Paraguay

El sistema de salud paraguayo enfrenta grandes desafíos para alcanzar la cobertura universal en salud. Para lograr atender la doble carga de enfermedades de su población, es necesario asegurar financiamiento sostenible, conseguir una operación más eficiente en el sistema y fortalecer su capacidad rectora. El país ha emprendido una serie de reformas para modernizar el sistema que han logrado sentar las bases para un nuevo enfoque de la atención sanitaria basada en la atención primaria. Sin embargo, no han modificado significativamente los pilares del sistema de salud ni su fragmentación en múltiples subsistemas.La tercera fase del Estudio Multidimensional tiene como objetivo salvar la distancia entre las recomendaciones incluidas en el Volumen 2 del estudio y su implementación a través de una serie de actividades participativas para generar un plan de acción y una serie de instrumentos de monitoreo. Durante una reunión de alto nivel con las autoridades paraguayas, se abordaron diferentes aspectos de la política de salud y de una potencial reforma, y se identificaron cuatro ejes temáticos clave para poner manos a la obra: (i) asegurar el financiamiento sostenible del sistema; (ii) reducir la fragmentación, integrando la prestación de servicios y mejorando el sistema de pago a proveedores; (iii) definir un paquete de beneficios en salud; e (iv) implementar compras públicas más eficientes de medicamentos e insumos médicos. Este capítulo también presenta una serie de herramientas conceptuales con el objetivo de apoyar al gobierno para la toma de decisiones y la reestructuración del sistema de salud en estas áreas clave.

Este capítulo propone un tablero de seguimiento que incluye una serie de indicadores para monitorear el progreso derivado de la implementación de las reformas propuestas en las áreas de protección social, salud y educación y habilidades. Después de presentar la metodología detrás del tablero de seguimiento, el capítulo presenta los objetivos que Paraguay debe alcanzar a 2030 para cada indicador.

The Paraguayan health system is faced with major challenges to achieve universal health coverage. To respond to the double burden of disease among the population, it needs to secure sustainable funding, ensure it is run more efficiently and strengthen its stewardship. The country has undertaken a series of reforms to modernise the system, laying the foundations for a new approach to health care based on primary care. However, it has not significantly altered the foundations of the health system and its fragmentation into multiple subsystems.The third phase of the Multi-dimensional Review aims to bridge the gap between the recommendations made in Volume 2 of the review and the implementation of those recommendations through a series of participatory activities to generate an action plan and a series of monitoring instruments. A high-level meeting with Paraguayan authorities discussed various aspects of health policy and a potential reform and identified four key areas in which work may begin: (i) securing sustainable funding for the system; (ii) reducing fragmentation by integrating service delivery and improving the system of payment to suppliers; (iii) defining a package of health benefits; and (iv) making the public procurement of medicines and medical supplies more efficient. This chapter also presents a series of conceptual tools with the objective of supporting the government for decision making and restructuring of the health system in these key areas.

Desde las décadas pasadas, Perú ha avanzado en diversos indicadores de desarrollo. Entre 2005 y 2016 el porcentaje de la población que vive con menos de 5.50 USD al día (PPA de 2011) se redujo a la mitad; bajó de 52.2% a 24.3%, cifra que coincide con el promedio de 24% de América Latina y el Caribe (ALC). Al mismo tiempo, el porcentaje de la población vulnerable que vive con 5.50-13.00 USD al día (PPA de 2011) aumentó de 31.9% a 39.6%. La tasa de mortalidad infantil del país se redujo con fuerza de 57 a 12 por cada 1 000 nacidos vivos entre 1990 y 2016.

Paraguay has made progress in some development indicators in the last decades. The net secondary enrolment rate remains below the 74.4% average of Latin America and the Caribbean (LAC) at 64.9%. However, the country has improved its infant mortality rate (18 per 1 000 live births) and life expectancy at birth (73.1 years). Moreover, the share of the population living on less than USD 5.5 a day (2011 PPP) decreased from 35% to 20.1% between 2005-16. The share of the vulnerable population – those living on USD 5.5-13 a day (2011 PPP) – has remained stable, at around 39.3%, over the same period.

Paraguay was first reviewed during the 2017/2018 peer review. This report is supplementary to Paraguay’s 2017/2018 peer review report (OECD, 2018[1]). There is no filing obligation for a CbC report in Paraguay yet.

Most of the difference in GDP per capita with OECD countries is explained by labour productivity. Labour productivity is close to 81% lower than the top 17 OECD economies in 2014. Capital accumulation per worker and TFP has been the main drivers of labour productivity growth, while human capital has played a marginal role. Improvements in the quality of human and physical capital and the promotion of policies enhancing the agriculture sector are fundamental to boost sustainable productivity in Paraguay. To finance most of these policies, the adoption of a comprehensive tax reform is needed.

Having achieved robust economic growth and remarkable macroeconomic stability over the past 15 years, Paraguay has set a course to become not only more prosperous, but also more inclusive by 2030. To deliver on its development ambition, the country will have to overcome a number of crosscutting constraints that limit progress towards widely shared improvements in citizen well-being, as identified in Volume 1 of the review. Putting Paraguay on a more inclusive development path requires co-ordinated actions to increase the capacity of the state to redistribute, to improve the delivery of public services, and to break the persistence of poverty and inequality across generations. This report discusses policy actions and priorities in three critical areas to make Paraguay’s development more inclusive. It presents in-depth analysis and recommendations to improve the effectiveness of social protection, the delivery of health services, and the formation of skills for all Paraguayans.

Tras haber alcanzado un crecimiento económico sólido y una estabilidad macroeconómica considerable a lo largo de los últimos 15 años, Paraguay ha trazado el rumbo para llegar a ser un país no sólo más próspero, sino también más inclusivo en 2030. Para alcanzar su ambición de desarrollo, el país tendrá que superar varios obstáculos transversales que limitan el progreso hacia mejoras generalizadas del bienestar ciudadano, tal como lo resalta el Volumen 1 de este estudio. Para poner a Paraguay en una trayectoria de desarrollo más inclusiva, es necesario emprender una serie de acciones coordinadas para aumentar la capacidad redistributiva del Estado, mejorar la prestación de servicios públicos y para romper la persistencia intergeneracional de la pobreza y la desigualdad. Este informe examina acciones y prioridades de política pública en tres áreas claves para hacer más inclusivo el desarrollo de Paraguay. Presenta un análisis detallado y una serie de recomendaciones para mejorar la efectividad de la protección social, la prestación de los servicios de salud, y la formación de competencias para todos los paraguayos.

Paraguay has experienced strong growth since the early 2000s and has committed itself to a development path to become more inclusive, efficient and transparent. To achieve sustainable and inclusive development and deliver on its vision to 2030, Paraguay will have to overcome two key challenges: buttressing the sources of economic prosperity by fostering structural transformation, and making development more inclusive. The objective of the Multi-dimensional Country Review of Paraguay is to assist the country in achieving its development objectives. The second volume provides in-depth analysis and policy recommendations in three key areas to better share the benefits of development: education, social protection and health. This chapter provides an overview of the analysis contained in the report, the main conclusions and their implications for development policy in Paraguay. The chapter also discusses possible scenarios for the future and their implications for development prospects and priorities in the country.

To sustain and further improvements in living standards and well-being, Paraguay will need to review its social protection policies and transform them into a coherent system for all. This chapter analyses social protection in Paraguay and provides policy recommendations to foster coherence, equity and an integrated system. Social protection is split along the line of informality, leaving parts of society unprotected. Formal dependent workers are covered by social security, whose fragmentation results in unequitable provisions. The high degree of self-employment limits the reach of social security, while informality and evasion further reduce its coverage. Means-tested social assistance needs to be better targeted and scaled up to fully address the needs of the population not covered by social security. Key bottlenecks to expand social protection to the whole population are its governance, insufficient financial resources for social assistance and the inclusion of independent workers into social security. Independent workers’ low and unstable incomes, as well as the system’s design itself are barriers to the inclusion of independent workers.

Paraguay has set ambitious targets to improve the health of its citizens. The country faces a double burden. The weight of non-communicable diseases is growing, fuelled by longer lives but also less healthy lifestyles. At the same time, unresolved issues remain in communicable diseases, maternal, neonatal and nutritional diseases. The health system in Paraguay suffers from fragmentation and the weaknesses of its stewardship institutions. To measure up to the challenge, the country has undertaken a series of reforms, starting with a landmark law passed in 1996. The reforms have succeeded in setting the stage for a new approach to healthcare based on primary care. However, they have not altered significantly the foundations of the health system and its fragmentation into multiple subsystems. This chapter describes the health challenges that Paraguay faces and focuses on challenges in financing healthcare and in achieving universal health coverage.

Paraguay has made substantial progress in various dimensions of its education system in recent years as highlighted in Volume I of the Multidimensional Review of Paraguay. However, major challenges remain and reforms are unfinished. Access to the education system has expanded markedly, but is still a challenge in pre-primary and secondary education and for some socioeconomic groups. Schooling has improved, but learning outcomes are poor. And the relevance of the education and skills provided by the system is questionable, as illustrated by the problematic transition from school to work, with many young people leaving the education system too early to enter inactivity or informality. This chapter analyses these challenges in depth, and provides recommendations to improve the education and skills system in Paraguay in order to foster inclusiveness and employability.

Economic growth matters, but it is just one facet of development. Policy makers should focus their attention on ensuring that their country’s development path is sustainable and that the lives of their citizens improve. This requires reconciling economic, social and environmental objectives.

Having achieved robust economic growth and a remarkable level of macroeconomic stability over the past 15 years, Paraguay has set a course to become not only more prosperous, but also more inclusive by 2030. To fulfil its development ambition, the country will need to overcome the multiple constraints. Specifically, it will need to foster structural transformation to unlock new sources of growth. Paraguay will also need to enhance its capacity to further social development and inclusivity.

Paraguay ha registrado un fuerte crecimiento desde principios de la década de 2000 y se ha comprometido a emprender una senda de desarrollo más inclusivo, eficiente y transparente. Para lograr este desarrollo sostenible e inclusivo y hacer realidad su visión para 2030, Paraguay tendrá que superar dos retos fundamentales: reforzar las fuentes del crecimiento económico, impulsando una transformación estructural, y conseguir un desarrollo más inclusivo. El Estudio Multidimensional de Paraguay se propone apoyar al país en la consecución de sus objetivos de desarrollo. El segundo volumen ofrece un análisis detallado y recomendaciones de política en tres ámbitos clave a fin de compartir mejor los beneficios del desarrollo: educación, protección social y sanidad. Este capítulo ofrece una descripción general del análisis recogido en el informe, las principales conclusiones y sus implicaciones para la política de desarrollo de Paraguay. Expone, asimismo, posibles escenarios futuros y sus repercusiones en las prioridades y perspectivas de desarrollo del país.