The project region, with high vulnerability to drought, low provision of water and basic sanitation, has a high indigenous population with low immunization rates, low risk perception of COVID-19, and cultural barriers that limit access to health services. Before the pandemic, Bolivia was already considered one of the countries in South America with the worst maternal and child health indicators, right after Haiti, especially in rural and indigenous populations. According to the Economic Commission for Latin America and the Caribbean (ECLAC 2020), the estimated infant mortality rate among indigenous peoples is 75.9 per thousand, which is 46% higher than the non-indigenous population (51.9 per thousand); 20% of indigenous infants die before their first birthday and 14% of the survivors die before reaching school age. Fifty percent of all infant deaths occur in the first month of life, when babies must adapt to a different way of feeding, breathing and keeping warm, and can easily get sick and worsen rapidly due to infections. At the same time, the growing presence of diabetes and other chronic diseases among the indigenous population, associated with changes in their lifestyles, is a cause for concern. The most visible barriers that limit access to health care in health centres and health posts are: 1) the lack or deficiency of medical supplies and basic medicines, 2) deficient infrastructure and 3) human resources without training and updating in the new COVID-19 context. Most health facilities lack quality or culturally adequate infrastructure, equipment and instruments to attend to emergencies and complications in the case of childbirth, prevalent childhood illnesses and COVID-19. More complex health cases are referred to referral hospitals in the city of Santa Cruz de la Sierra which is located at a distance of 307 km, involving 4 to 5 hours of travel by car. Since the beginning of the pandemic, the focus of health programs has been Covid-19, reducing the attention and coverage of national maternal and child health programs, such as the immunization program (PAI) and the attention of other pathologies or prevalent childhood diseases. Coverage for the first dose of MMR (Measles-Mumps-Rubella) vaccine in 2016 was 94% and in 2020 it only reached 58% (Bolivian Ministry of Health).
The project aims to improve maternal-child health and treatment of COVID-19 in the most vulnerable population of the community of Camiri, and to make a significant contribution to the prevention of maternal-child mortality and COVID-19 in the Guarani indigenous population. The project will strengthen the health system by improving infrastructure, providing basic medical
equipment, creating emergency plans, and training health workers and health workers to improve care for pregnant women, new-borns, and children under 2 years of age, as well as treatment for COVID-19.
Sub-target 1: Improvement of the infrastructure of the Integrated Network of Health Services to provide quality maternal and child health care in COVID and post-COVID contexts.
Sub-target 2: Strengthening the capacity of health personnel and community health workers for the health care of pregnant women and children under 2 years of age in health centers and at the family and community level in the municipality of Camiri.
Sub-target 3: Strengthening the capacity of the Health System of the Municipality of Camiri for the effective response and health care of COVID-19.
- 74% of pregnant women with 4 Prenatal Care controls (current proportion 54%) (1,434 expected pregnancies).
- 70% of institutional and/or skilled attendance at birth (current coverage 56%) (1,400 expected deliveries) and 80% of newborns and their mothers receive essential care in the first 48 hours after birth.
- 90% of children under 1 years of age with complete vaccination schedules (current 59%) (1,265 children).
WV implements collaborative actions with partners and the municipality, strengthening national public health policies, ensuring that all actors such as local health services interact in these processes and provide primary health care in a timely manner and with quality. The Municipality finances the ongoing operation and WV contributes with actions and its own budget and other funds for humanitarian and development cooperation; the health needs observed in the context demand a multipurpose intervention with funds from different sources. WV promotes and accompanies community initiatives, ensuring active participation and strengthening the community's role of exercising social control and participatory management with municipalities and health centers, promoting public advocacy to maintain the actions and maximize resource management. WV will be the executing partner in Bolivia through a local interdisciplinary team, which has extensive experience in similar interventions and has a permanent presence in the project implementation areas. It will also carry out the inter-institutional coordination with the different actors, partners and departmental, municipal and local authorities. Periodically (quarterly, semi-annually and annually), data will be collected and analyzed to know the progress, achievements and difficulties that may arise. The project partners will be permanently involved and informed of the progress and will have the possibility to make their contributions and observations to the operational and technical processes known.
WV has signed a National Framework Agreement with the Chancellery of the State, where WV is recognized as an NGO that strengthens and implements programs and projects under the umbrella of the policies, strategies and priorities of the Sectoral Plan for the Integral Development of Bolivia. WV also has a framework agreement with the Ministry of Health, the governing body of public health, to support state health policies at the national level; it also has an agreement with the Departmental Health Secretariat of Santa Cruz, and at the local level, with the Provincial Network Management that allows the implementation of coordination actions, training, health care
compliance with the mandate established in the SAFCI (Salud Familiar Comunitaria Intercultural – Family Community Intercultural Health) policy, national and departmental plans and the Political Constitution of the State. Therefore, the project's actions have sustainability mechanisms from governmental bodies because public policies are supported. WV promotes and accompanies community initiatives, ensuring active participation and strengthening the community's role of exercising social control and participatory management with municipalities and health centers, promoting public advocacy to maintain the actions and maximize resource management. The project does not build new structures but strengthens the existing health policy called SAFCI and its implementation in the regions of the Cordillera Province through which it will contribute significantly to the realization of the rights to health of the local population and specifically of the indigenous rural population. The continuity of health services at the local level is guaranteed by the active cooperation of the local structure of the public health sector, health personnel and Community Health Workers. The appropriation and transfer of preventive and promotional maternal and child health measures to the family level contributes to improved family health.
Maternal and Child Health under consideration of the COVID19-context.