ut activities under their National Plans include the following: a) Financing. The main problems identified include: (1) the economic adjustment policies that have been implemented in the countries and the burden of external debt payments; (2) difficulties in estimating the cost of implementing the National Plans in the medium and long terms; (3) shortfalls in the funds required to cover the needs that have been identified; (4) failure to include in national budgets the resources needed to attain the goals of the Summit. b) Information shortage. Problems exist mainly in three areas: (1) difficulty in making a diagnosis on the basis of which to begin planning, (2) lack of up-to- date information, and (3) absence of standardization and uniformity in government and agency data. c) Limitations in terms of managerial capacity and experience. d) Lack of coordination within the health sector and between the various ministries and governmental agencies. 2. Identification of Strategies for Improvement of the National Plans of Action 2.1 With regard to the enlistment of participation by the various sectors and by civil society in the countries' efforts to attain the goals set by the Plan of Action, most of the countries indicated that insufficient progress has been made. In almost all the countries, support and political commitment have been obtained from the highest levels of government. However, responsibilities have not always been clearly defined in terms of coordination and dissemination with other areas of government and other social sectors. There was consensus on the need to promote participation by society as a whole in order to create a collective consciousness that will support the effort and the actions aimed at attaining the goals of the Summit. 2.2 As for the preparation of Plans of Operation for each of the components of the National Plan of Action, almost all the countries, after approving the National Plan, have taken steps to ensure intersectoral coordination, as well as comprehensiveness and complementarity. The countries that have not yet prepared Plans of Operation are in the process of doing so. There was consensus on the desirability of making provision in the Plans of Operation for work at the municipal level in an effort to ensure regionalization and decentralization and to generate participation at the local level. The delegates agreed that the Plans of Operation are the basic instrument for launching the process of attaining the proposed goals and also for determining resource requirements. 2.3 Relative to the establishment of mechanisms for financing activities under the National Plan of Action, all the groups recognized the importance of identifying mechanisms that will guarantee adequate financing for the plans and programs. Most of the groups indicated that there have been demonstrations of budgetary support for activities in the area of maternal and child health. However, only limited progress has been made in ensuring more rational use and optimization of the available resources. At the plenary session, it was recommended that steps be taken to simplify and streamline the slow and cumbersome process of gaining approval for projects and obtaining the first disbursement of funds. Moreover, it was recommended that activities be implemented with a view to securing resources from bilateral agencies that provide technical and financial cooperation, as well as acquiring information about the areas of interest of such agencies and also of the countries and some NGOs that provide this type of collaboration. Several of the working groups expressed concern about the impact that external debt and structural adjustment policies would have on attainment of the goals established by the Summit. In both the working groups and the plenary session, it was recommended that an effort be mounted not only to prevent budget cuts but to promote increases in the budgets of social welfare programs and the social sectors, particularly health and education. The participants agreed that it was crucial to identify financing mechanisms in order to attain the goals of the Summit. In this regard, it was underscored that an effort must be made to: a) channel government spending toward the health sector, especially areas that were defined as priorities by the Summit; b) identify other mechanisms of financing such as tax-related reforms, contributions from the private sector, and funds from regional and local budgets; and c) obtain external resources. It was recommended that the international agencies provide technical support to assist the countries in their search for financing, including mechanisms to improve efficiency and mobilize internal resources. 2.4 In regard to the establishment of mechanisms to follow-up on the National Plan of Action, it was considered extremely important to form a Commission to Follow-up and Monitor the National Plan in order to safeguard the advances made and indicate corrective measures when necessary. Very few countries have established a specific commission for this purpose, and it was recommended that the formation of such groups be promoted. On the topic of indicators, the plenary session recommended that the Governments endeavor to improve their information systems and update the existing statistical data in close collaboration with the agencies, with a view to establishing reliable, uniform, and timely baseline information that will make it possible to evaluate the progress toward attainment of the goals of the Summit. 3. Preparation of the Plan of Work for the Period 1992-1995 Most of the countries had difficulties in proposing a Plan of Activities for the period 1992- 1995. The problems were mainly related to the failure to establish Plans of Operation for 1992, weaknesses in intersectoral coordination, and the need to implement or strengthen certain activities that are essential for the success of a medium-term plan. It was emphasized that it is essential to: (a) increase the participation and commitment of society as a whole, (b) prepare and implement Plans of Operation for each component of the National Plan of Action, (c) establish the National Committees and the Interagency Coordinating Committees as permanent bodies, (d) institute mechanisms to obtain financing and to follow- up and monitor the National Plans of Action. The working groups proposed that subregional meetings be held for the purpose of evaluating progress under the National Plans and facilitating the exchange of experiences. Moreover, the Organizing Committee for the event was asked to seek mechanisms that will make it possible to follow-up on the agreements and recommendations that came out of this Meeting, as well as those that will come out of other similar gatherings to be held in the future. The participants reaffirmed their commitment to doing their utmost to see that the goals of the Summit are realized in their respective countries. E0197.FIN PUBLISHED VERSION 30/IV/92 BOLIVIA In 1991 the Government succeeded in maintaining economic stability, advancing measures to modernize the infrastructure of the State, and promoting private capital investment. Despite the good results achieved in the country's economy, critical poverty continues ravaging most of the population and the situation is aggravated by unemployment, illiteracy, and high maternal and child death rates. The Government, recognizing the accumulated social debt, continued applying a social policy which gives priority to the health and education sectors and focuses on the most vulnerable populations in the country. In PAHO/WHO cooperation during the year, major support was provided to carrying out the National Survival, Child Development, and Maternal Health Plan which the Government implemented in 1990. In that respect, activities were oriented toward developing the infrastructure of the health services, strengthening local health systems, priority personal health care and environmental programs, and training health personnel to carry out the Plan. Concerning development of the infrastructure, PAHO/WHO cooperated in publishing basic documents for the process of change and the new functions that the Ministry of Social Welfare and Public Health plans to execute to carry on development of local health systems, which are known as health districts. Among the documents disseminated was a manual on the standards and procedures of the National Plan which emphasizes comprehensive health care for women, children, schoolchildren, and adolescents. The collaboration given by the Organization to the authorities charged with the National Bureau of Health Services and at the managerial levels of the sanitary units and health districts made it possible to increase technical and administrative capacity at the national level and develop the management process. At the district level, local planning was initiated with community participation and a guide prepared with the collaboration of PAHO/WHO was implemented for comprehensive planning and programming. With the experience obtained in implementing the information system of the Polyclinic Hospital as part of the World Bank's institutional development project, similar systems were implemented in Cochabamba and Santa Cruz which have supplemented the health information subsystem. This subsystem was put into operation beginning in April in all the health districts. As part of the Comprehensive Health Project financed by the World Bank, the Government, with th