Bolivia

Bolivia, and its dramatic Andean landscape, is home to 9.8 million citizens, two-thirds of whom are engaged in subsistence farming in remote areas and live below the poverty line. Even though health care is universally guaranteed in Bolivia, access to services is a constant challenge—particularly in rural areas nestled in or between mountains.

For more than 20 years, EngenderHealth worked in Bolivia to improve both availability and quality of reproductive health services by:

• Expanding contraceptive options
• Making motherhood safer
• Involving men as partners
• Implementing management techniques that lead to better services

Expanding Contraceptive Options
Through the ACQUIRE Project, funded by USAID, EngenderHealth worked to improve the availability and quality of a range of contraceptive methods. Highlights include:

• Providing technical assistance to Bolivia’s Ministry of Health in developing and updating national norms, protocols, and standards for family planning services
• Developing medical curricula on family planning methods, and counseling and clients’ rights
• Working with local partners to provide technical training to health care networks in the eastern lowlands of Bolivia
• Providing training for health workers as part of Nur University’s master’s degree in public health

Making Motherhood Safer
EngenderHealth worked with partners to ensure that emergency obstetric care is available where needed and that referral networks are functioning well. To ensure the best maternal health care, EngenderHealth’s activities included:

• Mobilizing community participation in health care and encouraging families to better prepare for routine births, recognize warning signs during pregnancy, and use local resources to transport women to health facilities
• Improving provider skills in basic and emergency obstetric care

To improve women’s access to postabortion care, EngenderHealth trained doctors and midwives at health centers in six districts to provide comprehensive postabortion services. We also encouraged the integration of postabortion care into routine maternal care services.

Masculinities: Involving Men As Partners 
EngenderHealth's Men As Partners® program—known as "Masculinities" in Latin America—addressed gender norms in an effort to promote sexual and reproductive health. We trained health care providers to introduce reproductive health services for men. In addition to strengthening health services to meet men’s reproductive health needs, we also held workshops in communities on male and female sexual health, gender roles, HIV and other sexually transmitted infections, relationships, and sexual and domestic violence.

Improving the Quality of Reproductive Health Care
EngenderHealth introduced and integrated quality improvement approaches to Bolivia’s health care system. Our hands-on workshops trained local health care providers to use COPE® and facilitative supervision—two quality improvement tools that help health care staff identify and resolve problems on their own. We also worked with providers in clinics nationwide to ensure clients’ rights to respect, dignity, and confidentiality.