Prevention of child mortality in Bolivia through Triangular Cooperation

Infant deaths as a result of congenital heart disease can be prevented through the strengthening of institutional and public health capacities for better diagnosis and treatment, contributing to Good Health and Well-being (SDG 3) in the Ibero-American region.

Since 1999, the World Congenital Heart Disease Day is celebrated on February 14th. Congenital heart disease is a condition, usually prenatal, which affects babies’ heart normal development. According to the World Health Organization (WHO, 2020), one in 33 infants worldwide has congenital heart disease. However, thanks to different innovative technologies, preventive diagnoses can be made which, together with prenatal care and the required treatments, can make the difference and prevent future complications.

According to Revista Hitos —a magazine that provides information on German cooperation in Bolivia and Paraguay—, cases of congenital heart disease in the Andean country have annually increased and “the probability of being born with heart disease doubles” in higher regions. The estimated annual number of Bolivian children born with congenital heart disease reaches between 2,500 and 3,000 cases” (2020, p.5).

In response, the Ministry of Health of the Plurinational State of Bolivia, together with Germany and Argentina, have implemented the project “Consolidation of the pediatric care network and capacity building in infant cardiology, as a decentralized healthcare model. A contribution to the reduction of childhood mortality rates (COTRICI by its Spanish acronym)”.

The objective of this initiative, which implementation was estimated from 2016 to 2020, was focused on capacity strengthening in pediatric cardiology through the optimization of healthcare networks and the decentralization of pediatric services. According to the project’s Evaluation Report, 2 lines of action were defined to achieve this goal: on the one hand, institutional development to manage healthcare networks for the timely care of congenital heart diseases in a coordinated manner; and, on the other hand, strengthening pediatric heart care, improving the capacities of healthcare professionals from a preventive approach (Durán, D. and Peres, J. 2021, p.10). Thus, the measures promoted by this project in these two lines of action included both the strengthening of pre-existing capacities in Bolivia and the promotion of new ones, such as:

  • Systematizing information from healthcare centers of the prioritized networks.
  • Developing clinical care regulation.
  • Capacity strengthening for the detection and care of congenital heart disease.
  • Implementing the detection of congenital heart disease.
  • Setting up the Coordinating Center.
  • Developing a system to register newborn screening for the detection of congenital heart disease (2020, p.4).

This project, which contributes to the alignment of Ibero-American cooperation with SDG 3 Good Health and Well-being, was the result of joints efforts made by Argentina (first provider), Bolivia (recipient) and Germany (second provider). In this regard, since 2010, the southern country has been implementing the National Congenital Heart Disease Program, through which in 2016 more than 1,800 free surgeries were performed throughout the country on children who suffered from congenital heart disease and had no formal health coverage in cardiovascular centers (Garrahan Pediatric Hospital, 2017). GIZ, in turn, provided technical and financial assistance to its Ibero-American partners and Bolivia, in line with its own needs and guidelines, made its institutional framework and experience available for the proper implementation of this project. As a result, the project had the following outcomes:

  • Diagnosis of the current situation of human resources, infrastructure and equipment related to heart care in healthcare centers of the two prioritized health networks.
  • Provision of equipment to 24 healthcare centers of the prioritized networks.
  • Congenital heart disease care guidelines, booklet for the detection of congenital heart disease by oximetry, algorithm and form for early and timely detection of children with this pathology.
  • 300 physicians trained to identify, care for and/or refer these patients and 5 healthcare professionals trained in Argentina.
  • A Congenital Heart Disease Coordinating Center has been set up at the Ministry of Health.
  • A registry of congenital heart disease has been implemented, according to different levels of care (2020, p.6).
February 2022

Source: Durán, D. and Peres, J. (2021), Garrahan Pediatric Hospital (2017), (WHO, 2020), Revista Hitos (2020).

Photograph: Omar Lopez in Unsplash