Q)JAL ACMcBHL&ES Ewa5 OF MaawI VU" Done for USAID/BOLIVYIAD contract No, AID..5U1.89T ProJect No.,5U.9u00.525 Submitted by: Eloy Anello,. N.P.L. L~ynn Anellov M.P. UN or COM 1. Introdwtion A. ObJeetWs and Nithodolog I 1. Objectives I 2. MethodloW 2 B, Activity Sum (See Annex m'e) 1. aithI for Oetober (e Annexz') 2. WnthV RePort fbr 30ovembu (Bee Annex ') 3. ithY eport tbw Decmibe (See Ann "S') C. 7al limet of Ontract 3 D. Definition of Terms II. F6in6 A. Are Smry - Vale Oeste 6 I. Hoalth Seetor 6 a. Health Faeilities 6 b. Health Personnl c. Health Pactitioners 1 d, Health Attitudes and PrcticeO e. Bwifronfntal Health Factors 22 f. 00 FjUov-up Supervision of Health esources 25 2. Interseetoril Reletionship a. Agricultrta progrm 26 b. *m "ityDev3OP&Mt Pfjects 3O o. Other Procram 3) e, Act i m61Oaml .1-o 3. Area &=wry - blle Alto 1. Heal.th Sector a.. Health Fecilities 2 b. HeaLth PersonneL 50 c. Health Prctiolows 51 8. Health Attitudes end Plectices e. kvironwantal Health Factors 59 f. 003 Po vm-up Supervision of Health Resources 61 2. IntersectorLa. Relatimehip. 62 a. Agriculture Pr rams 6 62 b. Comunity Devlopme t Proja 7 66 c. other Program / 1 69 d. Eution to, / 70 e. Active Conmnity Bsed Organitatios 76 C, Food for Peace Distribution and Ue 80 D. Traditional Medicine le Cairander82 2. Parteros, 88 a. Deliver Ptocedwe 88 b. Abortions 8p 3. Medicinal Herbs 89 L Inatitutional SONm 91 Govement Institutios 91 I. Enistry of Helth 91 o. 1 UiMties eM Pearsonel 91 b.. hvzommta atti a. mtwm]i a* Zat Om' 2. Soool of Nedloe 91 3. Miniatry of Agrctedtae i. Clomnity Development 96 5. Servilco Geolgico do Boivis 6. Acci Civics Ge Ise Jrsa.ss hrds 9 T. COarporactn do Deaanrolo do Coobabebte 98 8. tnistry of Ruxal Duaetion 98 9. Iniatry of Urban Mueetlo 101 10. Borm.wl Schools 102 U1. National Social Devealopment OmnCl. 102 12. aftit Interinstltucional de Omoraiusto& pwr e. Desaaollo del Oooperativisn en Ow bhbeab. 102 luntary Inatitution 103 1. Catb Uo Chiurch 03 2. IMS 103 3. Padlo Sez Rafael IRA 4. Rational Federation of OCopmtlvw 105 5. A taUt Boliviano 105 6. Inatituto, do Mwcoi& Pal 106 T. Centro pars el Dmorrollo Social y Nbono co 106 8. btrsi we 9. Adventtit school 3o 10. comma M.. American naltitamwO 12. Methodist (ua'b 09 1. Potential of OftnLt7y hed OrapnLmtions flo eaflth Vwk 11 1. Lw end Mary Clbs 110 2. Pro-4evlopwat Oomttlm 10 3. 10the Clubs 110 4. Spo t Clb 1ll 5. Artisan Oroup 121 6. Savings end Eoss Oooestives 112 T. Agriculture (ooperatives 112 8. Parents Comittles 112 9. Civic Clubs 113 10. Ridio Clubs 113 III. Recommendations IM A.. Suggested locations for administrative centers end sub- 12D centers in a integrated rural health delivery systaw 1. Vle Alto 1M 2. VbWlt Oeste 123 B. Recomended Area for Pilot Pfject 126 C. Suggestions for an Integrmtaed nl health delivery system 12 1. Objectives 127 2. Decription of ntagated Rurml Health Deliver7 6stma 127 0. Health sector 127 b. Muctio 128 1.. 2u7a1 ucatiom 28 11,A r r Muottios 19 a~~~~ i0 A-~utrI I. ApVU~dtwr httemoa AdOU 330 It ApLeaitwt. Nupm'lmta otaw m 4.OoWOh1'DveoM t 131 g, Inteation of Hsltb Prsctttioer into 4 amis sealth f~at 132 1. WeI)rn Practitionui 132 li. TmdItlorAl lrnctiti.onmr 132 3. Oomanitry InvOlvegmt In HODlth Props.. 133 4,. Vblutary Agemiss 133 Annex "AN -methodology fbi ERval Heelth Surv~t in 0ockm bombs WD11res. RMa or U .LI Department of Owbsbaulm with Valle O te snd Veel Alto 5 indicated 2.1 Mmnties -visited In Slte Oeste T 2.2 *jor transportation routes 8 2.3 Health fbelites 10 2.4 Health persomsel 15 2.5 EDviromnentel health foctors 23 2.6 Agriculture Wnd Oomzmity Development projects 27 - 29 2.T hclear schoolJ And satellites 32 2,8 Active commmnity based orpnizatios 39 2.9 Ibrkets and ares of utllisatIM 1 2.10 Suggested locations for oduliitzatve centar 0d 125 sub-centers 3.1 00maizite Tiited In Wl Alto 43 3.2 e3or transporttion routes 3.3 Health facilitii 45 3.4 Health persuonnel 4 3.5 -. r-oXnOM tel health fctor 58 3.6 Agriculture projects 63 3.7 Ommity developmeat qejuts 65 3.8 DAClear schoola and steLte TI 3.9 Local comitV booed opaisation 17 3.10 ntkete and areas, of stiliatim 311 3.12. Mg.te8 locatiMoS fer dSAnitrstive Cetw eM sub-eeuters. X. rmwrcpOi A. Objectives and Nethodolo u 1. Objectives In Nbrch of 197 the oovemnaent of ulivia and WaI/B sponsored an assessment of the health sector involving *n evelzation of rural health services on a national scale by r. obert Le Moy. The assessment vas with a view tovords developing a better rural health delivery system. The evaluatioo pointed to 6 priority regions where a rural health system could be potentially developed. The folloving is an evaluation of one of these regions--the Vlle Alto and 'lle Peste of Ochabamba. For more details regarding the clate, gsaphy and other characteristics of the area, refer to Dr. Robert Le Bo's consultant report and the Health Sector Assessment Chapter II. The specific objectives of the survey ver to develop a regional survey Instrument designed to provide conplementary health planning Inormation to the Health Sector Assessment efrt, at the request of the Miniater of Nelthj to carry out the proposed sawvq; and to tabulate analyze, and interpret the data vf.th recommendations iateilift the positive and negative aspects repgxa-dg the potential development of ean integrated r I health delivery stes in the B e a YoLle Oeste of O~cbebo. Methodolog The nethodolov used in the Suw involved: 3) inteviewing representatives from (OB ad vlntary Institutions that have health related programs in the eres 2) visitlng rural communities in an effort to verwi the above informtion end gather editional date, end 3) utilize the services of our a Quechua speaking cholite in order to obtain informtlon reprding traditional health prectitioners. The detailed methodolog is presented in Appendix A. -3 3.Monthly R~eports (&@e s Dn.) C. Fulfillment of the Contract Lutie To Be llrlormed.o-pltetd Contract 1. Communities to be visited ho to 6o 61 2T5 2. IntervievS to be obtained 200 to 300 23 3. Institutional visits 15 to 20 4. tesicians survey 3D to 4o 53 and Of the 61 commmities visited, 1,were in the I "y the field 20 in the yI1L Sdg 220 people vere intervievwed during order visits, en 55 in conmection with the institatiocal surve'. In to visit ell to carry out the pbmicians survey it vm not necesary helpful in distri­ of the doctor since Dre. Btambaek ad Sabot vere A to­ buting and collecting the urvey forms from their colleagues. to the *j tal of 53 doctors participated in the survey. In addition coorduiting institutions visited, and ad-hoe later-institutional comittee was visited. D. DlefibitiOPS Por the purposea of thie report ve bave defiLne the terme listed below as oMS ,!a!derM: a parson w has a trditional outlook on edicime and diagnoses by readiM cards or coets leae. He usually cures vith herbs, b t in some cases my use drup. Porto: a nso who has learned to deliver babies through exper ence, end uses herb tes to faicilitate the bi'th., tr ining i delivering Midfe: a person who has" bed sore babies. In ost areas thee people ae calied mti-s as coziparod to go a Person -ho does dental vork, but does not have the quired training or titles. and injee- Snitariost a erson Lo admia'ters first-1i4 give tiom. Bow sale nurses prefer to "".llthemelves smnterios. Hgiene teachers are also considered to be saitarios. p~Mcewiticasi a perewon run a Pracy, gives prectriptionte, irJectioM amo consultations to his Clients. he OW0A'O of the parmolief UOlLlSr have "d"esin Peor 1w. f IGURE 1.-1 'DEPARTMFMT OF COCHARAMBA. WITH VALLE OESTE AND VALLE-ALTO .INDICATED I Kilometers *0 .. ar, N~~~r~rN. LTioto -. 2~..... ,~oMisqu 6. A. Aram Wuuuy -V*12* Oesto 1. Health Sector. s. Health fbcilitles. Qe"trom de sew Hospitale There i one Ceutdo de Solud isptal sponsored t' the Ministry of Health in the area, located in Ospinota. The utilization of the hospitel is very lov--tbe doctor sees about 3 petients a day# and the dentist I or R. The nurse and dentist complained about the lack of equipment and the poor facilities. There is no equip­ ment for emergencies, no ambulence, medical texts, or lab equip­ ment. The dental equipment is old and antiquated. Staff mccoam­ datlons are inadeTate. The greatest need of the hospital is an ambulance. Cepinote is 63 kilometer from Cehbabasbe, end in emergencies people aunt run all over the town looking fbr someone to take the sick person to Ooehabambe. The day ve visited COpinota both the doctor and one nurse had gone to Cochabmbe. Puestos Midicom The 4 Lestos lei" sponsored t7 the MWnistry of Health are 1s­ cated in QuilUacollo, Vinto, Sipe Sipe, and Arque. Mtilization is low for the &ustos the average being 50 patients a suath fbr Vintoj, Sipe Sipe and Arque. The 6octor in Qilaollo 5"s be soe T p­ tients a day. If this is t74, then the Puesto In QuillaoIlo he fbir'l good utilisation as conaxr to other al .f Ofton the 6o4toits estimate is bhow than the actuaL Waa of patlent vislts o-- .