Bolivia

Throughout its history, Bolivia has been beset with political and civil unrest. Even after democratic civil rule was established in 1982, widespread poverty, racial tensions (two-thirds of the population are indigenous), and illegal drug use continued to limit the government's ability to provide adequate health and social programs for the population of 8,989,046. Bolivia's population has tripled over the last half-cen-tury, and resources are strained.

A debt-forgiveness plan is under way to take some of the burden off the government so that greater resources can be directed to social programs. Bolivia's Strategic Health Plan has been instituted with the intention of eradicating poverty through family planning, domestic violence prevention, and Basic Health Insurance and National Mental Health programs designed to close the health gap between the poor and the rest of the population. Universal Maternal-Child Insurance is an important part of this program. The health plan also calls for universal access to health-care through individual, family, community, and government cooperation.

Around one-tenth of Bolivia's national budget is allotted to healthcare. The government designates 6.7 percent of the Gross Domestic Product (GDP) for such expenditures and spends $176 (international dollars) per capita on healthcare. The government provides 64 percent of healthcare funding, and the private sector funds 36 percent. Out-of-pocket expenses furnish [Page 275]79.30 percent of all private expenditures. Social security spending accounts for 65 percent of government spending. There are 1.22 physicians. 3.19 nurses, 0.1 midwives, 0.71 dentists, and 0.55 pharmacists per 1,000 population in Bolivia.

Eight percent of Bolivia's workforce is unemployed, and there is widespread underemployment. With a per capita income of only $2,900, Bolivia is one of the poorest and least developed countries in Latin America, ranking 160th in world incomes; 64 percent of the population live in poverty. Some 20 percent of the population are malnourished, and 34 percent live on less than $2 a day. More than 14 percent survive on less than $1 a day. Income is unequally distributed, with a Gini index of inequality of 60.6 percent. The richest 10 percent of the population share 32 percent of resources and the poorest 10 percent survive on only 1.3 percent.

Life expectancy is only 65.84 years, with women living an average of six years longer than men. While most of the male population (93.1 percent) is literate, only 81.6 percent of females are considered so. Primary school enrollment is reported at 95 percent and secondary school enrollment at 88 percent. More than one-fifth of children between the ages of 5 and 14 are in the workforce. While 95 percent of urban residents have sustained access to safe drinking water, only 68 percent of rural residents have such access. Some 58 percent of urban residents have access to improved sanitation, but less than a quarter of rural residents have this basic health requirement. The United Nations Development Programme (UNDP) Human Development Reports rank Bolivia 115th of 177 countries on overall quality-of-life issues.

At 2.85 children per woman, Bolivia has the 88th highest fertility rate in the world. Contraceptive use is around 58 percent. Skilled personnel attend 67 percent of all births, and 79 percent of women receive prenatal care. Maternal mortality is extremely high at 420 deaths per 100,000 live births, and Plan Vida has been instituted with the goal of halving maternal mortality.

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