Strengthening Health Systems To Face Pandemics: Subnational Policy Responses To COVID-19 In Latin America

Abstract

Non-pharmaceutical interventions (NPIs) such as stay-at-home orders continue to be the main policy response to the COVID-19 pandemic in countries with limited or slow vaccine rollout.Often, NPI are managed or implemented at the sub-national level, yet little information exists on within country variation in NPI policies. We focus on Latin America, a COVID-19 epicenter, and collect and analyze daily subnational data on public health measures in Argentina,

Governance and COVID-19 in Bolivia

“…While COVID-19 restrictions did not prevent community spread in Bolivia, they may have slowed and reduced it (Knaul et al 2022). The per capita case data suggests that strict policies may have reduced infections: we see peaks in June and December after restrictions loosened, suggesting that policies in prior periods had worked to reduce transmission.…”

“…Beni, Pando, and Santa Cruz share important border crossings with the Brazilian border states of Acre, Rondonia, Mato Grosso, and Mato Grosso do Sul. Acre, Mato Grosso, and Mato Grosso do Sul had the lowest restrictions of Brazil's states, which were already much lower on average than any department in Bolivia (Knaul et al 2022;Touchton et al 2021). While border closures helped to insulate Bolivia, shared borders with lax Brazilian states may have increased transmission in Beni, Pando, and Santa Cruz, especially the transmission of more contagious variants.…”

“…Figure 1 charts daily mobile phone mobility across the nine departments and demonstrates that people listened to the government-at first. The initial drop in movement across Bolivia was one of the largest drops in the Americas (Hummel et al 2020;Knaul et al 2022). However, as the lockdown dragged on, people started to move around, albeit slowly.…”

“…Observers have noted that countries with federal structures, such as the United States, Mexico, and Brazil, appear to have fared worse than countries with unitary structures (Knaul et al 2022). Bolivia's decentralized governance structure is between these two types.…”

“…This paper contributes to the literature on COVID-19 policies and experiences by developing a quantitative case study that examines subnational variation in a decentralized context. Most studies of COVID-19 policies aggregate data at the national level and miss important variation in local responses and experiences (Knaul et al 2022). In particular, national averages hide subnational inequalities in healthcare, resources, and experiences, as well as the local effects of political polarization around the pandemic.…”