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Bolivian-Healthcare

Although the Bolivian government’s new and improved universal healthcare plan has made a considerable dent in child and maternal mortality numbers, the plan still seems to be more suited for improving statistics than the lives of rural Bolivian women.

With one of highest rates of maternal and child mortality in the Latin America, second only to Haiti, Bolivia remains one of the worst places in the world to give birth, especially in rural areas. Mortality rates have historically totaled to 390 mortalities for every 100,000 live births in central cities (like the capital, La Paz), and reach as high as 887 per 100,00 live births in rural areas, according to UNICEF.

Beginning in 1994, Bolivian government officials centered in La Paz developed a series of free healthcare plans—or, more aptly, three free service packages—intended to keep mothers and children alive past the ordeal of childbirth. The most recent addition to these packages is the “Universal Maternal and Child Heath Insurance plan (SUMI).”

Upon its creation, SUMI was lauded as the symbol of iconic change of fate for Bolivian mothers. Targeted at pregnant women and children under the age of five, the program boasted that it would cover 500 common ailments. Additionally, SUMI was the first Bolivian public health program that did not come from a presidential decree, meaning that it would have longevity through congress even as presidential power shifted.

“The system was created to fight child mortality, to fight that economic barrier that prevented the mother from having proper attention from the start,” said Dr. Dante Ergueta, who works with SUMI at the Bolivian Health Ministry, in an interview with the U.K. Guardian. “It is an icon for Bolivia and I might even say for Latin America.”

Initially, SUMI managed to cut the alarming child mortality statistics. After its introduction, Bolivia saw reduction in infant mortality between 37.7% in urban areas. Even in rural areas, the program saw a 29.9% drop in infant mortality, which, although still less than the drop in metropolitan areas, represented a significant change.

However, the effects of SUMI have been blunted, if not entirely counteracted, since this initial drop.

The seeds for this decline can be found written into SUMI itself. According to a study done by Focal, SUMI’s plan to attack statistics was limited to quick fixes. Every service that SUMI provided was a double-edged sword, all of which left the deep roots of maternal health barriers in Bolivia untouched.

Where SUMI expanded the number of ailments covered by insurance, it also drastically tightened the program’s membership requirements, restricting it to women who had given birth within the past six months and children under the age of five. Previously, Bolivian health insurance had covered all women of childbearing age as well as the general population for endemic disease. SUMI cut the general public endemic disease coverage entirely, along with several family planning services for non-pregnant women.

Focal reports that “health indicators worsened after its [SUMI’s] implementation, particularly in rural areas. Inequity in health outcomes also grew because the services of high complexity that the SUMI plan made available in urban areas never reached the segment of the population [rural, indigenous communities] that needed them most.”

This “icon for Bolivia” is perhaps one of the most stark examples of one of the most common failures in public health: the rush to address startling statistics, instead of attacking underlying socioeconomic, or even cultural, gender-based problems.

According to UNICEF, Bolivian women exist in a culturally persistent subordinate role to men. Their rates of illiteracy are significantly higher, ranging as high as 37.91%, compared to 14.42% of men. This gap also drastically decreases the number of women who are capable of participating in the workforce, giving women less access to employment-based private healthcare options.

These socioeconomic and cultural forces show that the answer to improving Bolivian maternal health is more complicated than implementing a system of health-services handouts. It is not about the number of services the state can provide; it is about changing the situations of people receiving those services.

Emma Betuel

Sources: Unicef, The Guardian, ITG, WHO, Focal
Photo: Projects Abroad

Bolivian-Coca
Coca leaves have been consumed by natives in Bolivia for centuries. The native Bolivian population used coca to treat many medical conditions such as fatigue and altitude sickness as well as hunger and thirst. In many other countries, however, coca consumption is frowned upon and the substance is considered a narcotic.

When Pope Francis recently visited South America in early July, he drank a brew of chamomile, anise and coca leaves — an ancient South American elixir that wards off altitude sickness. This led to some stir on the internet regarding his consumption of coca.

Bolivia is considered a lower-middle-income country, where the gross national income in 2014 was USD $2,830 per person, according to the World Bank. Coca production in Bolivia contributes greatly to the economy and is a means of livelihood for many farmers. It is the second largest producer of coca leaves behind Peru.

During the 1980s, coca production and trade amounted to USD $1 billion in annual exports, according to analysis by the United States Library of Congress. That number is much higher today: in 2014, Bolivia’s GDP was $34.18 billion, according the World Bank.

There is, however, a dark side to coca leaves. It is the main ingredient used to process cocaine. Bolivia supplied over 15 percent of the cocaine that reached the streets of the United States in 1980s, making it a strong target of international criticism from Congress.

At the 1961 United Nations Single Convention on Narcotic Drugs, coca was outlawed and Bolivia’s use of coca was greatly limited and restricted. The treaty commanded Bolivia and other Andean nations to ban the consumption of coca leaves amongst their citizens.

In its natural state, the coca leaf is not scientifically harmful, and consuming it is a benign practice that is central to the cultural practice of millions of indigenous South American people. The treaty, however, declares that the exportation of coca is restricted; most countries outside of South America consider the trade and exportation of coca illegal, even in its natural state.

Bolivian prime minister Evo Morales held up a coca leaf at a U.N. narcotics assembly in 2012, defending the practice of chewing coca and urging the council to reconsider its stance on the leaf. He told the council, “Producers of coca leaf are not drug dealers; consumers of coca leaf are not drug addicts.”

But the outlawing of coca over 50 years ago has led to many continuous problems in Bolivia, including the illegal smuggling of coca paste throughout South America in order to process cocaine. The cocaine trail is a lucrative business that entices poor farmers to sell a portion of their crops to support their families.

Drug cartels hold citizens hostage, run prostitution rings and force violence wherever they are operating. In order to profit through the black market, It is in their best interests to see that nations do not work together to solve problems such as legal coca trade.

In 2011, the Obama administration rejected Bolivia’s proposed amendment to change the treaty and allow citizens to chew coca. A change in policy and cooperation between the United States and Bolivia would not only increase popularity among the nation’s people, but would also strengthen drug prevention efforts throughout the region.

The move would allow farmers to legally sell their goods, encouraging them to not trade their crops to drug traffickers. The sales would boost the economy of Bolivia and other South American countries, allowing more resources to be allocated to fighting the real violent criminals.

In turn, the United States would also get more cooperation from the Bolivian government, gain trust and better strategically combat cartels. Not all of the problems with drugs can be solved with a single policy, but together, by working to carefully reform international coca laws, the United States can help reduce poverty and illegal drug operations that are plaguing North and South America.

Adnan Khalid

Sources: About Coca Leaf, CNN, Library of Congress, The Guardian, UNTC, Washington Office on Latin America, World Bank
Photo: Indian Country Today Media Network

Energetica Supplies Energy Systems to Communities in Bolivia
According to a survey conducted by Energetica, a nonprofit organization located in Cochabamba, many citizens in Bolivia believe that the more energy they have, the better. Energetica is working to fight this misconception. Their mission is to provide equal energy to Bolivians and seek proactive ways to encourage a greater and more rational use of energy. To promote this, Energetica diversifies energy supply sources, provides efficient development for energy sources and utilizes renewable energy to contribute to environmental conservation.

Their vision is to improve the quality of life of disadvantaged Bolivians, increase productivity and preserve the environment. Some of their methods consist of training individuals for management and human resources roles, finding solutions through technology and innovation, and increasing access to energy for impoverished citizens.

Energetica was started on February 18, 1993 by now-Executive Director Miguel Fuentes Fernandez. The team is made up of a set of advisers, technicians and project managers who come together to create and implement projects throughout Bolivia.

They divide their work methods into four different programs. The first program focuses on developing access to energy to extend the coverage of energy services in rural and urban areas so that it can be used domestically and for community and productivity uses. They do so by looking at three different things: how energy is used in a household, how it is used in the community and how it can be utilized to create more energy.

They use municipal projects to gauge the average household’s energy consumption and then apply this information to help families obtain the access to the energy that they need to improve the quality of lighting, communication and cooking.

Project managers create projects to strengthen social infrastructure in order to improve health and education in rural areas. Lastly, to increase energy, Energetica promotes dedicating different energy sources—such as natural gases, biomass and solar energy—to productivity, harnessing it to optimize internal management mechanisms.

The second program focuses on sharing knowledge. To complete this project, they educate the residents of Bolivia through seminars, workshops and training sessions to teach them how to efficiently use and conserve energy. This ties into the third program, which involves meeting with citizens to become better informed about their demands. With this knowledge, they are able to help provide more energy and education where it is needed.

The fourth and final program involves strengthening institutions and companies. This program focuses on meeting with companies to train employers on energy-saving tactics, teaching them about the importance of sharing energy and evaluating their energy use. This helps keep companies and big organizations from overusing energy.

Right now, Energetica has projects happening all over Bolivia. In the last 15 years, they have successfully installed over 31,000 renewable energy components throughout the country. In addition, they have trained 70,000 citizens of Bolivia in energy conservation and knowledge sharing. The project will be continued until Bolivia is supplied with optimal energy.

Julia Hettiger

Sources: Energetica, Matador Network, Market Watch
Photo: Energetica

education in bolivia
Education in Bolivia appears to be lacking: one in every seven children in Bolivia does not complete primary school, and the majority of Bolivians never go on to secondary school. In fact, over one million Bolivians over the age of 15 are illiterate. This lack of education contributes to the overall poverty Bolivians face. What factors are contributing to this lack of education? Here are the top four:

    1. Classes are mainly taught in Spanish, but some children learned to speak Quechua and Aymara at home. Many children, especially those from rural areas, cannot understand what is being taught. Being taught a second language in school is also not typical. It is easy to see why kids would become discouraged and decide to drop-out.
    2. Due to widespread poverty and not prioritizing education, schools can be very run-down with little to no proper classroom materials. While there is a lack of resources in Bolivia in general, schools are ranked at the bottom when it comes to addressing the country’s needs.
    3. The poverty in Bolivia also affects the teachers—they often go on strike to protest for higher wages and other related issues. This leaves children without teachers for sometimes days or even weeks at a time.
    4. The primary reason for a child not being in school and the shrinking literacy rate in Bolivia is poverty. Children in urban areas are able to go to school on average for 9.4 years, while those in rural locations only make it on average for 4.2 years. Many children have to work and help support their impoverished family rather than go to school.

Some changes to education in Bolivia have been made, however, with the help of nonprofits. Many organizations have helped provide classrooms and classroom materials in decent condition. One organization, the Foundation for Sustainable Development, helps provide training, tutoring, childcare and workshops to assist Bolivians with their educational needs. When given support and better learning conditions, children typically stay in school and even begin to learn at higher levels than their peers who are not given that support.

If their educational needs are met, they are more likely to succeed. Bolivian children should receive the education they need to thrive.

– Melissa Binns

Sources: Bolivia Bella, Foundation for Sustainable Development
Photo: Netpublikationer

Education in BoliviaThe history of Bolivia is a clear representation of how education can be used as a tool for maintaining political control.

Education in Bolivia was first formalized by Spanish-speaking Europeans who colonized the Iberian states occupying present-day Bolivia. In order to keep power from returning to the indigenous people after the liberation of these Iberian states, Bolivians of European descent used education as a tool to eradicate indigenous languages, traditions and ultimately, identity.

They believed they were “remaking Indians into productive peasants” and wanted to integrate them into campesino culture so that it would grow dominant over the indigenous culture. Education in this context was used as a method of control and subordination; it promoted prejudice against any language or culture that differed from that of the hegemonic group.

The schools set up for these indigenous groups did not teach its students traditional subjects such as arithmetic, reading or social studies. Instead, they focused on agriculture and pushed literacy to the edge of the curriculum. Reading and writing was assumed to be useless for people meant to work the fields—even potentially dangerous. In a world where knowledge is power, the ruling class knew that literacy among the working class would only undermine their authority.

The revolution of 1952 changed the power structure in Bolivia and eventually led to the redevelopment of the education system.

A new education act unified all people under one system, taking the place of the previous system where the working class and upper class had separate schools. However, students were only taught in the national language from that point on—a change that was intended to help integrate the indigenous population into the national Spanish-speaking culture, but instead further marginalized them. Indigenous children forced into Castellan-taught classes could not understand their teachers properly and often dropped out. Furthermore, teachers were poorly trained and classes often focused on memorizing rather than practical learning.

The result of these educational practices is a Bolivian population that is only 50 percent literate and an elite educated minority. It is estimated that 70 percent of the rural populate and 30 percent of the urban population are illiterate.

However, this is not necessarily a result of lack of funding. Bolivia devotes 23 percent of its annual budget to educational expenditures—a greater investment than most South American countries usually spend. The problem more likely has to do with lack of effective spending, to which the Bolivian government has responded by decentralizing spending on education in order to meet the diverse needs of local communities.

Since 1994, this decentralization has significantly improved dropout rates. More children are going to school across the nation; however, schools still seem to be lacking in quality teachers and relevant curriculum. This can be observed by the high rate of secondary school graduates who want to attend university but must take an entire year’s worth of extra courses in order to bring their knowledge up to speed with international standards.

Bolivia still has a long way to go in terms of improving its education system in order to substantially increase literacy rates and to help its students acquire the skills needed to lift themselves and their families out of poverty.

– Shenel Ozisik

Sources: FOCAL, Journal of Intercontinental Communication, Foundation for Sustainable Development
Photo: Lab

Combatting Malnutrition Bolivia
Malnutrition is devastating Bolivia, with over 75 percent of households lacking access to basic food items. Conditions are much worse in the indigenous and rural communities, especially among children and pregnant women. Almost a quarter of Bolivian children suffer from hunger, while one in three children under the age of five suffers from stunting—a result of chronic malnutrition. Bolivia has the second highest stunting rates in Latin America and the Caribbean, indicating the urgent need for food security solutions.

Furthermore, among women of childbearing age, nearly 27 percent are considered so anemic that they are at risk of passing iron deficiency to their unborn children. Anemia is often the result of poor dieting, which in certain parts of Bolivia is based on cheap carbohydrates such as rice and other starchy foods high in fat.

In response to this long-standing reality, the Government of Bolivia established a National Zero Malnutrition program in 2006 to combat severe malnutrition among the most vulnerable populations. The nonprofit organization Action Against Hunger has taken on parts of the plan and has aimed to provide long-term food security and agricultural support while strengthening the healthcare system to better serve children who are chronically malnourished.

By working closely with local communities, Action Against Hunger is able to propose alternative methods to deal with seasonal hunger, including diversifying livelihood options, promoting diet diversification and ensuring affordability of more nutritious foods.

In addition, the organization has provided sustainable solutions for Bolivia’s ongoing drought problem. In 2010, the country was facing a severe drought that caused widespread water scarcity and staple crop damage. Action Against Hunger immediately secured water supplies for over 50 communities, while also helping over 4,000 farmers retool their destroyed harvests. Moreover, the team is working on community-based agricultural projects in Rio Grande’s lower basin, and other areas prone to drought, by promoting techniques that maintain soil moisture and avoid soil destruction. Some methods include demonstrating proper crop rotation techniques and teaching ways to overcome livestock overgrazing. These projects are already making great strides in combating malnutrition in Bolivia and are paving the way to a healthier and more prosperous country.

Leeda Jewayni

Sources: FSD International, IADB, Action Against Hunger
Photo: BCPS

child labor
In a legal decision, Bolivian officials have changed the legal working age from 14 to 10, thereby becoming the first nation to legalize child labor.

Despite provisions for children who are working at such a young age, including their being supervised by a parent if they are under the age of 12 or that they must continue school, the legalization of child labor still violates the minimum working age protocol declared by the International Labor Organization. It is still “‘an abandonment of a child’s right to a childhood.”

Moreover, the Guardian reports that there are only 78 child labor inspectors and over 800,000 currently working. The promise that the child protection requirements for these new labor laws will be consistently upheld is unlikely.

Co-sponsor of the bill and deputy Javier Zavaleta told Time Magazine that he supported the bill in the hopes that it would help decrease the amount of poverty in Bolivia. He said that “extreme poverty is one of the causes, not the main one, of child labor, so our goal is to eliminate child labor by 2020. While it is ambitious, it is possible.”

Human rights activists, however, find it suspect that these officials are trying to justify child labor by claiming it will ultimately end child labor.

Children’s rights advocacy director at Human Rights Watch, Jo Becker, told Time Magazine that “child labor perpetuates the cycle of poverty” and that “the Bolivian government should invest in policies and programs to end child labor, not to support it.”

Becker also explained that when children from poor families are sent to work instead of school, they are more likely to end up with low-wage jobs later in life, thus continuing the cycle of poverty and the misconception that child labor will help end it.

– Jordyn Horowitz

Sources: The Guardian, Forbes, TIME
Photo: VNews

Bolivian_Income_Gap
Bolivia is the poorest country in South America. It possesses the largest ratio of indigenous people, who make up 62 percent of the population. Most of these indigenous groups suffer from poverty—over 74 percent are poor. The indigenous groups also make up most of the rural areas, where the greatest amount of poverty in the region is found. The unemployment rate remains high, with 8 percent of the population without jobs, increasing poverty in rural areas.

Bolivia’s income distribution is one of the most uneven in the world, ranking second in unequal income distribution. The land is rich in minerals and resources, but the elite Spanish ancestry dominates the economic system. Most Bolivians are low income farmers and traders. There has been long running tension over the rich natural gas resources by exploitation and export, which continues to strengthen the Bolivian income gap.

Social unrest in Bolivia is growing with the tax reform. The inflation rate is controlled by the tax reform and causes more tension within Bolivia’s economy. These issues in the economic system are creating poverty that affects groups like the indigenous people. Poverty can lead to inequality, which limits human rights and mobility through different strata of class, causing a separation of income.

Throughout history, indigenous people have been the poorest and most excluded from social economic growth. Access to basic health care and necessities is limited due to isolation. The high fertility rate among the indigenous people of Bolivia has increased their population to over 5 million people. The increase is so drastic because of the lack of access to education and health care needs.

Bolivia sees the highest rate of child malnutrition, particularly among indigenous cultures. World Vision estimates that over a quarter of the children under the age of five are malnourished and do not have access to proper health care.

Recent organizations, like World Vision, have formed local centers in Bolivia to help monitor the well-being of these children. This includes the implementation of training for local health care workers to bring awareness to kids to stay safe from different forms of child maltreatment.

 

Causes of poverty.

 

Most of the women living in rural areas have limited education or training for employment. There is also a lack of health services and education in the health sector for women. This restricts the growth of the economy by preventing these women from bettering their futures and the economy.

The rural areas continue to suffer from poverty. With the deficiency of natural resource management and limited approach to technology in rural areas, infrastructures such as roads will be neglected. Without the proper road system, isolation of indigenous groups will increase, causing lack of job opportunities and access to education.

These regions of Bolivia are facing obstacles in the economic development in many of the indigenous groups. The advancement of these obstacles relies on policies to protect the economic growth in the rural regions, where indigenous groups reside, and to help increase labor productivity.

— Rachel Cannon

Sources: BBC, UNICEFGeorgetown University, World Vision
Photo: Next Starfish

Bolivia Minimum Wage
In the wake of recent national economic gains, Bolivian President Evo Morales has promised that the nation’s minimum wage will increase by 10 percent.  The move is a hotly debated one concerning Bolivian unions, and the employer federation has been embroiled in the debate for some time.  The labor unions applaud it, saying it would equalize things between the “haves and have-nots,” while the Confederation of Private Entrepreneurs (CEPB) spurned it and contended that it would increase taxation.  A BBC report also notes that President Morales is in an election year and may have had political reasons for siding with union wishes.

The same BBC piece also points out that “Bolivia’s gross domestic product tripled to $27 [billion] in 2012 since Mr. Morales took office in January 2006, according to World Bank figures.”  Changes to the national Constitution and increasing the role of the state contributed to the gains, along with “high commodity prices and a prudent macroeconomic policy.”  The World Bank also states that public debt dropped vastly, bolstering the banks in the process and alleviating national poverty to a great degree.

However, despite the gains nearly half of all Bolivians still live in poverty.  The unpredictability of commodity pricing can affect and potentially reverse positive gains, so private industry must play a more substantial economic role.  Bolivia’s informal economy, where a large portion of the population finds work, “results in lower productivity” according to the World Bank.  Lagging infrastructure is also a deterrent to further and faster progress.

The International Monetary Fund (IMF) is projecting slower economic growth in Latin America in 2014.  “Weak investment and subdued demand for the region’s exports held back activity in 2013… For 2015, the IMF projects a modest pickup, to 3 percent. The key risk is a sharper decline in commodity prices caused by weaker demand.”  More specifically, growth in Bolivia “is projected to fall sharply in 2014, to about 2.75 percent  from nearly 6 percent in 2013.”

President Morales may be trying to draw support from his political base with his pledge to increase the Bolivian minimum wage.  In 2013, Morales was publicly inveighed when per diems paid to the families of Morales and his vice president were worth “more than twice the minimum monthly wage,” according to an AFP report.  The money covered travel expenses when the families accompanied the leaders on official trips.  Political rival Adrian Oliva likened the per diems to stealing and contended that Morales had abandoned his socialist roots.

The science behind hiking minimum wage rates is contentious to say the least, often crossing the proverbial bridge from impartial observation to political overtones.  However, the work of UC Irvine economist David Neumark and William Wascher of the Federal Reserve Board can’t be easily disputed.  A Forbes report said they “determined that 85 percent of the best research points to a loss of jobs following a minimum wage increase.”  Empirically, the wage increases aimed at eliminating poverty also quash private sector employment and hiring; a study in the Journal of Human Resources posits that higher minimum wage can increase poverty.

What lies ahead for Bolivia and the rest of the Latin American region remains to be seen as outside economic forces control the commodity rates that are so woven into recent economic gains.  In a race for political power and reelection, Bolivia’s Evo Morales has evidently chosen to adhere to the populist vision that won him initial favor, but at what cost?

Do large-scale informal economic gains qualify as a national victory when nearly half of all Bolivians are still considered poor?  Does alienating the private sector through a push for more reforms mean greater prosperity and long-term economic growth and stabilization?  What is clear is empirical evidence suggesting that minimum wage hikes do more harm than good, even in a strong commodities market.  President Morales may be best served to explore other options that appeal not only to national unions and workers but to the firms who employ them, thereby increasing private investment and paving the proverbial road out of Bolivian poverty.

– Dave Smith

Sources: BBC, WorldBank, Free Malaysia Today, Global Post, Forbes
Photo: Interet General Info

Bolivia_Raises_Minimum_Wage
Following recent labor union protests in Bolivia, demanding an increase in the minimum wage, President Evo Morales has acquiesced to their demands by increasing the Bolivian minimum wage 20 percent from 1,200 Bolivianos (around $175) to 1,488 Bolivianos (about $215). This increase in the minimum wage has come as a result of a small but concerted effort on behalf of the Bolivian Central Labor Union to agitate for change. Workers were concerned that their wages were not keeping up with inflation, which is currently sitting at 6.5 percent.

Morales explained the reason for the increase in the minimum wage is the economic growth Bolivia has experienced recently, which grew at a rate of 5.2 percent in 2012.

The leader of the Bolivian Central Labor Union, Juan Carlos Trujillo, stated that he asked Morales to recognize “the need and the obligation to create a salary structure which is based on the country’s growth and the recognition that the riches of Bolivia have to be shared between the haves and the have-nots in equal measure.”

Other groups were not so pleased with the announced rise in the minimum wage, saying that the move would simply result in workers paying more through taxes. Moreover, the move can also be seen as political maneuvering and as an attempt to curry favor amongst the workers in time for presidential elections in October, when Morales is going to run for a third term.

The original proposal by the government was for the minimum wage to be increased by 10 percent, until trade unions negotiated a higher rise. Analysts have noted that the increase in the minimum wage would not affect the majority of workers since most people earn above 1,400 Bolivianos (about $203.) The rise would affect house workers and trash men.

Morales himself was a notable leader in the cocalero trade union movement for indigenous coca growers prior to being elected president. Since being elected president in 2006, Morales has helped triple Bolivia’s gross domestic product to $27 billion.

– Jeff Meyer

Sources: La Razon, BBC, Bolivia Information Forum
Photo: Nation of Change