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Project Rjohn Snow, Inc CHILD SURVIVAL IN BOLIVIA CURRENT STATUS AND PRIORITIES FOR ACTION USAID/La Paz NOVEMBER 1387 Resources for Child Heath Project_ RJohn Snow, Inc. RC',,"''"Arlington, 1100 Wilson VA Boulevard, 9th Floor 22209 USA Telex: 272896 JSIW UR Telephone: (703) 528-7474 CHILD SURVIVAL IN BOLIVIA CURRENT STATUS AND PRIORITIES FOR ACTION t15ATD/Ia Pa; November 1987 Duncan Peder.qen, Crin.viitant Claudc Bett.s, Consu]tant Jorge Mariscal, (:onsultant Javier Torre.s Gnitia C.i Consultant The Resources for Child Health Project 1100 Wilson Blvd., Ninth Floor Arlington, VA 22209 AID Contract No: DPE-5927-C-O0-5068.O0 TABLE OF CONTENTS PAGE LIST OF ACRONYMS LIST OF TABLES LIST OF FIGURES I. EXECUTIVE SUMMARY I II. WORKING GROUP 5 1. Goals of the Working Group 5 2. Terms of Reference 5 3. Methodology 6 4. Composition of Working Group and 6 Duration of Assignment III. BASIC INFORMATION ABOUT BOLIVIA 7 1. Brief Geopolitical Description 7 2. Demographic Data and Migrations 9 3. Chronological Summary of the History of Bolivia, from 1879 to Present 16 1V. HLAL1H, DiSEtASL, AND Nui TALITY ]9 1. Health Profilc- of th- Country 19 2. Health Status of Women 21 3. Infant Mortality 32 4. Structure of Mortality in Children 49 V. COMMUNITY ORGANIZATIONS AND PROCESS OF 60 PARTICIPATION IN HEALTH 1. Brief Historical Summary 60 2. Levels of Community Participation 61 3. Recent Experience in Community 62 Participation in Health VI. HEALTH SECTOR AND SERVICES 66 1. National Political Framework 66 2. Health Policies and Strategies 66 3. Sector Organization and Principal Programs 68 4. Health System Coverage 69 5. Service Network Structure 73 VII. SOCIO--ECONOMIC AND CULTURAL CONTEXT 76 1. Socio-Economic Context 76 2. Cultural Context 97 VIII. CHILD SURVIVAL PRIORITTES: 107 PRINCIPAL PROBLEMS AND DANGERS IDENTIFIED 1. Birth and Perinatal Health 107 2. Nursing and Weaning III 3. Malnutrition 112 4. Immunopreventible Diseases 120 5. Acute Diarrheal Disease 129 6. Acute Respiratory Infections 142 7. Malaria 147 8. Chagas' Disease 149 9. Working Children 150 10. Child Abuse and Neglect 153 IX. GROUPS AT RISK AND PRINCIPAL INTERVENTIONS 155 1. Major Diseases and At-risk Groups 155 2. Priorities for Action 156 3. Principal Technologies and Interventions 157 Proposed BIBLIOGRAPHICAL REFERENCES 165 CSCS TEAM 170 LIST OF INSTITUTIONS VISITED AND PEOPLE INTERVIEVED 171 ANNEX 1: Construction of Population levels 176 ANNEX 2: Provinces in Extreme Poverty Conditions 178 ACRONYMS ADD: Acute Diarrheal Disease ARI: Acute Respiratory Infections BCL: Bolivian Confederation of Labor BHRSC: Bolivian Human Reproduction Consultant's Survey CHC: Community Health Committees CHICOLAC: Child Milk Centers CHR: Community Health Representatives CPI: Lonsumer Price Index CS: Child Survival DWH: Department Worker's Headquarters EAP: Ecomically Active Population EPI: Expanded Program on Immunization GPR: Gross participation Rate HAP: Health Area Program IBRD: Iriter-iational Bank for Reconstruction and Development IMR: Infant Mortality Ratev INAN: National Institute of Food and Nutrition MLW: Minimum Living Wage MPS: Medicine Prevalance Survey MPSSSP: Ministry of Social Welfare and Public Health MSWPH: Ministry of Social Welfare and Public Health NCHS: National Center for Health Statistics (Unitod States) NDS: National Demographic Survey NGO: Non-Governmlc-hjt Uigani zatiul NPHC: National Population and Housing Census NSI: National Statistic I: t it utc' ORS: Oral Rehydration Salts ORU: Oral Rehydration Unit ORU-C: Oral Rehydration Unit-Community ORU-I: Oral Rehydration Unit-Institutional ORU-P: Oral Rehydration Unit-Popular PAHO: Pan American Health Organization RNM: Revolutionary Nationalist Movement TFR: Total Fertility Rate WFP: World Food Program WHO: World Heaith Organization UDS: Urban Demographic Survey UNFPA: United Nations Family Planning Association UNICEF: United Nations Children's Fund USAID: United States Agency for International Development LIST OF TABLES TABLE III-1 Estimated Population By Sex, According to Age Group Bolivia, 1987 TABLE 111-2 Population Projections in Urban And Rural Areas, Bolivia, 1980-85 TABLE 111-3 Population Distribution By Ecological Region, Bolivia 1985 TABLE 111-4 Absolute Population Growth and Growth Rates By Departments and Department Capital Cities, Bolivia, 1980-85 TABLE 111-5 Net Permanent Migration By Ecological Region, Bolivia, 1976 TABLE 111-6 Place of Birth and Residence of Permanent Migrants By Ecological Zone, Bolivia, 1976 TABLE 111-7 Proportion of Permanent Immigrants and Emigrants By Ecological Region, Bolivia 1976 TABLE IV-1 Participation Rates in Economic Activity By Sex According to Urban and Rural Contexts, Bolivia 1976 TABLE IV-2 Illiteracy Rates and Net Reduction By Se>:, Bolivia 195n and 1q76 TABLE IV-3 School Marginalization Rates By Group and Sex, Bolivia 1984 TABLE IV-4 Marital Status of Urban Female Population By Department, Bolivia, 1976 TABLE IV-5 Total Fertility Rate By Ecological Region and Urban-Rural Context, Bolivia, 1976 TABLE IV-6 Maternal Mortality Rdtes in Selected Countries of South America TABLE IV-7 Aggregate Underlying Causes of Maternal Death, (. Urquidi Maternity Hospital, Cochabamba, 1979-86 TABLE IV-8 Births & Deaths Recorded By' the Civil Registrar and P',timat-,: Derived From the 1976 Census, Bolivia, 1976-82 TABLE IV-9 Infant Mortality in Bolivia, According to Various Sources By Urban and Rural Areas Surveyed, 1975-84 TABLE IV-10 Variation in Infant Mortality in Various Bolivian Cities, According to the 1976 Census and the 1983-84 BHRC Survey TABLE IV-11 Mortality in Children under 2 Years Old, According to Age at Death By Ecological Area and Place of Residence, Bolivia, 1976 Census TABLE IV-12 Probability of Death Per Thousand Live Births Between Birth and Age Two By Ecological Region Context and Social Sector TABLE IV-13 Infant Mortality By Mother's Language, According to Place of Residence and Socio-Economic Group, Bolivia, 1987 TABLE IV-14 Population Distribuion According to Language, By Age Group, Bolivia, 1976 TABLE IV-15 Infant Mortality By Ecological Region According to Mother's Education Level, Bolivia, 1976 TABLE IV-16 Infant Mortality By Regions, According to Quality of Housing and Services, Bolivia, 1976 TABLE IV-17 Relative Distribution of Children of Mother's Ages 15-4q By Region, Accoiding to Quality of Housing and Services, Bolivia, 1976 TABLE IV-18 Ten Primary Causes of Death in Children Under 5, According to Civil Registry, Bolivia, 1981 TABLE IV-19 Ten Primary Causes of Death in Children Under Five By Age Croup According to the Civil Registry, Bolivia, 1981 TABLE IV-20 Five Primary Groups of Causes of Death in Children From 0-35 Months of Age, Civil Registries of Urban Areas, Bolivia, August 1982-July 1981 TABLE IV-21 Five Principal Groups of Causes of Mortality in Children of 0-35 Months Old, According to the Civil Registry of Urban Areas By Age Group, Bolivia, August 1982-July 1983 TABLE IV-22 Ten Principal Groups of Hospital Mortality in Children 0-35 Months Old By Causes, Bolivia, August 1982-July 1982 TABLE V-1 Women's Organization in Bolivia, 1984 TABLE V-2 Number of Community Health Communities By Department and Urban/Rural Areas, Bolivia, 1987 TABLE VI-I Human Resources Classified By Category, Ministry of Social Welfare and Public Health, Bolivia, 1980-84 TABLE VI-2 Number of MPSSP Facilities and Bed By Area, Bolivia, 1986 TABLE VII-1 Gross National Product Per Person and Annual Variation By Year (in millions of Bolivian pesos and at 1970 prices), Bolivia, 1970-82 TABLE VII-2 Income and Consumption Patterns of Families During the Economic Crisis: Variations of Some Economic Indicators With Respect to 1980, Bolivia, 1985-86 TABLE VII-3 Guvernment Health Expenditures Per Person/Year For Certain Latin American and Caribbean Countries 1970-1984 ( In 1982 U.S. Dollars) TABLE VII- Availability of Energy. Protein, and Fat Per Person Per Day. Bolivia, 1981-83 TABLE VII-5 Availability of Calories and Nutrients Per Person Per Day, Bolivia and Latin America, 1982 TABLE VII-6 Percent Distribution of Selected Population Groups According to Adequacy of Required Protein Consumption in Depressed Rural Areas of Bolivia, 1984 TABLE VII-7 Changes in the Minimum Living Wage and Prices of Some Food Products (in bolivianos) Bolivia, August 1985 TABLE VII-8 Origin of the Caloric Contribution of Principal Food Products, Bolivia, 1985 TABLE VII-9 Housing Distribution By Floor Type, Bolivia, 1976 TABLE VII-1O Distribution Of Sanitation Services (Toilet, Latrine, etc.) By Urban and Rural Area, Bolivia, 1976 TABLE VII-11 Population Served By Sevage Elimination System By Urban and Rural Area, Bolivia, 1976 TABLE VII-12 Total Population and Percentage of Rural Population in Provinces in Extreme Poverty TABLE VII-13 Population in Extreme Poverty Conditions Living in Deprived Prov'inces By Depaitni'tu and Degree of Poveity, Bolivia, 198' TABLE VTI-14 Population in Extreme Poverty Conditions By Department, Bolivia TABLE VII-15 Population Distribution According to Language By Age Group, Bolivia, 1976 TABLE VII-16 Bolivia: Reasons for not Using Public Health Services Among Families in Rural Depressed Areas, Bolivia, 1984 TABLE VIII-i Nutritional Status of Children 6-59 Months of Age Accoiding to Waterlow Classification, By Region and Geographical Area. Bolivia, 1981 TABLE VIII-2 Nutritional Status of Children 0-59 Months of Age, According to the Gomez Classification, By Region and Geographical Area, Bolivia, 1981 TABLE VIII-3 Nutritional Status of Children 0-59 Months of Age According to the Gomez Classification,
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