Committed to health

The Andean Development Corporation (CAF) and the Integrated Health Coordination Program (PROCOSI) signed an agreement in Calamarca to promote the project "Building Bridges between the Community and Health Services with a Gender and Intercultural Approach."

The initiative will contribute to reducing child and maternal mortality by offering sexual and reproductive health education to women in the communities, along with the instruments they need to negotiate with health services providers on culturally acceptable terms. The project will be executed simultaneously in Calamarca (La Paz) and Morochata (Cochabamba) municipalities. The CAF will contribute up to $243,567.

The ceremony was attended by the ministers of Health, Fernando Antezana, Popular Participation Roberto Barbery, and Education Donato Ayma; CAF Executive President Enrique García; director a.i. of Procosi, Ignacio Carreño; manager of Research and Innovative Initiatives Erika Silva; Kart Henne, member of the Procosi board; Calamarca Mayor Antonia Santa Maria; general secretary of Calamarca (Mallku) Eduardo Hinojosa Escobar; and Morochata Mayor Elías Patzi.

CAF President Enrique García emphasized the social importance of the project, which addresses the serious health problems that affect sectors of the socially and economically underprivileged indigenous population. The project is part of the area of community management of services, based on the approach of building basic capacities, generation of social fabric in the community, respect for autochthonous cultures, predominantly Aymara (Calamarca) and Quechua (Morochata), promotion of gender equity, and enrichment of civic culture around the demand for public services. The CAF head said that no one knows the health problems, how to solve them and the type of health care desired better than the community itself.

The Integrated Health Coordination Program (PROCOSI) is a national network of 37 non-profit institutions that promote and execute integrated health and development programs in marginal rural and urban areas in Bolivia. PROCOSI´s work benefits disadvantaged populations lacking opportunities for access to education and health services. The project will be executed by two PROCOSI organizations "Save the Children USA" and "Project Concern International" in the Calamarca and Morochata municipalities, respectively. After working in the municipalities for several years, these organizations´ direct knowledge of local conditions will facilitate the execution of the project.

This initiative is CAF and PROCOSI´s response to the high child and maternal mortality and morbidity rates on the Bolivian Altiplano and Valleys. In the region, Bolivia has the highest maternal mortality rates - 390 per 100,000 live births on average, reaching a maximum of 680 for every 100,000 live births in some rural areas (ENDSA 1994). The Calamarca and Morochata municipalities are considered high-risk localities because of their high rates of maternal and neonatal morbi-mortality.

The death of a mother has profound consequences for her family. In countries like Bolivia, after the death of the mother, the risk of death to her children under five increases 50%. Because women die during their productive age, their death affects the family economy and society as a whole. However, the problem is not only maternal deaths but also a female population disabled by injuries during pregnancy and labor. At the Millennium Summit (2000), the United Nations set the target of a 75% reduction in maternal mortality by 2015 from the rate in the 1990s, and the XXVI Pan-American Health Conference set the medium-term target of reducing maternal mortality to 100 maternal deaths per 100,000 live births.

Maternal deaths occur because of women´s ignorance of their own physiology and of signs of dangerous pregnancy, which delays the decision to seek health care, as well as bad quality health services, among other factors. The project addresses these causes by improving knowledge, and adapting services to community demands. Women also learn to recognize danger signs in children with diarrhea and acute respiratory infections, which are the most frequent cause of infant mortality, and to take preventative measures.

The "Building Bridges between the Community and Health Services with a Gender and Intercultural Approach" project has four basic components designed to reduce maternal mortality: 1) reinforcing the knowledge of the female population on exercise of their sexual or reproductive rights, and health care; 2) helping the female population to understand their own normal biology and pregnancy (anatomy and physiology) so that they can identify changes, alterations and health risks. This component includes sexually transmitted infections, uterine cervical cancer; pregnancy, labor and puerperium; contraception and violence; 3) reducing delays in using health services because women with adequate knowledge will make better decisions on their own health; and 4) helping to improve access to health services and their quality, and adapting the care offered by the health services to women´s needs, taking into account local culture.