The Government of Bolivia is taking its commitment to universal health coverage seriously by ensuring indigenous populations’ participation in decision-making and planning processes for health, along with improved access to quality health services.
The meaningful inclusion and engagement of indigenous populations in health policy planning, taking into account the social determinants of health, is critical to ensure context-specific interventions, uptake of guidance and services, and positive health outcomes for all.
Social participation in planning processes has been strengthened across Bolivia, with leaders from 64 indigenous communities reaching an agreement with municipal and departmental authorities and health personnel on advancing a health improvement plan for the most vulnerable populations.
Social participation in health is a mechanism that brings decision-making closer to the communities, and the Ministry of Health and Sport of Bolivia is implementing structural changes at community, departmental, and national levels to ensure indigenous voices and knowledge are part of policy processes.
“It is very important for the community to be able to help solve their health problems and have a say when discussing health issues. They express their needs and then their requirements for care can be met. We know that what is needed is coordination and joint planning across the health sector.”
"We cannot modify geographical conditions, but in recent years we have improved telecommunications and electricity, and also receive monthly visits from health personnel."
"Today, communities, social movements, and civil society are exercising their right to obtain health for all. It is an achievement that we have this space to carry out our activities."
"The active participation of indigenous communities through their health representatives, health authorities, and operational network personnel allows us to identify problems and make legitimate decisions for the benefit of our communities."
“This participatory and intercultural model which decentralizes decision-making on health and empowers indigenous people to claim their right to health is a huge step on Bolivia’s pathway to achieving universal health coverage. As Bolivia’s indigenous population takes greater control over the promotion and protection of health, the country will see impressive health outcomes in the future.”
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Rocio Lazcano is an indigenous leader and President of the Social Health Council in the Department of Pando in Northern Bolivia, an area of rainforest that borders Brazil. She is passionate about ensuring the health of the indigenous population by advocating and representing the needs of the community.
“It is very important for the community to be able to help solve their health problems and have a say when discussing health issues. They express their needs and then their requirements for care can be met. We know that what is needed is coordination and joint planning across the health sector,” said Rocio.
Bolivia’s indigenous native persons make up over 40 percent of the country’s population. They often live in remote and rural areas and face particular health challenges such as an increasing prevalence of diabetes and cancer, as well as high rates of teenage pregnancy. In some areas, 50% of girls under 16 are pregnant, and all are at risk. Poor health outcomes are influenced by unhygienic water supplies, inadequate waste management, hard-to-reach locations, lack of transport for outreach health workers, and precarious health facilities.
For the past 25 years, Bolivia has undergone a process of political and administrative decentralization that has brought decision-making closer to the population. As a result of these changes, indigenous people now have more opportunities to participate in decision-making about their health.
"We cannot modify geographical conditions, but in recent years we have improved telecommunications and electricity, and also receive monthly visits from health personnel," said Mr Rafael Guzmán Zelada, a local leader from Yuracaré village, located in the Cochabamba Tropic region. Rafael was chosen by his community to act as a community health leader. His role is to represent indigenous and native peoples in decision-making processes. He is one of the hundreds of indigenous people now involved in health planning and policy-making, influencing how his community can access health care.
Community participation to reduce health inequities
The Ministry of Health and Sports of Bolivia formulated the community participation process within a policy known as Family and Community Intercultural Health. This policy seeks to ensure the right to health guaranteed by the State, as well as the elimination of social exclusion in health and the reduction of cultural barriers that prevent people from accessing health services.
The Pan American Health Organization/World Health Organization (PAHO/WHO) through the Universal Health Coverage (UHC) Partnership has supported the Ministry of Health and Sports of Bolivia in this endeavour since 2021. This technical support has been provided in three main areas: strengthening institutions to enable social participation, advocacy to extend participation, and operationalizing structures and decision-making.
The UHC Partnership operates in over 125 countries, representing over 3 billion people. It is supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO.
Strengthening institutions to enable social participation
Thanks to support from PAHO/WHO, Bolivia formed the National Social Health Council Board with representatives from its 9 departments, including from social organizations and indigenous populations.
Representatives from community levels cascade upwards to form Departmental Social Health Councils, which are convened by the National Social Health Council. PAHO/WHO prepared planning documents for the activities of all the Councils. Members of these Councils participate in planning, monitoring, and evaluation of health services and their decisions feed into the Municipal Operational Plans and budgets.
In 2023, PAHO/WHO supported the formation of 4 Departmental Social Health Councils in Oruro, Cochabamba, Beni, and Pando. The support also enabled the Departmental Social Health Council in Santa Cruz to organize meetings of 56 municipalities with the Indigenous Confederation of Original Peoples of Bolivia. This body represents 36 different indigenous peoples of the eastern, Chaco, and Bolivian Amazon regions.
"Today, communities, social movements, and civil society are exercising their right to obtain health for all. It is an achievement that we have this space to carry out our activities," said Mr Mario Ojeda Kama, President of the Departmental Social Health Council, Santa Cruz.
Advocacy and collaboration to extend participation
PAHO/WHO provided technical support to improve advocacy capacities, technical cooperation, and the creation of strategic planning spaces. This resulted in the elaboration of the National Social Health Council and the Departmental Social Health Council work plans. The National Social Health Participation Regulations were also updated, which expanded participation and included the consideration of social aspects such as approaches to address gender and patriarchy. The specific notion of indigenous health was positioned on the government's agenda, and participatory management in health at the departmental level was improved.
Operationalizing structures and decision-making
With technical support from PAHO/WHO, the Indigenous Health Network was created to discuss issues such as the right to free health care, to culturally appropriate health services, and to incorporating the use of traditional medicine. As part of this network, indigenous communities shared their concerns and proposed solutions.
Dr Keyla Ávila, Coordinator of the Indigenous Health Network, led the Information Analysis Committee and recognized the importance of this mechanism for improving health management in the region and for indigenous native communities.
"The active participation of indigenous communities through their health representatives, health authorities, and operational network personnel allows us to identify problems and make legitimate decisions for the benefit of our communities," said Dr Ávila.
Indigenous organizations were clear about their requests. They wanted free and equitable access to health care, an improved indigenous health network, incorporation of traditional medicine, and the consideration of the indigenous population’s culture, customs, and practices. Leaders from 64 indigenous communities reached an agreement with municipal and departmental authorities and health personnel to advance a health improvement plan for the most vulnerable populations.
Many of the solutions that the indigenous representatives proposed will be addressed through the Family, Community, and Intercultural Health Policy. Interventions include promoting greater health and community participation in health and awareness raising, information, and education on topics such as sexual and reproductive health, healthy eating, and the recovery of ancestral knowledge.
One immediate achievement was that the Health Analysis Committee decided to organize a comprehensive medical brigade comprising specialist doctors such as pulmonologists, internal medicine, gynaecology, paediatrics, and psychology in the community of Bía Recuate of the Yuqui village. This brigade aims to provide comprehensive medical care, screening, and treatment covering a total of 250 people at the municipal level.
“This participatory and intercultural model which decentralizes decision-making on health and empowers indigenous people to claim their right to health is a huge step on Bolivia’s pathway to achieving universal health coverage. As Bolivia’s indigenous population takes greater control over the promotion and protection of health, the country will see impressive health outcomes in the future,” said Dr Alma Morales, the PAHO/WHO Representative to Bolivia.
Health security
Bolivia has demonstrated its commitment to strengthening health security by participating in various global health preparedness efforts. In 2021, the country conducted an Intra-Action Review (IAR) to evaluate its response to the COVID-19 pandemic and identify areas for improvement. Building on these insights, Bolivia further bolstered its health emergency response capacities by carrying out a Simulation Exercise (SimEx) for the vaccination plan for pandemic influenza vaccines and other respiratory viruses with pandemic potential in 2023.
These exercises have been critical in refining Bolivia’s preparedness strategies and ensuring that the health system is equipped to handle future pandemics and public health emergencies. Through these continued efforts, Bolivia is laying the foundation for a more resilient public health system that can effectively address both current and future health challenges.
You can find more information by visiting the Strategic Partnership for Health Security and Emergency Preparedness (SPH) Portal: https://extranet.who.int/sph/.
