Health in Bolivia

The Ministry of Health steers the national system. Departments coordinate through their Departmental Health Services (SEDES), while autonomous municipalities and indigenous autonomous territorial entities help support first- and second-level facilities. Healthcare includes public facilities, Caja schemes for short-term social security, private providers with or without agreements, and recognized traditional medicine. The SAFCI principle, or Family, Community and Intercultural Health (Salud Familiar Comunitaria Intercultural (SAFCI)), combines family and community work with social participation, cultural adaptation, cooperation between sectors, and comprehensive care. The usual point of access is a Centro de Salud or another first-level facility. Under Ministry of Health requirements, authorities generally request a Bolivian identity card and proof of residence, such as an electricity or water bill, for registration. These facilities provide initial examinations, basic diagnostics, treatment, and prevention. If needed, a referral from the first level leads to the second level; the third level is normally reached through the first or second level. In an emergency, every level of care must provide immediate treatment without requiring prior SUS registration. The emergency medical service can be reached at 118, the police at 110, and the fire service at 119. In remote areas, response times and prehospital care depend heavily on distance, traffic, and available emergency resources. For eligible people in the public sector, the SUS covers, among other services, examinations, diagnostics, hospital treatment, medical, dental, and surgical services, as well as approved medicines within the applicable benefits catalog. Bolivians without short-term social security can generally receive this care free of charge. Foreigners receive equal treatment where reciprocity or an international agreement applies; regardless of this, special access exists, among others, for pregnancy through six months after childbirth, sexual and reproductive care, children under five, people aged 60 and over, and people with certified disabilities. Private treatment may require payment in advance, while availability, equipment, specialist staff, medicine stocks, and referral procedures in the public system vary by facility and department. Prevention includes the free national immunization program (PAI) with the National Vaccination Schedule (Esquema Nacional de Vacunación). The official scope for 2026 covers 19 vaccine-preventable diseases and extends from newborns to older adults. An immunization card, complete doses, and required boosters make verification easier; vaccinations are recorded in the National Vaccination Registry (RNVE). SAFCI-MiSalud teams also work in communities and households. The adolescent health program AIDA serves young people aged 10 to 19 and offers, among other things, sexual and reproductive counseling, contraception, STI and HIV services, protection from violence, nutritional counseling, and mental healthcare. Pregnancy and newborn care follows intercultural guidelines and may connect medical staff with midwives and traditional birth attendants. First-level facilities also provide prevention and early detection for HPV, VPH/PAP, breast cancer, and prostate cancer; depending on the indication and the provider's capacity, the SUS may also cover chemotherapy and radiotherapy. The necessary precautions depend on the geographic area. In the high Andes, such as La Paz at approximately 3,650 meters, altitude sickness can occur; gradual acclimatization and immediate examination for severe symptoms reduce the risk. In the tropical lowlands, dengue, chikungunya, Zika, malaria, and yellow fever occur, among other diseases. Malaria transmission affects areas below 2,500 meters, but not La Paz. Yellow fever vaccination is particularly recommended depending on the region, especially east of the Andes and below approximately 2,300 meters. Chagas disease is especially common in warm rural areas. In 2026, the CDC issued a chikungunya warning for Santa Cruz and Cochabamba; Bolivia also monitors tuberculosis and HIV nationwide. Medicines should be obtained from an authorized pharmacy or a municipal institutional pharmacy. The national medicines agency (AGEMED) is the responsible medicines authority; a dispensing outlet operates under the responsibility of a registered pharmaceutical manager. Sanitary registration, expiration date, and package information should be checked. In the SUS, medicines mainly come from the National Essential Medicines List (LINAME) or the applicable approved benefits catalog, but availability is not uniform. A prescription and an up-to-date medication list help with treatment, referrals, and emergencies. Unregistered products and self-medication can cause interactions, incorrect dosages, or delays. When medically indicated, the SUS also covers psychological and psychiatric treatment, diagnostics, medicines, and inpatient care. However, specialists are concentrated mainly in larger centers. According to the Mental Health Atlas 2024, 2.0 percent of government health expenditure in Bolivia went to mental health; it did not report a current nationwide mental health survey. In an acute mental health crisis, use the emergency access route; the reachable facility or emergency medical service at 118 should be confirmed locally. After discharge, people should keep instructions, referrals, findings, prescriptions, and discharge documents. Depending on access, chronic illnesses, rehabilitation, palliative care, and oncology follow-up are managed through the public network, a Caja, or a private provider. If the condition worsens, an urgent reassessment is necessary. Continuity of medication may be affected by procurement and stock levels at the relevant facility. The right to health and the prohibition of discrimination also apply in the intercultural healthcare context. Traditional medicine is recognized within SAFCI, but medicines and treatments should be checked for registration, safety, and compatibility with medical therapy. Users should provide their complete medical history, carry identity and proof-of-residence documents for SUS access, follow referral and appointment procedures, and continue vaccinations and follow-up care. Cities more often have specialized services, while rural, Indigenous, and widely dispersed communities more frequently face distance, transport, language, cultural barriers, and staff shortages. The universal health coverage index stood at 65.06 in 2021, while out-of-pocket payments remain a significant burden.