origin": "country-evidence-improvement-sources", "period": "SUS implementation guide issued in 2019", "publication_date": null, "publication_year": 2019, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c", "page_count": 29, "response_sha256": "2e04455b1076d6a37c431940fd80a1e128778e6ff6fab0e1a4a16fd2d56e629c" }, "statement": "The Ministry guide sets out implementation arrangements for SUS. It is evidence of the formal 2019 operational framework and must not be read as proof that every municipality, network or service route was functioning as designed.", "tags": [], "territory": "Bolivia (Plurinational State of), Sistema Único de Salud public-service network", "title": "Guía instructiva para la implementación del Sistema Único de Salud", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/images/Descarga/SUS/Instructivo_guia_completo_001_SUS_2019.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes. Histórico: Gobierno y directores acuerdan optimizar la atención en hospitales de tercer nivel con equipamiento, personal y SUS. 4 June 2024. https://www.minsalud.gob.bo/8153-historico-gobierno-y-directores-acuerdan-optimizar-la-atencion-en-hospitales-de-tercer-nivel-con-equipamiento-personal-y-sus", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "facility_data", "governance", "government_responsibilities", "hospital_organization", "networks", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "agilizar la referencia-contrarreferencia", "institution": "Ministerio de Salud y Deportes, Estado Plurinacional de Bolivia", "locator": { "locator_type": "web_section_anchor", "source_word_anchor": "agilizar la referencia-contrarreferencia", "source_word_count": 3 }, "material_id": "material:db1b2ddb87286eabc9107633", "notes": [ "Do not convert a reported agreement or stated priority into evidence of completed referral improvement." ], "origin": "country-evidence-improvement-sources", "period": "Ministry news report, 4 June 2024", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "3dbd8a43f0159f92f51ecdf11857a7aa9ce2c592e0411051a3fc1a9f5bc1dff1" }, "statement": "The Ministry reports an agreement with 34 third-level hospital directors to improve equipment, staffing, medicines and referral-counter-referral work. This documents a stated administrative priority and reported problem context, not achieved changes or national referral outcomes.", "tags": [], "territory": "Bolivia (Plurinational State of), Ministry meeting with 34 third-level hospital directors", "title": "Histórico: Gobierno y directores acuerdan optimizar la atención en hospitales de tercer nivel con equipamiento, personal y SUS", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/8153-historico-gobierno-y-directores-acuerdan-optimizar-la-atencion-en-hospitales-de-tercer-nivel-con-equipamiento-personal-y-sus" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministerio de Salud y Deportes. Ministra de Salud resalta la importancia de acudir al primer nivel de atención para aliviar la carga del tercer nivel. 8 January 2024. https://www.minsalud.gob.bo/7957-ministra-de-salud-resalta-la-importancia-de-acudir-al-primer-nivel-de-atencion-para-aliviar-la-carga-del-tecer-nivel", "country_ids": [ "BOL" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "networks", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "primer y segundo nivel dependen de los municipios", "institution": "Ministerio de Salud y Deportes, Estado Plurinacional de Bolivia", "locator": { "locator_type": "web_section_anchor", "source_word_anchor": "primer y segundo nivel dependen de los municipios", "source_word_count": 8 }, "material_id": "material:460a037236fc7827ea4a6af4", "notes": [ "Do not treat this Ministry news report as a legal allocation, a measure of provider autonomy, or evidence that referrals follow the stated levels." ], "origin": "country-evidence-improvement-sources", "period": "Ministry news report, 8 January 2024; service counts cited for 2023", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "6b95cd5ce7cf262de7cd3921e956cd7e2c90798e4978d44a575da5a2ffad98d2" }, "statement": "A Ministry news report states that first- and second-level care depend on municipalities, third-level care on departmental governments, and fourth-level care on national government. It is an official reported account and does not establish legal detail, facility autonomy, or actual care-routing compliance.", "tags": [], "territory": "Bolivia (Plurinational State of), reported public SUS service arrangement", "title": "Ministra de Salud resalta la importancia de acudir al primer nivel de atención para aliviar la carga del tercer nivel", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.minsalud.gob.bo/7957-ministra-de-salud-resalta-la-importancia-de-acudir-al-primer-nivel-de-atencion-para-aliviar-la-carga-del-tecer-nivel" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Pan American Health Organization. Perfil de País: Bolivia. Salud en las Américas+, 15 September 2024. https://hia.paho.org/es/perfiles-de-pais/bolivia", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "authoritative_review", "facility_data", "governance", "patient_flows", "primary_care", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "lanzamiento del Sistema Único de Salud", "institution": "Pan American Health Organization", "locator": { "locator_type": "web_section_anchor", "source_word_anchor": "lanzamiento del Sistema Único de Salud", "source_word_count": 6 }, "material_id": "material:fa8a28c39950ce8db6b94880", "notes": [ "Use indicator-specific dates and do not replace current national administrative data with profile estimates." ], "origin": "country-evidence-improvement-sources", "period": "Country profile published 15 September 2024; indicators use stated source years", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "7b0d01e81b2105954235fde3e7cc2fbd04591ffd7a35d9a7b915c9ce355a78ea" }, "statement": "PAHO reports that SUS was launched from February 2019 and presents national, departmental and municipal health indicators. The profile cautions that its interagency indicators may differ from more recent country figures.", "tags": [], "territory": "Bolivia (Plurinational State of), national profile with department and municipality indicators where specified", "title": "Perfil de País: Bolivia", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://hia.paho.org/es/perfiles-de-pais/bolivia" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization. Primary Health Care in Rural Areas and Indigenous Communities of Bolivia. https://cdn.who.int/media/docs/default-source/documents/gender/phc-for-indigenous-people-of-bolivia.pdf", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "facility_data", "governance", "government_responsibilities", "hospital_organization", "networks", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "HEALTH SYSTEM MANAGEMENT LEVELS", "institution": "World Health Organization", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "HEALTH SYSTEM MANAGEMENT LEVELS", "source_word_count": 4 }, "material_id": "material:a876e2d9f3a67f1f1dc6c8b5", "notes": [ "Separate the indigenous-network examples from national system-wide observed service use." ], "origin": "country-evidence-improvement-sources", "period": "WHO presentation material available in 2021", "publication_date": null, "publication_year": 2021, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315", "response_sha256": "adc3cf6c4608dcceb4ffc66b28f7a2eded1f3bbfa429de97f1ad27a722c4f315" }, "statement": "WHO depicts Ministry, departmental SEDES, municipalities, health networks and community organizations as distinct management or operational levels. It describes rural and indigenous-network examples and should not be generalized into a complete current national referral-performance measure.", "tags": [], "territory": "Bolivia (Plurinational State of), rural and indigenous communities; examples include Cochabamba Tropics municipalities", "title": "Primary Health Care in Rural Areas and Indigenous Communities of Bolivia", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://cdn.who.int/media/docs/default-source/documents/gender/phc-for-indigenous-people-of-bolivia.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Alvarez FN, Leys M, Rivera Mérida HE, Escalante Guzmán G. Primary health care research in Bolivia: systematic review and analysis. Health Policy and Planning. 2016;31(1):114-128. doi:10.1093/heapol/czv013. https://pubmed.ncbi.nlm.nih.gov/25953966/", "country_ids": [ "BOL" ], "coverage_domains": [ "actors", "authoritative_review", "facility_data", "governance", "government_responsibilities", "networks", "primary_care", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "there has not been a comprehensive analysis", "institution": "Health Policy and Planning", "locator": { "locator_type": "web_section_anchor", "source_word_anchor": "there has not been a comprehensive analysis", "source_word_count": 7 }, "material_id": "material:d3cce084d2ac242df94ce8f2", "notes": [ "Keep the review's policy description and evidence-gap finding distinct from current observed performance." ], "origin": "country-evidence-improvement-sources", "period": "Literature reviewed through the study's 2015 publication; journal issue 2016", "publication_date": null, "publication_year": 2016, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "c46ce33aed23220695c647edc2eb2c4598f3543a78b5f2fbc31de4bbdedc990f" }, "statement": "This systematic review reports that SAFCI was intended to establish intercultural, intersectoral and integrated primary health care, while finding limited research to assess policy effects. It synthesizes a dated evidence base and does not measure current service delivery or referral performance.", "tags": [], "territory": "Bolivia (Plurinational State of), national primary-health-care research and policy context", "title": "Primary health care research in Bolivia: systematic review and analysis", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pubmed.ncbi.nlm.nih.gov/25953966/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Agafitei GA. The Bolivian Universal Health System and Effective Access to Healthcare: A Diagnosis. 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