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March 19, 2015

Manual Empowers Bolivians to Take Health Into Their Own Hands
Created with JICA's cooperation, the guideline was distributed to practitioners throughout Bolivia

photoA guideline called “Local Education Guide for Healthy Living” with lots of illustrations for ease of understanding
photoMedical personnel carry out health promotion activities using the FORSA Method.
photoRural areas lack access to health services.

A healthcare manual produced with JICA's cooperation is playing a central role in promoting proactive health efforts among the largely poor rural population of Bolivia, who have lacked the interest and know-how to protect their own health, and also distrusted medical facilities.

Bolivia has a poverty rate of 45 percent, making it the most impoverished country in South America, and in its vast, low-population-density rural areas, many lack access to health services.

From Nov. 19 to 20, JICA and the Bolivian Ministry of Health held a workshop on a guideline called the Local Education Guide for Healthy Living at the Japan-Bolivia Technical School for Public Healthin the Cochabamba Department of Bolivia. About 62 health stakeholders from all nine departments of Bolivia participated. They learned the objectives of using the guide through theory and practice.

The guide covers 1. organizing stakeholders in the community, 2. analyzing issues and needs, 3. goal setting, 4. looking for solutions and prioritizing, 5. creating activity plans and 6. monitoring and evaluation.

For five years beginning in November 2001, the Japan International Cooperation Agency carried out the Project for Strengthening Regional Health Network in Santa Cruz Department in six cities, assisting with efforts to strengthen regional health systems. Based on Japan's experiences with regional health, this project conceived of and introduced what would later be known as the FORSA (Fortalecimiento de las redes de salud) method. It is a method of changing the consciousness of residents and improving their capacity to cope with and solve health issues by creating opportunities for talking about regional health issues.

Until then, residents' interest and abilities regarding health had been insufficient, and they had a low level of trust toward formal health facilities. However, in the regions where health promotion activities were practiced using this method, residents' health consciousness, their level of trust toward health facilities and their interest in community activities improved, and their awareness and actions were statistically demonstrated to differ from residents of regions outside the target area.

To disseminate this method, the project created the Guideline on Practicing Health Promotion Using the FORSA Method. The target area was then expanded to 30 cities within Santa Cruz Department and the project worked to make the FORSA method based on use of the manual practicable and to disseminate it. As a result, the mother-child health environment has improved. This includes the improvements of health check-up rate of children under 5 years old and the institutional delivery rate, which are linked to the maternal mortality rate and the mortality rate for children under 5 year old.

Separately, the Bolivian Ministry of Health in 2008 implemented its SAFCI (Intercultural Community Family Health) policy, which emphasizes indigenous peoples and communities, and positioned the proactive prevention of illness by residents as a pillar of it. For specific measures to use in this policy, the ministry looked to the Manual on Practicing Health Promotion Using the FORSA Method created by JICA. With the cooperation of JICA, the ministry created the Guide to Local Education for Healthy Living based on the FORSA guide. In October 2013, the guide was recognized by ministerial ordinance as a national guideline and its distribution to health service bureaus in all nine departments began.

However, for the Guide to Local Education for Healthy Living to be used in the field, not just distribution, but also an understanding of its purport and how to use it was essential for health practitioners in each department. That was the purpose of the aforementioned workshop.


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