However, these reform proposals met with widespread opposition by local authorities that feared this would decrease municipal and departmental autonomy, meaning that they were not passed. In place of a more comprehensive reform, the MSPS has instead issued decrees addressing specific elements of the health system, including strengthening service delivery in remote areas, regulation of biotechnology, updating criteria for affiliation to the SGSSS, and improved financial regulation of EPS (Box 1.3). Disaffiliation will only occur in case of death.