Only days after the Bolivian Constitutional Court ruled that Evo Morales could run for a third consecutive term in 2014, on May 1, Morales announced USAID’s expulsion from Bolivian soil–another one of Morales’ efforts to decrease U.S. presence and influence in the country (he expelled the U.S. Ambassador and the Drug Enforcement Agency in 2008). Morales accused USAID of conspiring against the Bolivian government and explained that through the expulsion of USAID, the Bolivian government would be “nationalizing” the dignity of the Bolivian people. Since becoming president in 2005, Morales has been using May 1st (Bolivia’s Labor Day) to announce the nationalization of industries. For example, in 2006, Morales signed a decree nationalizing gas reserves in the country, and last year, Morales announced the nationalization of the electric grid. As it is, the people of Bolivia face a number of challenges to their health. According to the Bolivian Government’s National Development Plan (NDP), “57% of the population is excluded from access to health services, primarily in the rural areas of the altiplano and the valleys.” Exclusion has been based on economic, social, cultural, and geographic factors. In particular, Bolivia faces challenges in the areas of maternal health, child nutrition, and family planning. Also, Bolivia has experienced an increase in adolescent pregnancy to 18% and has one of the highest rates of sexually transmitted infections (STIs) in the region. Given that one of USAID’s focus areas had been providing greater access to health services to marginalized communities, USAID’s expulsion is likely to add new barriers to achieving health equity to Bolivia.
USAID had been operating in Bolivia since 1964, funding health, sustainable development, and environment programs. Its Health Program aimed at strengthening the health system and was designed to “explicit[ly] focus on the reduction of social exclusion from healthcare and [address] the need for equity of access and cultural acceptability.” Specifically, the Program worked to reduce the exclusion of “the rural, indigenous population from [the] health system.” The Program was designed to involve a variety of local stakeholders at both the national and international level. Such actors included the Ministry of Health, local NGOs that provide health and reproductive services to underserved communities, the Pan-American Health Organization (PAHO), and the United Nations Children’s Fund (UNICEF). According to USAID, since 2005, its work has yielded: “475,000 antenatal care visits have been provided by skilled providers trained by U.S. Government partners, 27,000 newborns have received essential care, approximately 150,000 children have benefited from USAID supported nutritional programs, nearly 50,000 people have received voluntary counseling and testing for HIV/AIDS, more than 340 municipal pharmacies were strengthened in commodity support and service provision, over 2.2 million couples have received family planning services.”
The Bolivian government has promised to fund the programs previously covered by USAID, yet many have already begun to close. Two organizations, Proyecto Comunidades Saludables (PCS) and Programa de Mercadeo Social (Promeso), have been forced to close now that USAID’s funding will cease. PCS received $14 million from USAID and focused on implementing public health policies in 57 low-income / rural municipalities, working within the local communities to instill preventive and healthy practices concerning sexual and reproductive health, maternal and child health, and tuberculosis. Promeso received $5 million from USAID and worked to increase access to contraceptives and lower maternal and infant mortality rates, as well as lower the prevalence of HIV/AIDS in the country. It subsidized eight products at the national level, of which, seven were contraceptives. For example, without such subsidization, a female condom would cost the end-user seven times more.
On June 1, only a month after Morales’ announcement, the Bolivian government launched a health program “Mi Salud” (“My Health”) in El Alto, a city outside of La Paz of approximately one million inhabitants of indigenous descent who live in extreme poverty. El Alto faces a number of health issues, including chronic malnutrition, increasing obesity rates, and lack of access to health care services. Mi Salud is intended to provide the population of El Alto with free preventative health care services that will be conducted through door-to-door visits. The program will receive support from the Cuban government through the assistance of 150 doctors, 150 nurses, and other technical staff trained in Cuban universities. If successful, the program intends to expand nationally.
In times when international assistance is being questioned by a number of recipient countries, the Bolivian government’s drastic moves are not too surprising. However, for the sake of all those in need of health, one only hopes that the Bolivian government has thoroughly weighed its options upon deciding to expel USAID from the country, that its new health program will be successful and sustainable, and that the government will be able to fill the gap that will be left by USAID. In short, the hope is that Morales is acting wisely to protect the well being of Bolivians and moving the country forward—not backward.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.