Difficulties hit Bolivia's programme for pregnant women

Abstract

For The Lancet paper on maternal mortality see Lancet 2010; 375: 1609–23 1 year after Bolivia introduced a social programme to reduce the country’s high maternal and child mortality rates, hundreds of thousands of women and children have benefi ted from the initiative but an array of teething problems, logistical bottlenecks, and a lack of resources continue to mar its progress and prevent its widespread implementation. The conditional cash transfer programme known as the Juana Azurduy stipend, off ers cash payments totalling US$260 to pregnant women paid in instalments on condition they attend regular prenatal and postnatal check ups until their child is 2 years, and have a skilled attendant present during birth. Bolivia’s health ministry hopes the initiative, which is a signature policy of the leftist government of Evo Morales and a declared state priority, will reduce maternal mortality rates by roughly half by 2015. With 290 maternal deaths per 100 000 livebirths in 2009, according to government data, Bolivia has one of the highest rates in the Americas. Last year, nearly 350 000 women received cash payments, says the government, whereas the number of pregnant women visiting clinics on any day, particularly in and around the capital La Paz, has more than quadrupled. But although the cash transfer programme has encouraged preg nant women to see a doctor and prevent potential pregnancy-related complications, there are substantial diffi culties in its implementation. “The Juana Azurduy [conditional cash transfer scheme], combined with the implementation of the SAFCI Health Delivery Model, could bring about some positive change in the indicators mentioned above, including maternal mortality. For that to happen, it will be important to overcome the administrative bottlenecks that have been aff ecting the scheme so far”, said Jaime Nadal, the UN Population Fund’s (UNFPA) representative in Bolivia. In recent months, Bolivia’s local press have draw attention to diffi culties facing the programme, including the fi ring of some 20 offi cials (some of whom were national directors) in what has become a highly sensitive and politically charged issue.