A/HRC/43/45/Add.1 dictate,15 the State pursued alternative policy choices: it continued to expand public investments by tapping accumulated international reserves and increasing external borrowing. 8. Despite the economic slowdown, the State still dedicated 15 per cent of GDP to public investment in 2016 and 13 per cent in 2017, which was the highest in the Latin America and the Caribbean region.16 As implied in paragraph 11.9 of the guiding principles on human rights impact assessments of economic reforms (A/HRC/40/57) – which were recently endorsed by the Human Rights Council, in its resolution 40/8 – the balanced use of foreign reserves for the purpose of social spending and public investment is an important measure for the realization of human rights, particularly at times of economic downturns. 9. The dedicated public investments since 2006 have been translated into significant improvement in a number of social indicators. According to official statistics, between 2005 and 2018, the poverty rate fell from 59.6 per cent to 34.6 per cent, and the extreme poverty rate declined by more than half, from 36.7 per cent to 15.2 per cent.17 The Gini coefficient of income inequality has also followed a downward trend, from 0.61 in 2002 to 0.45 in 2017.18 According to the Ministry of Education, the indicators in education have improved and the school dropout rate at the primary level has been halved from 4.53 per cent in 2005 to 2.02 per cent in 2015. 19 The State has also made important strides in improving the health indicators. The infant mortality rate was reduced from 46.0 to 29.0 per 1,000 live births between 2005 and 2016.20 The maternal mortality rate recorded a decline from 305 to 206 per 100,000 live births between 2005 and 2015.21 10. These figures and statistics uniquely demonstrate the ability of developing countries to create the necessary fiscal space to realize human rights through targeted macroeconomic policies. They also provide empirical evidence that structural adjustments based on the neoliberal and orthodox ideology, such as fiscal consolidation, privatization, deregulation of markets and labour flexibilization, are not necessarily the only or optimal policy option for economic growth and sustainable development. III. Sustainability of the revenue matrix 11. Despite these impressive achievements, the Plurinational State of Bolivia still faces challenges in achieving sustainable development and the realization of human rights for all its population. According to regional statistics, it remains one of the poorest countries in the region.22 Various estimates suggest that the incidence of multidimensional poverty is high and exceeds 50 per cent,23 while the human development indicators still fare poorly compared to those of other countries in the region.24 15 16 17 18 19 20 21 22 23 24 Isabel Ortiz and others, “The decade of adjustment: a review of austerity trends 2010–2020 in 187 countries”, Extension of Social Security Working Paper, No. 53 (Geneva, International Labour Office; New York, Columbia University; Geneva, South Centre, 2015). Comments of the Ministry of Economy and Public Finance. National Institute of Statistics data (see www.ine.gob.bo/index.php/podreza-desarrollo/introduccion2, accessed 24 December 2019). Social Panorama of Latin America, 2018 (United Nations publication, Sales No. E.18.II.G.7), p. 18. Figures provided by the Ministry of Education (on file). United Nations Development Programme (UNDP), “Mortality rate, infant (per 1,000 live births)”, Human Development Data (1990–2018). Available at http://hdr.undp.org/en/indicators/57206 (accessed on 24 December 2019). UNDP, “Maternal mortality ratio (deaths per 100,000 live births)”, Human Development Data (1990– 2018). Available at http://hdr.undp.org/en/indicators/89006 (accessed on 24 December 2019). Social Panorama, p. 78. Silvia Escóbar de Pabón and others, Desigualdades y pobreza en Bolivia: una perspectiva multidimensional (La Paz, Centro de Estudios para el Desarrollo Laboral y Agrario, 2019); and UNDP, Multidimensional Progress: Well-being Beyond Income – Regional Human Development Report for Latin America and the Caribbean (New York, 2016), p. 100. See, for example, World Bank Group, “Reducing maternal and infant mortality: a multi-project evaluation of 16 years of World Bank support to the health sector – Bolivia”, Project Performance 5