#Interview: Dr. Franz Trujillo, Coordinator of Bolivia’s Intercultural Community Family Health Program


Implemented as of 2011, the Community and Intercultural Family Health Program revolutionized the health policy in Bolivia, with a special focus on participatory management and the articulation between health personnel and traditional doctors of indigenous peoples. Its Coordinator, Dr. Franz Trujillo, tells us about the impact of the program and the importance of strengthening human resources to address the principle of interculturality.

Since 2006, Bolivia has been implementing important changes in its health policy, which has led to the creation of SAFCI. What are its main lines of action and what impact on the health of the Bolivian people could you highlight?

The transformation of a totally care focused system was necessary. The implementation of the health policy of the Plurinational State (SAFCI) incorporated the principles of Primary Healthcare and has as fundamental pillars: Integrality, intersectoriality, Interculturality and Community Participation.

The SAFCI has two components: Comprehensive and intercultural care based on actions to promote health, prevention and treatment of diseases in a relevant, timely, efficient and efficient manner, through the acceptance, respect and appreciation for the feelings, wisdom, knowledge and healthy practices of the population within the framework of interculturality.

It incorporates Health Promotion as its main strategy, with emphasis on the preventive approach, through family visits and with the intersectoral actions of the Social Determinants of Health, from the local level up to the higher decision levels.

The other important component is Participative Management and social control, which is recognized in the Political Constitution of the State and strengthens the social structure in health allowing for the interaction and coordinated decision-making.

As an example of impact, through the Mi Salud Program, the infant mortality rate has been reduced from 54 to 24 per 1,000 live births; the neonatal mortality rate dropped from 27 to 15.

Nine out of ten pregnant women are treated in health facilities during childbirth by health personnel. Chronic malnutrition in children under two was reduced from 25.1 to 15.2%. These actions guarantee access to health care.

Social participation is one of the pillars of SAFCI. How is this reflected in the practice of the program? What advances would you highlight in that context?

Social participation is one of the fundamental pillars of the SAFCI policy, and a Social Structure in Health has been established in the local level of each community. It has a representation in each Health Establishment, Municipality and Department. These are active participants in the different meetings of analysis in health, in the planning of actions, in decision-making and in joint actions aimed at modifying social determinants of health, within the framework of intersectoriality.

This social structure is duly recognized from its bases, that is, according to uses and customs that base health management activities and the epidemiological surveillance.

A fundamental factor in any health policy is the strengthening of human resources. How is awareness raised among the medical personnel for integrative and intercultural practices and what strategies do you use to retain these professionals?

In our country in the year 2007 a medical specialty has been created in the social clinical area called Family Community and Intercultural Health. This specialty is included in the National Medical Residency System, whose training includes a whole process of capacity building and raising awareness, within a framework of interculturality and decolonization. The idea is to create suitable Human Resources in Health, with a holistic vision, that currently manage the Mi Salud Program. Up until now, we have trained a total of 492 Specialist Physicians SAFCI. The Ministry of Health has so far incorporated these new specialists into its structure.

As of 2006, around 5000 general practitioners with the expertise of PHC have been trained in the Cuba and Venezuela. They were gradually incorporated into the health system to work together with the SAFCI specialists. These professionals receive an update training on the SAFCI policy.

The so-called SAFCI specialists have among their functions to be tutors of the “Permanent Education Course in SAFCI Policy”, aimed at health professionals and technicians from both the MI SALUD Program and those already in the conventional health system. In this activity, the SAFCI Policy is shared among students and plans of action for its implementation are created.

How can the health sector and, specifically, the SAFCI help to achieve the Good Living, as established in the Sectorial Plan for Integral Development for Living Well – PSDI?

The SAFCI Policy addresses 2 main pillars of the Sectorial Plan. Health Promotion, based on the focus and transformation of the Social Determinants of Health that, along with Education for Life, individuals, families and communities become aware of all those factors that damage their Health. An analysis is carried out at all levels of management and behavioral changes among families is generated out a respectful dialogue. This is also true to universal access to health, in which geographical, economic and cultural barriers are broken, prioritizing human resources and improving the resolution capacity of establishments in places whose families did not have the possibility of accessing a health service, promoting the free care and seeking an interpersonal and intercultural relationship.

Finally, one of the pillars of UNASUR and the bloc’s Health Council is the promotion of intercultural health policies, which is a distinctive feature in our region. How do you think the bloc can contribute to promote, as a region, policies that are based in interculturality?

Support in strengthening Human Resources is very important to be able to adequately address the interculturality principle. I am talking about creating spaces to exchange these experiences with the main actors that have to do with Human Resources; in the academic training of medical careers, and with the health personnel of the ministries so that, through policies, not only in health, the topic of interculturality is incorporated.

Read the other articles of Health to the South – April issue