We are so proud of our partners in Bolivia for their great work! We must also share the amazing dedication of our Board of Advisor, Hilary Moshman who helped push this forward in a huge way and to our founder and board member emeritus, Dr. Henry Perry. Of course, none of this success is possible without the countless healthcare heroes in Bolivia, including Dr. Dardo Chavez, Mitma Claure, Nat Robison, Ramiro Llanque and many others. Read more about the research below.
Objectives: This study describes the implementation of the census-based, impact-oriented (CBIO) approach for a program in Montero, Bolivia, managed by the Consejo de Salud Rural Andino (CSRA) that has been in operation for three decades, since 1988. A second paper in the series describes the effectiveness of the program, including population coverage of key interventions and changes in child and maternal mortality in the program area, over this period.
Results: The CSRA/Montero Comprehensive PHC Program provides services at clinics, but it also has a program of strong community outreach and community engagement that enables it to visit every household regularly, identify families with special needs, and involve the community in reviewing and addressing local health priorities. The program has been in operation for three decades at a current annual cost of US$11 per person per year.
Conclusions: The CSRA/Montero Comprehensive PHC Program is an example of an innovative approach to the provision of PHC that has worked effectively for three decades with the same dedicated leadership. The Program embodies strategies that are worthy of consideration for broader replication in the global pursuit of Universal Health Coverage. Evidence of the Program’s effectiveness is addressed in the following paper in this series.
Objectives: This report is the second in a series of two papers. The first paper describes the history and implementation features of the census-based, impact-oriented (CBIO) approach by the Consejo de Salud Rural Andino (CSRA)/Montero Comprehensive Primary Health Care Program that has been in operation for three decades, since 1988. This second paper in the series presents evidence of program effectiveness, including long-term trends in child and maternal mortality.
Results: A comprehensive PHC program that incorporates principles of the CBIO approach has achieved near-universal coverage of key child survival interventions and achieved levels of child and maternal mortality comparable to those in the United States. The CSRA/Montero Comprehensive PHC Program is now also addressing non-communicable diseases. Community collaboration, routine systematic home visitation, and targeted visits to high-risk households are vital components of the program.
Curamericas Global first began in 1983 in Bolivia as Andean Rural Health Care, or Consejo de Salud Rural Andino (CSRA). Through twenty years of partnership, as well as funding from the USAID Child Survival program and Curamericas Global’s supporters, Curamericas and CSRA have successfully addressed the causes of maternal and childhood illness and mortality through interventions including immunizations, diarrhea and pneumonia case management, nutrition, maternal and new born care, and family planning.
In 2015, our partners at CSRA reduced chronic malnutrition to 0.3% and acute malnutrition to 0.1% in 3,301 children under two years old. This was done by educating mothers on the importance of nutrition and vitamins through home visits, clinics, and cooking workshops.
Much needed health records were established for 3,914 families using our CBIO methodology. The CBIO approach provides the tools to analyze the health situation of families and communities, and to devise strategies to effectively address prominent health issues. One prominent health issue in the communities in Bolivia was Dengue and Chikungunya, which are illnesses caused by viruses spread through mosquito bites and can have devestating health effects for humans. In 2015, our partners at CSRA launched an educational campaign for families to reduce mosquito breeding grounds and implement preventative measures. Through this prevention strategy, the population of mosquitoes that spread Dengue and Chikungunya was reduced to only 2%.
Curamericas Global’s Strategy
Curamericas Global partners with CSRA as they continue to work diligently in the cities of Montero and El Alto to provide primary health care and community-based services. Both programs use Curamericas’ signature Community-Based, Impact-Oriented approach to save the lives of women and children. Current strategies address:
- Violence against women and children
- Unwanted pregnancies among youth
- Increasing cases of STDs including HIV/AIDS
- Increasing rates of homicide in women
- Malnutrition in children under the age of five
In 1995, the Andean Rural Health Care program became a legally independent organization, and has become one of Bolivia’s leading non-governmental health organizations. They are currently continuing their work in the highlands around La Paz and the tropical region of Santa Cruz, serving more than 150,000 low-income families.
The Andean Rural Health Care program serves as an example for Curamericas’ current projects, which strive to assist Curamericas’ in-country partners in becoming independent, self-sustaining organizations. It is Curamericas’ goal for all of the projects that the local partners have the capacity and resources in their own countries to be leaders in health care for generations to come. Today, the CSRA is an active partner organization in our continued, shared work with Bolivian communities.
Montero is located 31 miles north of Santa Cruz de la Sierra. Its economy is heavily based in agriculture. In 2014, Andean Rural Health Care provided medical consultations to over 22,000 children in the area of Montero. 95% of children in the area under two years of age received a growth assessment and 90% of children under one year of age were vaccinated for diphtheria, tetanus, whooping cough, hepatitis and pneumonia. Andean Rural Health Care launched a deworming campaign in ten schools in the area reaching 1,500 children. Additionally, Andean Rural Health Care hosted two health fairs where exercise and healthy eating were promoted.
El Alto, the second-largest city in Bolivia, sits on the rim of the valley that shelters La Paz. The city is composed of poor migrant Indians from the countryside and is known for its slums and political turbulence. In 2014, Andean Rural Health Care launched a program aimed at educating citizens of El Alto on human, sexual and reproductive rights. Also, in 2014, Andean Rural Health Care trained 18 public health personnel who met with nearly 4,600 women to discuss family planning strategies. Andean Rural Health Care also met with nearly 800 families in their homes where they provided vitamin supplements and nutrition education.