DESCRIPTION AND IMPACT EVALUATION OF A MODEL COMMUNITY-BASED PRIMARY HEALTH CARE PROGRAM IN MONTERO, BOLIVIA Public

Abstract

DESCRIPTION AND IMPACT EVALUATION OF A MODEL COMMUNITY-BASED PRIMARY HEALTH CARE PROGRAM IN MONTERO, BOLIVIA

By Hilary S. Moshman

Background:Community-Based Primary Health Care (CBPHC) has been identified as the optimum strategy to achieve desired reductions in under-five mortality. However, such programs are, at present, more the exception than the norm, and awareness of their potential is lacking in the global health field. More research on the effectiveness and methodology of CBPHC and dissemination of results are needed. Only then will countries, donors, foundations, and individuals increase their support

Objective: This paper examines a model CBPHC program in Montero, Bolivia, called Consejo de Salud Rural Andino (CSRA), and its utilization of the Census-Based, Impact Oriented (CBIO) principles. The development and current program of CSRA is described in order to share best practices and describe how community-based care is linked with facility-based care. This paper also assesses the change in infant and under-five mortality from 1990 to 2009 to assess the potential impact of CBPHC and those which use CBIO principles so that such programs may be further developed and scaled up.

Methods: Data on the history and description of the current program and the CBIO principles were gathered from literature and on the ground through observation, informal interviews with program staff, and formal interviews with key informants. Mortality data from the target population was gathered from CSRA records to assess the trend in infant and under-five mortality over the past 19 years.

Results: Annual infant mortality and under-five mortality in the CSRA service area declined by over 90% from 1991/1992 to 2009. Infant mortality declined from 54 in 1991 to 5 in 2009; under-five mortality declined from 96 deaths per 1000 live births in 1992 to 6 in 2009. The difference between the CSRA infant and under-five mortality rates at the beginning of the program and the rates at the end of the program are statistically significant at the conventional level.

Discussion: While it is likely that the decreasing infant and under-five mortality rates over 22 years is the result to the CSRA program, it cannot, without a control or comparison area, be proven beyond a reasonable doubt.

Table of Contents

CONTENTS

Chapter 1: Introduction. 1

Problem Statement 2

Purpose Statement 3

Research Questions. 4

Significance. 4

Chapter 2: Literature Review... 5

Introduction. 5

Evaluation of CBPHC Programs. 6

Criteria for Selection of Literature for This Review... 7

Jamkhed Comprehensive Rural Health Project, Jamkhed, Maharashtra, India. 13

Society for Education, Action and Research in Community Health (SEARCH), Maharashtra, India. 15

ICCDRB Maternal and Child Health--Family Planning Program, Matlab, Bangladesh. 17

World Relief Child Survival Project, Mozambique. 20

World Relief, Light For Life Child Survival Project, Cambodia. 22

Community Health and Family Planning Project, Ghana. 24

National Primary Health Care, The Gambia. 26

Hospital Albert Schweitzer, Haiti 29

Conclusion. 35

Chapter 3: Methodology. 37

Research Objectives. 37

Population. 37

Procedures. 38

History. 38

Qualitative research. 38

Quantitative Research. 42

Chapter 4: Results. 44

Census-Based, Impact-Oriented Principles. 44

History. 47

Establishment of Program... 47

Villa Cochabamba Health Center 48

Household Visitation. 50

Cruz Roja Health Center 52

Distrito 2 Health Center 53

Health Insurance. 54

Information System... 55

CSRA Relationship with Government 56

Current Program... 58

Health Centers. 58

Program Components. 59

Regular Public Meetings. 60

Sources of Funding. 61

Most Effective Strategies. 61

Challenges. 63

Quantitative Results of Impact 67

Infant Mortality. 67

Under- Five Mortality. 67

Maternal Health. 67

Chapter 5: Discussion. 72

Strengths. 72

Limitations. 73

Chapter 6: Conclusion. 74

Recommendations and Implications. 74

APPENDICES. 77

Appendix A: Definition of Terms. 77

Appendix B: Question Guide for Key Informant Interview... 78

Appendix C: List of Table….. 87

WORKS CITED... 88

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	under-five mortality Bolivia infant mortality primary health care impact evaulation community child survival
Committee Chair / Thesis Advisor	Foster, Stanley, Emory University Perry III, Henry Baker, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta)

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