Evaluation of fiscal space for health in Bolivia

Abstract

Objective. To assess, from a technical and political standpoint, the capacity of Bolivia to generate fiscal space for health that allows the country to sustain progress and fulfill the commitment of a public expenditure in health of 6% of gross domestic product. Methods. A review was conducted of the international evidence on fiscal space and how it is measured. The technical analysis was developed through statistics and official reports from multiple national and international secondary sources. The political and social analysis was carried out through 20 interviews with representatives of organizations and institutions. Results. There is capacity to create fiscal space in health for Bolivia. The three sources with the greatest technical and political feasibility are: economic growth linked to a commitment to reprioritize public spending on health; improvements in the internal sources of revenue through the reduction of informal work; and reduction of tax expenditures. External financing and an increase of Social Security contributions are less feasible. Conclusions. Bolivia is able to achieve a public health spending of 6% of gross domestic product. The timing to achieve this target depends on maintaining the prioritization of spending in the sector, with social and political consensus and within a framework of economic growth and stability.