Santa Cruz, Bolivia, September 4, 2023 (OPS)- The project “Improving the health of women and adolescent girls in vulnerable situations”, carried out in Bolivia between the Pan American Health Organization/World Health Organization (PAHO/WHO) and Global Affairs Canada, bases its actions on national alliances , departmental, municipal and local to contribute to the reduction of maternal morbidity and mortality.

The objective of the project is to increase access and coverage of sexual, reproductive and maternal health services, in order to provide a broad and comprehensive primary care response to women and adolescents living at risk in six countries, including Bolivia. The project in Bolivia is developed in La Paz, Cochabamba, Oruro and Santa Cruz.

With the visit to Bolivia of the project management advisor and the regional project funded by Global Affairs Canada, from the office of the Deputy Director of PAHO, Heidi Ullmann, the importance of continuing to work in coordination with the Ministry of Health and Sports is confirmed. , with subnational alliances – such as departments and municipalities – and with local and community partners – such as midwives or the Chaco Tekove Katu School of Public Health – to advance women’s health.

“We have collaborators at the international level like the Canadians who bring us a lot to be able to reach the communities, but the mayors are also important partners, for municipal work, and we also have NGOs and faith-based organizations who work with us and they collaborate so we can reach the community directly. It is very important to have cooperation at all levels, both intersectoral and sectoral, to achieve a reduction in maternal morbidity and mortality and access to health for people in the community,” explained the international advisor for family, health promotion and healthy living. of PAHO/WHO in Bolivia, Erick Rousselin.

Partners at subnational levels

In this sense, Evelyn Díaz, doctor and head of the Health Services and Programs Unit of the Departmental Health Service (SEDES) of Santa Cruz, corroborates the importance of the alliance with the OPS/Canada project: “Based on indicators of morbidity and mortality among adolescent girls in the department, SEDES, in close coordination with PAHO, established a work plan with the aim of strengthening the capacities of health personnel, through training and acquisition of their skills, in addition to creating skills development centers, improve care in health services intended for mothers and adolescents in the department.

“We intend to have a direct impact on the care of users, pregnant women, adolescents and newborns in order to provide timely, warm and quality care to be able to influence morbidity and mortality indicators,” said Díaz .

On the other hand, the project works hand in hand with the Association of Councilors and Mayors of Bolivia (ACOBOL) and has organized in recent months several meetings to advocate for the health of women and adolescents, within the framework of have healthy municipalities. .

Capacity Building

On the other hand, Rousselin explained that the project “has a strategy aimed at strengthening the capacities of human talent, in two areas: in specialized human resources of health networks and in non-specialized community human resources”.

In this context, it has developed several actions in this direction in recent months. For example, it carried out the national course for facilitators in obstetric emergencies in collaboration with the Ministry of Health and Sports, with international experts from the Latin American Center of Perinatology (CLAP), in which representatives of the nine departments of the three levels of care. and have already started replications in several level II hospitals.

In the following days, under the same concept, five workshops are planned with CLAP specialists on prenatal care, maternal mortality committees, neonatal workshop and training of medical technical teams for intentional search and reclassification of deaths (BIRMM) with experts from OPS from its headquarters in Washington DC and CLAP.

Impact on communities

In the area of ​​strengthening non-specialized community human resources, the project trained indigenous women as community facilitators, leaders and delegates of the indigenous peoples and lowland territories of Bolivia of the National Confederation of Indigenous Women of Bolivia CNAMIB, under the direction Knowledge Dialogue methodology developed by PAHO/WHO.

Just as it has generated a process of continuous improvement in the capacities of midwives, both in the highlands and in the lowlands of the country. The midwives participated in workshops where they held exchange meetings, strengthened their capacities in maternal health and intercultural dialogue aimed at reducing mortality and extreme maternal morbidity (EMM) in the communities, as well as received perinatal Pan risk detection kits. American Health Organization (PAHO), as part of the project funded by Global Affairs Canada.
After visiting the country, Heidi Ullmann was pleasantly impressed by the work carried out in collaboration with local actors who have direct coordination with rural communities and indigenous territories, for the positive impact on maternal and adolescent health.

“Midwives play a fundamental role in providing health services to women in communities, particularly indigenous communities. And they fulfill this role with a lot of solidarity, with a lot of affection, with a lot of empathy. And it is important that health systems are recognized so that there is a bridge between what they provide to communities and the services that might eventually be required by the health system, to ensure the absence of morbidity and maternal mortality. » said Heidi Ullmann.

For her part, the head of cooperation at the Canadian Embassy declared that “for Canada, it is interesting to see what the mixture of traditional or intercultural medicine with conventional medicine looks like. Because we have a plan for truth and reconciliation with indigenous peoples and we want to learn from them and their knowledge and be able to articulate and complement each other in everything we do. This differentiated and intercultural attention is essential to be able to move forward in this process of reconciliation and see that yes, beyond what is Western, we can learn from indigenous peoples.

Key partner: Tekove Katu School of Public Health

Finally, the OPS/Canada project works with strategic partners in the Chaco de Santa Cruz, such as the Tekove Katu School of Public Health, which has been training indigenous youth for more than 40 years.

Young people trained at school are elected by the assemblies or councils of their indigenous peoples and/or nations. The designation is a letter of commitment to return to the territory to provide health care. They are trained in three professions to meet the needs of the territory (indigenous): nursing technicians, nutrition and environmental health (based on the determinants of health).

“Although the school was born in Guarani territory, practically all members of the indigenous communities of Bolivia, Argentina and Paraguay access the school. We have had the opportunity to train up to 16 indigenous nations, with a single commitment to return to the community after being trained to be able to give back what they received for free. The idea is to train leaders. We know that health cannot be achieved by one person, it can only be achieved with organization. (Father) Tarcisio always reminds us that in Guarani we say opareiti oterami, just as if we were one. So the work of the young people who leave here is organizational work, if there is no organization, there is no health,” declares the academic director of the School, Francesco Cosmi .

OPS has twenty years of history of cooperation with the School. Currently, as part of the OPS/Canada project, the capacities of students are being strengthened so that at the end of the training, they become key players in the health of women and adolescent girls in vulnerable situations.

For her part, after learning about the experience, Heidi Ullmann emphasized that: “It seems to me that the work that the Tekove Katu school is doing here in Chaco is extremely fundamental, with young people in solidarity who want to work in health public and support the improvement of the health of women and adolescents. “They are absolutely a strategic partner in trying to improve public health in their communities. »

“In the Guarani world, Tekove Katu means Full Life, complete physical, mental and spiritual well-being. If we don’t have land, there is no health, if we don’t have water, there is no health, we don’t have education, work, justice. If there is no peace with your neighbor, we have no health. So, in this broad concept of health, school leavers will be a bridge to the community to seek to achieve what is a unique and intercultural health system for all,” says Cosmi.

Thus, the project “Improving the health of women and adolescent girls in vulnerable situations”, executed by PAHO/WHO in collaboration with Global Affairs Canada, will see young people trained in public health from Tekove Katu as key actors in the promotion of health and women’s health. prevention of maternal morbidity and mortality and adolescent pregnancies, particularly in communities of indigenous peoples and/or nations.