The South American Chaco, a vast 1,280,000 km² territory shared by Argentina, Bolivia and Paraguay, is one of South America’s last agricultural frontiers. A semi-arid region, it has both a low population density and one of the highest rates of deforestation in the world. The 20 percent of the region that lies within Paraguay’s borders faces a variety of challenges. The population is dispersed throughout the territory in small settlements on the riverbanks of rivers. Road access and communications are challenging, especially in times of floods or extreme drought. For decades, the economic model, which is focused on the extraction industry, agricultural expansion and mining development, has had serious negative impacts on its natural assets and indigenous territories and communities, particularly impacting women. These issues further exacerbate the region’s limited access to healthcare services.
In early 2023, Paraguay’s Ministry of Health partnered with Pan American Health Organization/World Health Organization (PAHO/WHO) to launch a comprehensive effort to increase both access and coverage of maternal and child health in the region’s dispersed rural areas, indigenous communities and border areas. Funded by the India-UN Development Partnership Fund, the project contributes directly to the achievement of Sustainable Development Goal (SDG) 3, ensuring good health and well-being, specifically in the areas of maternal, neonatal and child health. The project will run through 2024.
It is an ambitious effort both in reach and scope. The project is designed to reach 64,305 inhabitants including 93 indigenous communities and is focused on four key areas: providing maternal and child healthcare services for those in dispersed rural, indigenous and border areas; reducing maternal and child mortality; enabling safe water systems, basic sanitation and hygiene in healthcare service centres; and coordinating with indigenous communities and cross-border informal health networks that participate actively in healthcare, with intersectoral and intercultural approaches.
In addition to providing equipment, furniture and basic supplies to the first level of care for healthcare centres and service providers, the project also includes capacity-building activities in remote areas to strengthen the informal health networks that actively participate in enabling access to women’s and children’s healthcare in indigenous and cross-border communities.
South-South cooperation plays an important role in both development and implementation. The project is guided by successful practices from the PAHO-implemented initiative, Hacia la Salud Universal de la población del Chaco Suramericano (Towards Universal Health for the population of the South American Chaco), a South-South initiative involving Argentina, Bolivia, Brazil and Paraguay, which brought to the forefront local practices on adequate and culturally appropriate care for obstetric and paediatric emergency and health services for women and children.
It also incorporates successful PAHO/WHO knowledge methodology that enables intercultural exchanges between groups or individuals and trained health personnel in order to improve access to health services and build culturally aligned health practices. An emphasis is placed on solving previously raised problems to enable access to care, as well as following suitable medical protocols and their causes, and with a strong focus on mutual understanding.
By safeguarding and integrating ancestral indigenous practices such as adapting delivery rooms for horizontal birthing (i.e. sitting, squatting, or standing) as opposed to the Western-oriented vertical birthing, as well as reproductive health practices, these projects are providing alternatives. They also strengthen the capacities of healthcare teams at hospitals and family health units (USF) on code red (with obstetric risk factors) in indigenous communities. Moreover, they improve health services networks for referral/counter-referral and epidemiological surveillance of maternal mortality.
The sharing of information in epidemiological surveillance will enable joint actions to control diseases with epidemic potential such as COVID-19, dengue and other arboviruses. The project will ensure an intercultural approach, strengthening the dialogue between health personnel and indigenous populations on health issues, including access to safe water in health services, among others.