Committee: World Health Assembly

Topic: Healthcare System of BOLIVIA and BOLIVIA 's position on Malnutrition and
Stunted Growth, Premature Mortality, HIV, Migrant Workers Occupational Health & Safety,
Suicide and Substance Abuse.

Country : Bolivia
Delegate: Nisrina Khairunnisa

The health system consists of multiple public and private sector entities that perform
different functions such as leadership, financing, insurance, procurement, and health care
delivery. The public sector includes a public subsector and the short-term social security
subsector (10). The public subsector primarily covers the population not insured under any
entities of the Short- term Compulsory Social Security. Law No. 475 on Comprehensive Health
Services is the main social protection policy covering the health of children under age 5,
pregnant women, older adults, persons with disabilities, and women of childbearing age (for
delivery of sexual and reproductive health services).The private subsector includes for-profit
entities and nonprofit ones (such as churches and nongovernmental organizations) that provide
health services. There is an incipient market of private insurers providing health coverage.
Finally, Bolivian traditional medici1ne is an important component of the Sector, and in the past
decade it has been recognized and coordinated with the National Health System.

1. Malnutrition and tunded growth

The findings of this study have both methodological and policy implications. With regard to
methodology, this paper is the first to study socioeconomic inequality in childhood malnutrition
in the developing world using recently introduced WHO child growth standards. It was found
that, although average malnutrition is higher when using this reference population, esti mates
of socioeconomic inequality are fairly similar to those derived using the NCHS reference
population. In addition, the analysis demonstrated that, when studying the association between
average malnutrition and the concentration index, it is important to take into account the
dependence of this index on the mean value of the binary malnutrition indicator. When this
was done, there was no clear relationship between average malnutrition and socioeconomic
inequality.
2. premature Mortality
In 2010, laboratory confirmed cases were reported, 1of which was fatal. Neither had been
vaccinated against yellow fever. The first case occured during epidemiological week 6 (7-13
february) in a 19 year old farmer. The probable place of infection was the municapality of palos
blancos in the tropical region of the departement of La Paz. The second case occured during
epidemiological week 10 in a 40 year old male, a french citizen residing in the country. He
probably acquerid the infection in the pilon lajas reserve located in tropical area.

3.HIV
In 2014, the estimated prevalence of HIV carriers was 1.5 per 1,000 population. As of
December 2014, 13,180 cases had been reported, with 19% in the AIDS stage. However, due
to estimated 17.6% underreporting of cases, there may be 16,000 people with HIV/AIDS (24).
Transmission is mainly sexual (96%), with 3% vertical transmission and 1% blood
transmission. In 2014, there were 116 AIDS cases per million population. The prevalence of
HIV that had not reached the AIDS stage was eight times greater than the prevalence of AIDS.
The distribution of reported cases was 1.7 times higher in men, and more than half of the
population with HIV/AIDS was between 20 and 34 years old. In 2014 2,510 cases of HIV at
the AIDS stage were recorded, with 86.9% located in the central part of the country: Santa
Cruz, Cochabamba, and La Paz. In 2007, the prevalence of chlamydia was 10.5%,
trichomoniasis 4.6%, syphilis 2.6%, and gonorrhea 0.5%. Syphilis affects 7.2% of pregnant
women, and 11 per 1,000 newborns

4. Migrant workers occupational healthy&safety

The global profile presented here shows that there are more than 59 milion health workers in
the world, distributed unequally between an within countries. They are found predominantly
in richer areas where health needs are less serve . their bers remain woefully insuficcent to meet
health needs, with the total shortage being in the order of 4.3 million workers.
5. Suicide
Although there is a shortage of epidemiological data in bolivia, it is clear the impact of alcohol
adldiction in p1sychiatric admissions, domestic violence and traffic accidents. Violence against
woman and suicides are important issues to be tckled. Among to proposed strategies to afford
human resources for mental health in bolivia, “task shifting”, the delegation of tasks to improve
mental health care.

6. Substance Abuse
Much of the cocaine abuse in bolivia involves the use of cocoa base or “basuco”, a partially
refined from of cocaine that contains residues of toxic chemical such as gasoline or kerosene.
It is highly addictive and very damaging to the user’s health. Young people in urban areas often
abuse cocaine byproducts in a cigarette from called “pitillo”.
Ironically , a former bolivian president wa arrested in august 2010 for possession of pitillos
and was admitted to a drug rehab center for treatment. But for the average citizen, drug
treatment is virtually nonexusteint. With widespread societal ills such as malnutrition and
infant mortality, addiction treatment falls lower on the list of national prioritis.

Noteworthy among health policies is the plan to set up a Unified Intercultural

Community and Family Health System (SAFCI). Since 2015 Bolivia has deployed 2,710
primary care clinics throughout the country, providing access to primary care to 25% of the
most vulnerable population. The focus is on prevention, early diagnosis, and the social
determinants of health, and includes the direct participation of grassroots organizations. In
addition, the Zero Malnutrition Multisectoral Program uses a intersectoral partnership with the
ministries of social services and the economy to operate in the municipalities most vulnerable
to food insecurity and risk of malnutrition among children under 5 (especially those under 2
years of age)
Solution topic
 First, caregivers may have followed the advice of feeding children with more
recommended micro- and macro-nutrients (such as iron-rich animal protein) without
having received the message of eliminating other unwanted components from their diets
(such as sugars, white flours and excess fats). Therefore, projects of nutritional
counseling to households should consider not only advising on what should be done
but also on what should not be done.

 Second, caregivers may have felt pressured to “show the child’s progress” by monthly
weight and height monitoring, focusing on the variable that is most easily influenced in
the short term, from one visit to the next: weight. Therefore, it is recommended to
consider eliminating child measurements from home visits and instead to train health
center staff to make more precise measurements a part of regular health checkups.

 Third, in many cultures in Latin America and the Caribbean, the notion that “a chubby
child is a healthy child” prevails. The Aymara population of the city of El Alto in Bolivia
is probably no exception. To counteract the cultural and social value of weight rather than
growth in size that is much slower and harder to perceive, nutritional counseling projects
for indigenous populations could explore the use of the latest playful, creative and
culturally relevant socio-educational methods (such as puppets, theater, songs or poems
based on local characters and legends) to convey more effective and positive messages
about the size of children.

Topic 2:
Health determinant & inequalities
The environment and human security
Health conditions and trends
Health policies,system, and social protection
Knowledge,tekhnology, and information
Etc

Topic 3:
Language,education and cultural barries
The private character of the workplace
Social exclusion
Confinement & isolation
Topic 4 :
How to speread HIV
Stay away from alcohol & drugs
Have safe sex
Never share needles or syringes

Topic 5 :
Look for professional help
Talk about your thoughts immediately to people you trust
Get closer with god

Topic 6 :
Check up
Detoxtification
Stabillitation
Rehabilitation