Currently, Bolivia has the lowest ranking health system of any Hispanic country in the Western Hemisphere. At 69 deaths for every 1000 births, it holds the highest infant mortality rate of any nation in South America. For decades, Bolivia’s quality of life has been brought to its knees by the alarmingly low level of sanitation. Recent governmental response has initiated developments that have vastly improved the health of many urbanites. Extensive research demonstrates that, while the small class of wealthy urban citizens receive some degree of regular medical care, the overwhelmingly vast population of rural poor has largely been neglected.
The indigenous population, composed of native Bolivians of 36 recognized groups, reside primarily in the rural highlands of Southern Bolivia. They make up about 85% of the Bolivian population, yet are at a higher risk of mortality in every scenario. Less than a quarter of the indigenous population has access to clean water due to the geography of the Bolivian highlands, where malaria and Chagas’ disease runs rampant. In addition to the especially low quality of sanitation in rural regions, no formal medical clinics have been established. Patients are, therefore, required to travel fatal distances to urban areas for medical treatment. Physically, the indigenous people of Bolivia are at a disadvantage in their heightened exposure to lethal bacteria and communicable diseases. Due to their widespread location, routine illnesses such as diarrhea and pneumonia prove deadly. Geographic isolation also means that rural women have essentially no access to contraceptives or obstetric care, which is reflected in the incidence of early and multiple pregnancies among indigenous people. Additionally, the maternal death ratio is quadrupled in rural areas.
Although the Bolivian government has responded through multiple programs to revitalize its suffering health care system, such efforts have done little to alleviate the struggle of Bolivia’s rural majority. The Strategic Health Plan, instituted in 1997, aimed to lower infant and maternal mortality rate and reduce the financial barrier to medical treatment. In the past decade, immunization coverage and birth survival rates have improved gradually, but have been primarily limited to the urban elite who can afford coverage. The few rural initiatives that have been established have been hindered by low funds, medicine shortages, and a lack of staff willing to work in the highlands.
In the midst of decentralizing health care, one of the most vulnerable groups of Bolivians has been left stranded by their nation’s social security. Unfortunately, this crisis is a reflection of a financially struggling government, which can do little in the face of such a challenge. The solution lies in potential efforts of NGOs to institute a more cohesive system to deliver efficient health care to the Bolivian highlands. Rather than focusing on availability for sporadic emergency, a system must be developed to address regular physical examination to sustain the health of indigenous citizens. The establishment of equipped emergency medical centers in remote areas of the country is no doubt ambitious, which highlights the need for regular health check-ups and more uniform knowledge of basic medicine. Prior initiatives have demonstrated the effectiveness of instructing indigenous people on sanitation defenses and alternative pharmaceutical solutions. Bolivia’s recent initiatives have been successful in urban centers as their programs rely on the large population size and geographic convenience. Thus, the solution for aiding the indigenous population must be shifted toward an expansive effort of delivering regular medical supplies to villages and offering instruction on daily health and well-being so as to minimize the need for emergency room visits.
By Christopher Medrano