Case Studies on Leaving No One Behind

33. Strengthening treatment of congenital heart disease in Bolivia through triangular co-operation between Argentina, Bolivia and Germany

Natalie Bartelt

Ekatherine Murillo

A high incidence of heart diseases among new-borns in the highlands of Bolivia leads to a high infant mortality rate

Congenital heart disease is the most common birth defect, with an incidence ranging from 19 to 75 per 1000 live births (Mendis, Puska and Norrving, 2011[1]). This incidence is more important in the highland regions of Bolivia, a fact that affects infant mortality in the country. In Bolivia, 24 babies out of every 1000 live births die before the age of one, giving the country one of the highest infant mortality rates in Latin America.

Reducing infant mortality is a priority of Bolivia’s 2016-2020 National Economic and Social Development Plan and Sector Health Plan. So far, Bolivia has focused on the prevention and care of traditional medical threats, such as infectious diseases. Significant advances have been made, but the anticipated results are yet to be achieved.

A triangular co-operation project to share Argentina’s expertise in detecting and treating heart diseases

The triangular co-operation project aims to strengthen the healthcare network and decentralised health services in Bolivia and reduce infant mortality by focusing on paediatric cardiology. It is aimed at the population with the fewest economic resources and no access to healthcare, following the ‘leave no one behind’ principle of the 2030 Agenda.

This project sits within the framework of the Regional Fund for Triangular Cooperation in Latin America, which was set up by the German Federal Ministry for Economic Cooperation and Development (BMZ) in 2010.1 In this case, Argentina is the South provider, Germany is the traditional provider and Bolivia is the beneficiary. The countries are jointly involved, complementing each other with their experiences and competencies to achieve a shared goal. Argentina has advanced furthest in the detection and treatment of heart disease and now shares its technical expertise and experience with other countries in the region. Germany is co-operating bilaterally with Bolivia in governance, decentralisation and health issues and is assisting with processes and project implementation.

The following results have been achieved or are expected:

• The project partners have written and validated a Congenital Heart Disease Care Guide for timely detection of the disease. A range of national, departmental and municipal institutions are actively involved, including the Ministry of Health, Departmental Health Services-SEDES, relevant national scientific societies, Hospital de Niños of La Paz, specialists in paediatrics, neonatology and paediatric cardiology, cardiovascular surgeons, intensive care neonatologists and primary healthcare physicians.

• More than 100 health professionals have received theoretical and practical training in awareness and detection of congenital heart diseases.

• The project identified and helped overcome infrastructure and equipment deficiencies in hospitals in prioritised areas.

• A technical study is being developed to provide the Bolivian Ministry of Health with general guidelines for designing and implementing a national congenital heart disease programme.

• The project will help establish a departmental registry of congenital heart diseases that provides systematic and reliable information on the incidence of heart disease.

High commitment and ownership by a broad range of actors is key to success

An overarching success factor of this project was the determined participation and ownership of the broad range of actors involved, from the Bolivian Ministry of Health to health organisations at the departmental and municipal level.

The project partners, working with the Bolivian Ministry of Health, the Hospital del Niño of La Paz and other Bolivian, Argentinian and German stakeholders, developed a training plan to help health personnel develop competency in detecting congenital heart disease. Staff of the Hospital del Niño led the theoretical-practical training process, which was based on the Care Guide mentioned above. Interactions between healthcare personnel and different healthcare and specialisation levels strengthened the reference and counter-reference system between the specialised establishments and less specialised healthcare centres.

Combining capacity development with the provision of equipment to health facilities in two prioritised areas gave the trained health professionals the necessary tools to apply their newly acquired knowledge for the timely detection of congenital heart disease.

What next?

The triangular co-operation project will conduct a second phase of training for health professionals who carry out home visits. This should increase the early detection of congenital heart disease in newly born children from low-income homes. Furthermore, the project will initiate a process of registering patients to establish a database of accurate information on the incidence and prevalence of heart disease. There are also plans to finalise the technical study that will establish general guidelines for a national programme to tackle congenital heart diseases.

When the project ends in 2019, an external evaluation will assess the results achieved and their sustainability.

Reference

[1] Mendis, S., P. Puska and B. Norrving (2011), Global atlas on cardiovascular disease prevention and control, http://www.who.int/cardiovascular_diseases/publications/atlas.

Note

← 1.  More information about the Regional Fund for Triangular Co-operation in Latin America and the Caribbean is available here: www.giz.de/en/worldwide/11821.html