MABB ©
On February 21, 2016, Bolivians, once again, will head to the ballot boxes to cast their votes in yet another referendum. This time, the issue is whether the 2009 Constitution can be amended to allow Mr. Morales to run a third time for office in the coming elections. According to the Constitution, that is one thing he cannot do, but would be able to if the basic law is amended. While the country is asking itself how long Morales wants to stay in power, political observers instead are asking themselves questions about the level of support he has been having. How long can Morales keep the high levels of support he has up to now been having? Will this support be enough to bring about a constitutional amendment?
Support
One way of looking at this issue is by considering what is going on in the current referendum process. In fact, it seems as if Morales will have the necessary support to change the constitution in his favor.
According to the poll numbers you observe below, the level of support for the yes option, as in yes let us reform the constitution so that Morales can stay in power, has been stable since the end of 2015, which has given the government reasons for optimism for February 21. This level of support, the government has argued, has been solid since Morales arrived to government and will continue to be solid until the end. The main reasons cited are the desire of all Bolivians to continue in the path Morales has been working on. The government repeats itself without getting tired it has been governing by "obeying the people" and that the numbers give them right. On the other side, the camp in favor of the no, seems to have been started on a good foot to having dwindled a bit to gain some impetus in the last weeks towards the referendum. However, the jury is still out on whether the yes or the no camps will prevail.
Source: Electoral Office (http://oep.org.bo/#post/encuestas)
Currently, the country is in the middle of the campaign process, which according to law should take place 20 days before the referendum. The re-election issue is a loaded one in Bolivian politics because it has a history. Whereas Morales has been in office since 2006 but has been able to successfully argue the first term did not count because it was before the founding of the new Plurinational State in 2009, the president is seeking once again to stay in office beyond 2019, when his current term should come to an end.
If we go up the abstraction ladder a bit more, observers are beginning to talk about the fall of the so called new left in Latin America. If we look around, the Maduro government has collapsed, the Correa government is having its share of troubles and the rest of the leftist government around the region have left the stage, including that of the Kirchners. The new left is in retreat, that is how the headlines read in the newspapers around the world. One cause is mentioned over and over, the price downfall in the primary products.
Lack of support?
However, if we look at each situation with careful and unemotional eyes, we can observe there is a mix of causes, both, at the international and national levels. In the case of Bolivia, for example, Morales will loose support, much less because the new left is in retreat in Latin America or because the economy is growing at a lesser pace than before, but because Bolivians are not seeing a real and sustained improvement in their lives and their lives are not feeling the concrete efforts of the government. One illuminating example of the nature of such national causes is the state of the health system in the country.
The Health Care System
Bolivia's Health Care System is currently fragmented and difficult to get a grasp on. According to what I have been able to gather, it is divided into six areas: Public, Social Security, Armed Forces, NGOs, Church and Private.
I begin with the latter. The Private area includes all privately owned health centers, these can include hospitals, clinics, and other health center of that nature. Also, not to forget, is the fact that some of these centers might take care of publicly covered patients with a combination of public and privately billed services. In some areas away from the urban centers (either in the country side or at the limits of a large city), the Church has traditionally provided with some type of health care. While early on the Catholic Church was the one taking the initiative, today there are other initiatives from the evangelical tradition. Similarly, some non-governmental organizations, such as private groups or even many private persons, have engaged in the construction of infrastructure, supply of material and machinery and provision of health care.
However, the bulk of the coverage has been done by the central government. The Social Security area provides coverage mainly for salaried and organized workers. This coverage is mainly comprehensive, including disability benefits. Lastly, the public area covers, what recent Bolivian governments have considered, weak groups. Today the system scheme covers, free of charge, pregnant women (from before the birth to six months after), children up to 5 years old and also includes all women up to 60 years old. There is also an insurance scheme, also free of charge, for people older than 60 years old. Lastly, there is a scheme, free of charge, covering students.
The administration of public health care is carried out by the central and the subnational levels of government. In this manner, the closest level to the citizen, the municipal level, is considered the first level, where one can find sanitary posts, clinics, mobile health units and a basic level of health care. The second level is the departmental level of government, and here one can find hospitals with a larger health coverage and, many of them, are specialized in some areas. At the national level or the third level one would find national health institutes and highly specialized institutions.
Lastly, the Morales government has been implementing a "new" model of health care which they denominate Salud Familiar, Comunitaria Intercultural, SAFCI (Intercultural Communitary Family Health). This system has, most importantly, seeks to complement the western-style medicine with Bolivian traditional medicine, through the following principles: Social Participation, Integration, Intercultural and "Intersectoriality".
The system creates a series of spaces for the population to take part in planning and debate. This participation is more pronounced at the local level through assemblies and, what in Bolivia is known as social control and means entities created with the aim at exerting some type of control over the planning and financing processes. At the departmental and national levels there are committees which also discuss the policies, and above all, the compliance with the central government's policies. The model also provides for the integration of different components of traditional life, such as family, community, and nature. The intercultural part addresses the intention of complementing the western-style medicine with Bolivian traditional medicine and the "Intersectoriality" part seeks to build a comprehensive approach to health care by including diverse components such as health education, sanitary infrastructure, the production or supply of medicine, etc.
The latest Ombudsman report
The Bolivian Ombudsmen Office, in a report published in January 2016, has stated the issue of health is one of the most vulnerable human rights in Bolivia. Considering that a lot has been done in the passing of laws to better the health care sector, building of infrastructure and in the creation of posts for health workers, the report cites several conclusions which point to an unsatisfactory development of it: a) there is a general lack of knowledge of the law and therefore of the norms and principles of the new system; b) in that matter, the law is not being applied as it should be; c) there is still confusion on the administrative side of the process, forms and processes are not being handled as they should be handled; d) the level of information is insufficient, people still do not know their benefits and rights; e) insufficient infrastructure still or too many patients; f) delays in the transfer of funds between municipalities and health units; g) not enough medicines; h) additional charges in many cases where there should not be any.
The report also cites some more facts: four out of ten people do not have any type of health coverage, coverage in the country side is significantly less than that in the cities, specialized care is inadequate, with patients having to wait months before they get an appointment, and in many hospitals care is rejected due to deficiencies in facilities, i.e. not enough beds or no access to technology.
Support at the national level
In the course of this last ten years the Morales government has been in power, many things have been achieved, but by the same token, because the task is so monumental, there are still many more to achieve. If the average Bolivian, at the beginning of the current government, felt as if this was the one government that was going to change things for the better, ten years into the "process of change", they are starting to measure the government with different measurement instruments. In more concrete terms, if people do not feel the newly created health care system is not working for them, they will have less trust in the government and the level of support will erode. In political science, that is a well known association. The longer the government is in power, the less support it has. That is one reason why presidents who come into office with double digit support numbers, tend to leave office with single digit support numbers.
In the case of Evo Morales, it will not be different. The more he stays in office the more chance he has to do some work, but at the same time, the more chances he has to make some unpopular decisions. Added to that, the fact the process is a slow one, that almost guarantees impatience on the part of the people.
Sources:
http://www.paginasiete.bo/sociedad/2016/1/22/defensor-solo-cuatro-cada-bolivianos-tienen-seguro-salud-84196.html
http://www.ops.org.bo/textocompleto/pi31260.pdf
http://www.eldeber.com.bo/bolivia/41-poblacion-votaria.html![]()
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On February 21, 2016, Bolivians, once again, will head to the ballot boxes to cast their votes in yet another referendum. This time, the issue is whether the 2009 Constitution can be amended to allow Mr. Morales to run a third time for office in the coming elections. According to the Constitution, that is one thing he cannot do, but would be able to if the basic law is amended. While the country is asking itself how long Morales wants to stay in power, political observers instead are asking themselves questions about the level of support he has been having. How long can Morales keep the high levels of support he has up to now been having? Will this support be enough to bring about a constitutional amendment?
Support
One way of looking at this issue is by considering what is going on in the current referendum process. In fact, it seems as if Morales will have the necessary support to change the constitution in his favor.
According to the poll numbers you observe below, the level of support for the yes option, as in yes let us reform the constitution so that Morales can stay in power, has been stable since the end of 2015, which has given the government reasons for optimism for February 21. This level of support, the government has argued, has been solid since Morales arrived to government and will continue to be solid until the end. The main reasons cited are the desire of all Bolivians to continue in the path Morales has been working on. The government repeats itself without getting tired it has been governing by "obeying the people" and that the numbers give them right. On the other side, the camp in favor of the no, seems to have been started on a good foot to having dwindled a bit to gain some impetus in the last weeks towards the referendum. However, the jury is still out on whether the yes or the no camps will prevail.
Polls | ||||
Pollster | Publication date | In favor of: Sí | In favor of: No | Undecided |
Captura Consult. | Dec 2015 | 48% | 54% | 5% |
Mercados y Muestras | Nov-Dec 2015 | 40% | 54% | 6% |
Equipos Mori | Dec 2015-Jan 2016 | 41% | 37% | 19% |
IPSOS | Dec 2015-Jan 2016 | 38% | 44% | 14% |
Mercados y Muestras | 6-13-Jan 2016 | 41% | 38% | 21% |
Source: Electoral Office (http://oep.org.bo/#post/encuestas)
Currently, the country is in the middle of the campaign process, which according to law should take place 20 days before the referendum. The re-election issue is a loaded one in Bolivian politics because it has a history. Whereas Morales has been in office since 2006 but has been able to successfully argue the first term did not count because it was before the founding of the new Plurinational State in 2009, the president is seeking once again to stay in office beyond 2019, when his current term should come to an end.
If we go up the abstraction ladder a bit more, observers are beginning to talk about the fall of the so called new left in Latin America. If we look around, the Maduro government has collapsed, the Correa government is having its share of troubles and the rest of the leftist government around the region have left the stage, including that of the Kirchners. The new left is in retreat, that is how the headlines read in the newspapers around the world. One cause is mentioned over and over, the price downfall in the primary products.
Lack of support?
However, if we look at each situation with careful and unemotional eyes, we can observe there is a mix of causes, both, at the international and national levels. In the case of Bolivia, for example, Morales will loose support, much less because the new left is in retreat in Latin America or because the economy is growing at a lesser pace than before, but because Bolivians are not seeing a real and sustained improvement in their lives and their lives are not feeling the concrete efforts of the government. One illuminating example of the nature of such national causes is the state of the health system in the country.
The Health Care System
Bolivia's Health Care System is currently fragmented and difficult to get a grasp on. According to what I have been able to gather, it is divided into six areas: Public, Social Security, Armed Forces, NGOs, Church and Private.
I begin with the latter. The Private area includes all privately owned health centers, these can include hospitals, clinics, and other health center of that nature. Also, not to forget, is the fact that some of these centers might take care of publicly covered patients with a combination of public and privately billed services. In some areas away from the urban centers (either in the country side or at the limits of a large city), the Church has traditionally provided with some type of health care. While early on the Catholic Church was the one taking the initiative, today there are other initiatives from the evangelical tradition. Similarly, some non-governmental organizations, such as private groups or even many private persons, have engaged in the construction of infrastructure, supply of material and machinery and provision of health care.
However, the bulk of the coverage has been done by the central government. The Social Security area provides coverage mainly for salaried and organized workers. This coverage is mainly comprehensive, including disability benefits. Lastly, the public area covers, what recent Bolivian governments have considered, weak groups. Today the system scheme covers, free of charge, pregnant women (from before the birth to six months after), children up to 5 years old and also includes all women up to 60 years old. There is also an insurance scheme, also free of charge, for people older than 60 years old. Lastly, there is a scheme, free of charge, covering students.
The administration of public health care is carried out by the central and the subnational levels of government. In this manner, the closest level to the citizen, the municipal level, is considered the first level, where one can find sanitary posts, clinics, mobile health units and a basic level of health care. The second level is the departmental level of government, and here one can find hospitals with a larger health coverage and, many of them, are specialized in some areas. At the national level or the third level one would find national health institutes and highly specialized institutions.
Lastly, the Morales government has been implementing a "new" model of health care which they denominate Salud Familiar, Comunitaria Intercultural, SAFCI (Intercultural Communitary Family Health). This system has, most importantly, seeks to complement the western-style medicine with Bolivian traditional medicine, through the following principles: Social Participation, Integration, Intercultural and "Intersectoriality".
The system creates a series of spaces for the population to take part in planning and debate. This participation is more pronounced at the local level through assemblies and, what in Bolivia is known as social control and means entities created with the aim at exerting some type of control over the planning and financing processes. At the departmental and national levels there are committees which also discuss the policies, and above all, the compliance with the central government's policies. The model also provides for the integration of different components of traditional life, such as family, community, and nature. The intercultural part addresses the intention of complementing the western-style medicine with Bolivian traditional medicine and the "Intersectoriality" part seeks to build a comprehensive approach to health care by including diverse components such as health education, sanitary infrastructure, the production or supply of medicine, etc.
The latest Ombudsman report
The Bolivian Ombudsmen Office, in a report published in January 2016, has stated the issue of health is one of the most vulnerable human rights in Bolivia. Considering that a lot has been done in the passing of laws to better the health care sector, building of infrastructure and in the creation of posts for health workers, the report cites several conclusions which point to an unsatisfactory development of it: a) there is a general lack of knowledge of the law and therefore of the norms and principles of the new system; b) in that matter, the law is not being applied as it should be; c) there is still confusion on the administrative side of the process, forms and processes are not being handled as they should be handled; d) the level of information is insufficient, people still do not know their benefits and rights; e) insufficient infrastructure still or too many patients; f) delays in the transfer of funds between municipalities and health units; g) not enough medicines; h) additional charges in many cases where there should not be any.
The report also cites some more facts: four out of ten people do not have any type of health coverage, coverage in the country side is significantly less than that in the cities, specialized care is inadequate, with patients having to wait months before they get an appointment, and in many hospitals care is rejected due to deficiencies in facilities, i.e. not enough beds or no access to technology.
Support at the national level
In the course of this last ten years the Morales government has been in power, many things have been achieved, but by the same token, because the task is so monumental, there are still many more to achieve. If the average Bolivian, at the beginning of the current government, felt as if this was the one government that was going to change things for the better, ten years into the "process of change", they are starting to measure the government with different measurement instruments. In more concrete terms, if people do not feel the newly created health care system is not working for them, they will have less trust in the government and the level of support will erode. In political science, that is a well known association. The longer the government is in power, the less support it has. That is one reason why presidents who come into office with double digit support numbers, tend to leave office with single digit support numbers.
In the case of Evo Morales, it will not be different. The more he stays in office the more chance he has to do some work, but at the same time, the more chances he has to make some unpopular decisions. Added to that, the fact the process is a slow one, that almost guarantees impatience on the part of the people.
Sources:
http://www.paginasiete.bo/sociedad/2016/1/22/defensor-solo-cuatro-cada-bolivianos-tienen-seguro-salud-84196.html
http://www.ops.org.bo/textocompleto/pi31260.pdf
http://www.eldeber.com.bo/bolivia/41-poblacion-votaria.html