Academic journal article Journal of Health Population and Nutrition

Impact of a Community-Based Comprehensive Primary Healthcare Programme on Infant and Child Mortality in Bolivia

Academic journal article Journal of Health Population and Nutrition

Impact of a Community-Based Comprehensive Primary Healthcare Programme on Infant and Child Mortality in Bolivia

Article excerpt


Approximately, 10.5 million children aged less than five years die each year in less-developed countries, mostly from readily-preventable or treatable conditions (1). Child-survival programmes that emphasize immunizations, prevention and treatment of acute respiratory infection and diarrhoea, growth monitoring, and appropriate infant-feeding continue to be recommended strategies for reducing the number of these deaths (2). Although such child-survival programmes usually undergo periodic review, these evaluations are rarely published in the scientific literature, and they usually focus on process and coverage indicators rather than on impact mortality.

Results of the few published evaluations of primary healthcare programmes that assessed the impact of mortality suggest that substantial improvements can be achieved. Reductions in infant or child (<5 years) mortality ranging from 10% to 78% have been documented within 5-20 years after implementation (3-18). Many of these published evaluations are retrospective in nature, lack comparison or control groups, or lack a full description of the methodology used (19,20). Given the global importance of the problem of infant and child mortality and the growing level of resources being directed at this problem, additional well-conducted impact evaluations of child-survival efforts are needed (19).

The present study examined the impact on infant and child mortality of a community-based comprehensive primary healthcare programme carried out in two rural regions of Bolivia, South America. We use the term 'comprehensive' to emphasize the fact that these primary healthcare programmes provided more than child-survival interventions. In fact, these programmes provided a broad range of preventive and curative care services for all age groups in the entire population that they served, with an emphasis on maternal and child health.

The programme was implemented by two Bolivian non-governmental organizations: Consejo de Salud Rural Andino (CSRA) and Asociacion de Programas de Salud del Area Rural (APSAR). Andean Rural Health Care (ARHC), a U.S.-based private voluntary organization (PVO) receiving support from PVO Child Survival Program of the U.S. Agency for International Development, provided financial and technical assistance. For the sake of simplicity, we will refer to ARHC as the overall implementing organization. Since the time of this study, ARHC changed its name to Curamericas.


Study areas

Data from four health service areas were compared in this paper (Fig. 1). In two areas--Carabuco and Mallco Rancho--ARHC had been coordinating health services since 1983 and 1987 respectively and are, therefore, referred to as intervention areas. Data gathered from January 1992 to December 1993 in these two intervention areas were compared with those from two geographically-adjacent areas--Ancoraimes and Sipe-Sipe. In April 1992, ARHC began the initial stages of establishing health services in Ancoraimes and Sipe-Sipe. During that time, ARHC worked with a sub-sample of the communities in these areas to carry out censuses and prospectively gather vital statistics.

Carabuco and Ancoraimes are located on the Bolivian altiplano (high plain) and are inhabited by Aymara Native Americans living in small isolated rural villages. In addition to being geographically adjacent to one another, Carabuco and Ancoraimes are very similar in socioeconomic terms (Table 1). Mallco Rancho and Sipe-Sipe are also contiguous and very similar in socioeconomic terms (Fig. 1 and Table 1). These are located in the mountainous valley region of Bolivia and are inhabited by Quechua Native Americans living in small, semi-rural villages. Inhabitants of all four health service areas maintain a subsistence life-style based primarily on agriculture and domestic livestock production.


Censuses and assessment of mortality

Village maps were prepared in collaboration with local residents, houses were numbered, and each resident was enrolled in a census. …

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