Challenges

Latin America is experiencing one of the world’s highest growth rates of chronic kidney disease (CKD). Paraguay, in particular, has a high prevalence of the disease. In recent years, the country has seen an increase in risk factors for kidney disease, resulting in an increase in patients in the National Renal Health Program of the National Institute of Nephrology and increased admissions of people in kidney dialysis. This has a significant budgetary impact on public health, especially when treatments such as dialysis and kidney transplants are required. Paradoxically, chronic kidney disease can be easily diagnosed with a routine laboratory test, which is very inexpensive. If detected early, the aforementioned complications can be avoided.

With the increase in demand for specific treatments, such as dialysis, inhabit- ants of areas of Paraguay that border Argentina often seek those treatments from health institutions in Argentina, generating health migration practices and causing uprooting and greater social vulnerability of this population. Given these circumstances, working towards strengthening capacities for the prevention and care of kidney patients in the Paraguayan public sector can improve this situation, helping to resolve inequity in access to kidney health services.

Toward a Solution

This project Strengthening Capacities for the Prevention and Care of People with Kidney Disease, led by the National Programme for the Comprehensive Approach to Kidney Diseases (PAIER) of the Ministry of Health of Argentina, seeks to train Paraguayan health professionals in different specialties in the prevention, early diagnosis and care of kidney disease. With the objective of contributing to SDG 3.4 (reduce mortality from non-communicable diseases and promote mental health), the project aims to reduce premature mortality from non-communicable diseases by one-third through prevention and treatment. The Argentine Fund for International Cooperation (FO. AR) developed this project within a framework of bilateral cooperation between Argentina and Paraguay.

The target group of the project is medical and health professionals in Paraguay, including doctors, nurses, biochemists, nutritionists, psychologists, social workers, kinesiologists, dentists, physical education teachers, health promoters and health agents.

The project, jointly developed by the Ministries of Health of Argentina and Paraguay, focuses on preventive actions for kidney disease and its risk factors, promoting early detection and thus helping to prevent kidney deterioration. It aspires to strengthen the work of the National Institute of Nephrology of Paraguay and establish the problem of kidney diseases and their possible prevention in the public sphere, encouraging patients to undergo tests for early detection.

To carry out this project, the following strategies are used: application of guidelines for the detection of kidney disease; training of human resources for the prevention, diagnosis and timely treatment of kidney disease; and training in Argentina of surgeons from Paraguay on making vascular access for chronic dialysis.

With the COVID-19 pandemic, the work strategy was re-conceived, and in 2021, 100 health professionals from different locations in Paraguay were trained virtually through the course“Promoting self-management in people with chronic diseases and non-communicable diseases. ”This training provided tools to health personnel so that they could educate kidney patients not only about risk factors that cause kidney disease but also about self-management of the condition. This training contributed to the sustainability of the project. The virtual nature of the training made it possible to train more professionals than expected, not only from one city, but also to expand to different locations in the country. What ?s more, the target group was diversified and expanded, incorpo- rating primary health care professionals.

In 2022, to finalize the project, 500 openings were granted to carry out two additional virtual courses. Also, field training activities will be carried out for the preparation of arteriovenous fistulas for general surgeons at the Julio Perrando Hospital, in Resistencia, Chaco Province, Argentina.

The positive preliminary results of the project and the degree of adherence and interest of the trained health personnel demonstrate the potential of this activity to be applicable to other regions and countries with similar demands.