Challenges

In Bolivia, the COVID-19 pandemic has served to expose structural weaknesses, such as the reduced capacity of the health system, the poor targeting and limited reach of social protection programs, etc. Similar to what happened in other countries, the pandemic has tested the Bolivian health system´s capacity to respond to the needs of the population in a comprehensive manner. The high demand of ICU services for COVID-19 patients who need to be connected to a ventilator has resulted in the collapse of such services. Therefore, many patients in need of oxygen were not able to receive treatment in a timely manner.

Toward a Solution

In response to the increase in oxygen therapy in COVID-19 patients, the Government of Bolivia has developed a plan to increase access to oxygen. With PAHO/WHO support, the plan allowed the search for successful experiences, and there were good practices identified in the neighboring country of Peru. There was also a great level of commitment for the transfer of knowledge by the Peruvian authorities.

The South-South Cooperation between Bolivia and Peru seeks to increase coverage and access to oxygen therapy in patients with COVID-19 in the first and second level of care, preventing complications, reducing the need for high numbers of ICU referrals. By expanding the coverage of oxygen therapy services, complications and preventable deaths of patients with COVID-19 were avoided and catastrophic expenses were alleviated for low-income families who had been resorting to high-cost private services.

The Bolivian Ministry of Health, through the PAHO/WHO country office, took knowledge about the Peruvian experience and contacted their counterparts from the Peruvian Ministry of Health, who deployed a strategy to expand the availability of medicinal oxygen and improve the coverage of oxygen therapy services. The agreements were carried out through a mission to Peru led by the Vice Minister of Sanitary Management of Bolivia.

To reach this objective, two actions were developed: first, competencies in non-specialized healthcare staff in high flow oxygen therapy were created through the transfer of knowledge and good practices of the Ministry of Health of Peru, through the National School of Public Health (ENSAP); second, Oxygen Therapy Centres were established in first and secondary level of care, close to families and communities.

To begin implementing the Oxygen Therapy Centers, PAHO/WHO made an initial donation of 160 oxygen concentrators and complementary equipment, such as pulse oximeters, and the emergency import of liquid oxygen. In turn, the Ministry of Health of Bolivia, to make the intervention sustainable, took on the acquisition of high-flow oxygen therapy equipment and the installation of oxygen production plants, allowing the sustained and sustainable coverage of this service in the face of a new increase in COVID-19 cases.

In total, training in oxygen therapy techniques reached more than 3,000 healthcare staff from the first and second level of care in Bolivia and 20 Oxygen Therapy Centers were installed, with the number to increase with the equipment that is being acquired by the Bolivian State.

These actions contributed to the achievement of SDG 3.8 (Universal Health Coverage), which includes access to essential medicines, such as medicinal oxygen. It also made it possible to strengthen the country’s capacity to manage risk in the face of the pandemic emergency.

The fatality rate for COVID-19 decreased from 6.2 percent in the first wave to 2.7 percent in the third, showing a better management of the pandemic, partly due to the greater coverage of timely oxygen therapy services.