Plurinational State of Bolivia

The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of the Plurinational State of Bolivia was 8 592 656 inhabitants; by 2023 this figure had risen to 12 388 571, representing a 44.2% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 4.9% of the total population, a decrease of 0.2 percentage points compared to the year 2000. In 2023, there were 99.6 women per 100 men and 16. older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 64.6% of the total population of the country in 2023 (8 007 340 people). When we add these figures to the potentially passive population (3 776 903 under 15 years of age and 604 329 over 65 years of age), the result is a dependency ratio of 54.7 potentially passive people per 100 potentially active people. This ratio was 77.1 in 2000.

Life expectancy at birth in 2023 was 68.8 years, lower than the average for the Region of the Americas and 6.4 years higher that in 2000.

Figure 1. Population pyramids of the Plurinational State of Bolivia, years 2000 and 2023

Between 2001 and 2020, the average number of years of schooling in the Plurinational State of Bolivia increased by 36.2%, reaching an average of 9.8 years in the latest year for which information is available. The unemployment rate in 2022 was 4.4%. Disaggregated by sex, the rate was 5.0% for women and 4.0% for men. The literacy rate was 99.6% in 2020. In men, this figure was 99.5%; in women, 99.6%. In addition, 36.4% of the population were below the national poverty line in 2021, a decrease from 37.2% in 2019. In 2020, 4.4% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is below the regional average of 3%.

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 9.5% (from a score of 0.632 to a score of 0.692); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2020, public expenditure on health accounted for 5.65% of gross domestic product (GDP) (Figure 3) and 14.87% of total public expenditure, while out-of-pocket spending on health accounted for 21.27% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020

Digital coverage

In 2021, 66.0% of the population had an internet connection, representing a considerable increase from 2000, when 1.4% of the population had an internet connection.

Health situation

Maternal and child health

Between 2003 and 2016, infant mortality in the Plurinational State of Bolivia decreased from 54 to 24 deaths per 1000 live births, a decrease of 55.6% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 4.0% to 5.5% between 2001 and 2021. while exclusive breastfeeding in the child population up to 6 months of age was 53.6% in 2008 and 60.4% in 2018 (the latest year for which information is available).

Regarding the immunization strategy, measles vaccination coverage was 69.0% in 2022, a decrease of 31 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 160.9 deaths per 100 000 live births, a reduction of 43.3% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.5 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 31.0% decrease, from 90.3 live births per 1000 women aged 15 to 19 years in 2000 to 62.3 in 2023. In 2021, 98.1% of births were attended by skilled birth personnel.

Figure 4. Infant mortality per 1000 live births, 1995–2020

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2021, there were 59 new cases of tuberculosis per 100 000 population in the Plurinational State of Bolivia. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 10.7 (8.2 in women and 13.4 in men).

In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 24.7 per 100 000 population. The age-adjusted mortality rate for HIV was 1.7 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 92.1%. In 2021, there were five reported cases of human rabies in the country.

Noncommunicable diseases and risk factors

In the Plurinational State of Bolivia in 2023, the prevalence of tobacco use among people aged 15 and older was 11.3%. In the same age group, the prevalence of overweight and obesity was 56.1% in 2016.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 17.9%, a decrease of 3.6 percentage points compared to 2000 (21.5%). The prevalence of diabetes mellitus, which stood at 6.4% in 2000, increased to 8% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in the Plurinational State of Bolivia was 317.1 deaths per 100 000 population, a decrease of 32.9% from a rate of 472.5 in 2000. This meant that, in 2019, the rate in the country was 39.9% higher than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 153.7 per 100 000 population in 2019, which is 12.1% higher than the regional average rate; and the rate for treatable causes was 163.4 per 100 000 population, compared to the regional average of 89.6.

The overall age-adjusted mortality rate was 7.9 per 1000 population in 2019, a decrease of 21.6% compared to 2000 (10.1 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 136.8 per 100 000 population (141.3 per 100 000 in men and 132.0 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 584.4 per 100 000 population (598.8 per 100 000 in men and 572.4 per 100 000 in women). The rate of age-adjusted mortality from external causes was 69.9 per 100 000 population (101.4 per 100 000 in men and 39.4 per 100 000 in women), including road traffic accidents (23.2 per 100 000 population), homicides (9.7 per 100 000 population), and suicides (6.8 per 100 000 population). In 2000, the percentage distribution of causes was 53.2% for noncommunicable diseases, 38.3% for communicable diseases, and 8.5% for external causes; in 2019, the percentages were 72.7%, 18.6%, and 8.7%, respectively (Figure 5).

Figure 6. Proportional mortality in the Plurinational State of Bolivia, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 11.5 per 100 000 men; lung cancer, 10.3 per 100 000; and colorectal cancer, 4.7 per 10 000. In women, these values were 9 deaths per 100 000 for breast cancer; 5.4 per 100 000 for lung cancer; and 3.6 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In the Plurinational State of Bolivia in 2020, there were a total of 158 372 cases of COVID-19, representing 13 110 per million population. In 2021, there were 441 381 identified cases, equivalent to 36 538 per million population, while in 2022, there were 507 147 reported cases, equivalent to 41 983 cases per million population. In 2020, there were 9149 deaths directly caused by COVID-19 in people diagnosed with the disease, or 757 per million population; in 2021, 10 531 deaths were reported, or 872 per million, with a total of 2546 deaths in 2022, equivalent to 211 per million population. In 2020, the Plurinational State of Bolivia ranked 10th in the Region of the Americas in terms of the number of deaths from COVID-19, 30th in 2021, and 39th in 2022, with a cumulative 1839.9 deaths per million population over the two years (Figure 6).

According to estimates by the World Health Organization,  there was a total of 36 299 excess deaths in 2020, or 311 per 100 000 population; a total of 51 733 deaths were estimated in 2021, for an excess mortality rate of 437 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 61.3% of the country's population. As of 20 April 2022 (latest available data), 50% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and six types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Prospects

Measures to achieve universal health coverage

The Economic and Social Development Plan (PDES) 2021–2025, “Rebuilding the Economy to Live Well, towards Industrialization with Import Substitution,”  approved by the Government of the Plurinational State of Bolivia, focuses on the collective construction of a society without inequalities or poverty, with a central focus on the human being, aimed at achieving a balance between the social, economic, and environmental spheres, leading to the sustainable development of the country. This plan is structured in 10 strategic axes, linked to the 13 pillars of the Patriotic Agenda for the 2025 Bicentennial. 

Pillar 3 of the Agenda focuses specifically on health, education, and sport, and aims to guarantee the right and access to health for all people, without exclusion or discrimination, and free of charge, through implementation of the Unified Health System (SUS).  This system, in addition to being universal, constitutes the main national-level policy for the health sector, in order to provide free coverage to Bolivians who are not covered by social security. 

Similarly, the Intercultural Community Family Health Policy (SAFCI)  proposes models of health care and management based on the principles of comprehensiveness, intersectoriality, community participation, and interculturality, addressing health promotion and disease prevention from a collective-health approach, centered on the person, the family, the community, and the environment, and seeking to restore traditional and intercultural medicine.

Challenges related to population health

Important challenges for the public policy agenda remain, including the accelerated reduction of maternal mortality rates, and the strengthening of leadership (stewardship) and governance to reduce the fragmentation and segmentation of the health system, for which it will be necessary to conclude tripartite and bipartite intergovernmental agreements.

COVID-19 pandemic response

To address the pandemic, continued efforts are underway to strengthen first-level care and extend the application of SAFCI to the entire health system, as well as to advance the development of laboratory diagnostics and epidemiological surveillance capacities, aimed at establishing a system of early, timely alerts and response.

One of the main objectives of the pandemic response is to accelerate the vaccination process by increasing COVID-19 immunization coverage and reducing the lethality of this disease, through two key strategic initiatives:

• Implementation of the National Vaccination Plan, which proposes immunizing the entire population, including children from birth.
• Development of a national epidemiological surveillance, disaster response, and environmental health program.

National strategy to address inequalities in health

As mentioned, PDES 2021–2025 seeks collective construction of a society without inequalities or poverty. In the area of health, this means prioritizing groups living in situations of vulnerability and with little access to health services, such as rural and indigenous populations (particularly in the eastern part of the country). 

Lastly, it has also been proposed that resource allocation be made more equitable. To this end, a higher per capita amount will need to be allocated for municipalities with the largest dispersed rural and indigenous populations. 

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.