The World Bank, state reform, and the adjustment of social policies in Latin America. / Banco Mundial, reforma dos Estados e ajuste das políticas sociais na América Latina.

This article briefly analyses the central points of the World Bank's agenda for the reform of national states in Latin America, between 1980 and 2017. The text is based on World Bank documents and specialized literature. Initially some relevant aspects of the history of the World Bank and its configuration as a multilateral organization are presented. Next, it discusses the role of the institution in the encouragement of structural adjustment programs for the economies of the region during the 1980s, based on a hyper-market oriented agenda. Afterwards, the process of the renewal and expansion process of the Bank's political agenda from the end of the 1990s is looked at, which was based on the maintenance of the macroeconomic adjustment, the encouragement of institutional reforms, and combatting extreme poverty. Finally, the principal lines in the Bank's social policy reform agenda are discussed, including health.

Este artigo analisa brevemente os pontos centrais da agenda do Banco Mundial para a reforma dos Estados nacionais na América Latina, no período de 1980 a 2017. O texto se baseia em documentos do próprio Banco Mundial e na literatura especializada. Inicialmente, apresenta alguns aspectos relevantes da história do Banco Mundial e de sua configuração como organização multilateral. A seguir, discute o papel da instituição na promoção de programas de ajuste estrutural das economias da região durante a década de 1980, baseado numa agenda hipermercadista. Após, aborda o processo de renovação e ampliação da agenda política do Banco do final dos anos 1990 em diante, calcado na manutenção do ajuste macroeconômico, na promoção de reformas institucionais e no combate à pobreza extrema. Por fim, discute as linhas centrais da agenda do Banco de reforma das políticas sociais, entre as quais a de saúde.

Banco Mundial, reforma dos Estados e ajuste das políticas sociais na América Latina / The World Bank, state reform, and the adjustment of social policies in Latin America

Resumo Este artigo analisa brevemente os pontos centrais da agenda do Banco Mundial para a reforma dos Estados nacionais na América Latina, no período de 1980 a 2017. O texto se baseia em documentos do próprio Banco Mundial e na literatura especializada. Inicialmente, apresenta alguns aspectos relevantes da história do Banco Mundial e de sua configuração como organização multilateral. A seguir, discute o papel da instituição na promoção de programas de ajuste estrutural das economias da região durante a década de 1980, baseado numa agenda hipermercadista. Após, aborda o processo de renovação e ampliação da agenda política do Banco do final dos anos 1990 em diante, calcado na manutenção do ajuste macroeconômico, na promoção de reformas institucionais e no combate à pobreza extrema. Por fim, discute as linhas centrais da agenda do Banco de reforma das políticas sociais, entre as quais a de saúde.

Abstract This article briefly analyses the central points of the World Bank's agenda for the reform of national states in Latin America, between 1980 and 2017. The text is based on World Bank documents and specialized literature. Initially some relevant aspects of the history of the World Bank and its configuration as a multilateral organization are presented. Next, it discusses the role of the institution in the encouragement of structural adjustment programs for the economies of the region during the 1980s, based on a hyper-market oriented agenda. Afterwards, the process of the renewal and expansion process of the Bank's political agenda from the end of the 1990s is looked at, which was based on the maintenance of the macroeconomic adjustment, the encouragement of institutional reforms, and combatting extreme poverty. Finally, the principal lines in the Bank's social policy reform agenda are discussed, including health.

Recomendação nº 004, de 28 de fevereiro de 2017: recomenda ad referendum do Pleno ao Excelentíssimo Sr. Ministro da Saúde, Ricardo Barros, que: I. Considere as preocupações veiculadas na Carta Aberta ao Presidente da República, datada de 28 de fevereiro de 2018, anexa, sobre a eventual substituição do Subsecretário de Planejamento e Orçamento do Ministério da Saúde / Recommendation No. 004, of February 28, 2017: recommends the referendum of the Full to the Honorable Minister of Health, Ricardo Barros, who: I. Consider the concerns conveyed in the Open Letter to the President of the Republic, dated February 28, 2018, attached, on the possible replacement of the Under Secretary for Planning and Budget of the Ministry of Health

Recomenda ad referendum do Pleno ao Excelentíssimo Sr. Ministro da Saúde, Ricardo Barros, que: I. Considere as preocupações veiculadas na Carta Aberta ao Presidente da República, datada de 28 de fevereiro de 2018, anexa, sobre a eventual substituição do Subsecretário de Planejamento e Orçamento do Ministério da Saúde; II. Que, a bem do serviço público, reconsidere a nomeação do senhor Márcio Reinaldo Dias Moreira para o cargo de Subsecretário de Planejamento e Orçamento do Ministério da Saúde; e III. Garanta que esse cargo seja ocupado por pessoa detentora do saber técnico adequado cuja reputação, em exame de vida pregressa, esteja em conformidade com os fundamentos constitucionais indispensáveis ao exercício desse importante cargo comissionado.

[The health system of Bolivia]. / Sistema de salud de Bolivia.

This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.

[The health system of Brazil]. / Sistema de salud de Brasil.

This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

[The health system of Colombia]. / Sistema de salud de Colombia.

This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.

[The health system of Chile]. / Sistema de salud de Chile.

This paper describes the Chilean health system, including its structure, financing, beneficiaries, and its physical, material and human resources. This system has two sectors, public and private. The public sector comprises all the organisms that constitute the National System of Health Services, which covers 70% of the population, including the rural and urban poor, the low middle-class, the retired, and the self-employed professionals and technicians.The private sector covers 17.5% of the population, mostly the upper middle-class and the high-income population. A small proportion of the population uses private health services and pays for them out-of-pocket. Around l0% of the population is covered by other public agencies, basically the Health Services for the Armed Forces. The system was recently reformed with the establishment of a Universal System of Explicit Entitlements, which operates through a Universal Plan of Explicit Entitlements (AUGE), which guarantees timely access to treatment for 56 health problems, including cancer in children, breast cancer, ischaemic heart disease, HIV/AIDS and diabetes.

[The health system of Costa Rica]. / Sistema de salud de Costa Rica.

This paper describes the Costa Rican health system which provides health, water and sanitation services. The health component of the system includes a public and a private sector. The public sector is dominated by the Caja Costarricense de Seguro Social (CCSS), an autonomous institution in charge of financing, purchasing and delivering most of the personal health services in Costa Rica. CCSS is financed with contributions of the affiliates, employers and the state, and manages three regimes: maternity and illness insurance, disability, old age and death insurance, and a non-contributive regime. CCSS provides services in its own facilities but also contracts with private providers. The private sector includes a broad set of services offering ambulatory and hospital care. These services are financed mostly out-of-pocket, but also with private insurance premiums. The Ministry of Health is the steward of the system, in charge of strategic planning, sanitary regulation, and research and technology development. Among the recent policy innovations we can mention the establishment of the basic teams for comprehensive health care (EBAIS), the de-concentration of hospitals and public clinics, the introduction of management agreements and the creation of the Health Boards.

[The health system of Ecuador]. / Sistema de salud de Ecuador.

This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

[The health system of El Salvador]. / Sistema de salud de El Salvador.

This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.

[The health system of Guatemala]. / Sistema de salud de Guatemala.

This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

[The health system of Mexico]. / Sistema de salud de México.

This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.

[The health system of Nicaragua]. / Sistema de salud de Nicaragua.

This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.

[The health system of Honduras]. / Sistema de salud de Honduras.

This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.

[The health system of Peru]. / Sistema de salud de Perú

This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care.

[The health system of Dominican Republic]. / Sistema de salud de República Dominicana.

This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.

[The health system of Uruguay]. / Sistema de salud de Uruguay.

This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.