Challenges

The Chaco Paraguayan region faces major barriers to equitable maternal, neonatal, and child health services. Its vast territory, low population density, cultural diversity, and remoteness hinder effective service delivery, especially for Indigenous communities affected by poverty, exclusion, and limited access to basic services like clean water, sanitation, and education. Migration, environmental challenges, and cross-border dynamics with Brazil, Argentina, and Bolivia further complicate health planning. Key issues include adolescent and unplanned pregnancies, poor-quality prenatal care, limited family planning, and insufficient follow-up for newborns and children. Health services often lack cultural relevance, and preventive care awareness is low.  

The project tackled these challenges by strengthening local health systems, fostering intercultural approaches, and leveraging South-South Cooperation (SSC) to enhance cross-border collaboration and knowledge exchange. This good practice demonstrates how coordinated, culturally sensitive, and regionally integrated strategies can improve health outcomes in underserved and complex territories. 

Toward a Solution

To address the multifaceted challenges of healthcare delivery in the Chaco Paraguayan, the UN-India project implemented a comprehensive, intercultural, and regionally coordinated strategy rooted in South-South Cooperation (SSC). The initiative focused on improving maternal, neonatal, and child health outcomes in remote Indigenous and rural communities across four municipalities in three departments—Boquerón, Presidente Hayes, and Alto Paraguay. 

 The project’s solution was built on five strategic pillars: strengthening health infrastructure and services, enhancing human resource capacities, promoting intercultural community engagement, improving environmental health conditions, and fostering cross-border cooperation. The initiative aligns with Sustainable Development Goal 3, prioritizing maternal, neonatal, and child health in underserved areas. 

 Key Achievements: 

1. Expanded Maternal and Child Health Services: 
   A key innovation was the reorganization of local health networks through the ‘microrredes’ (micro-networks), which integrated local, regional, and national health actors Three micro-networks in Boquerón, Mariscal Estigarribia, and Carmelo Peralta were reorganized. Regional hospitals and health centers received equipment and supplies. The National Plan of Human Resources in Health was revised to address staffing needs in the Chaco, improving access to maternal and child healthcare. This decentralized model ensured that services were adapted to the specific needs of each community, including Indigenous populations. 
2. Reduced Maternal Mortality: 
   Capacity building was central to the project’s success. Training programs like Families Fuertes and Obstetric Code Red reached 1,118 health professionals. A new National Obstetric and Neonatal Care Simulation Center was opened, and 90 Indigenous health promoters were trained and equipped. Paraguay’s first guidelines for empirical and Indigenous midwives were developed. Committees for mortality surveillance were reactivated, and SIPPLUS helped improve data use for better care. Health facilities were trained and monitored, and three vans were delivered to improve outreach to remote communities. 
3. Improved Water and Sanitation Infrastructure: 
   Water safety plans were drafted with multi-level government input. Water treatment plants were installed at health facilities in Irala Fernández, Campo Aceval, and Virgen de Fátima. SENASA and DIGESA supported water system and waste management improvements. Health facilities were registered in the national waste registry, and staff received training in hospital waste management. These efforts ensured that health facilities met basic hygiene and sanitation standards, critical for safe childbirth and infection prevention. 
4. Community Engagement and Intercultural Health Promotion: 
   Coordination meetings were held in Boquerón, Alto Paraguay, and Presidente Hayes with Regional and Local Health Councils. Local health action plans were created with community input under the Healthy Municipalities Strategy in districts like Mariscal Estigarribia and Teniente Irala Fernández. These platforms enabled dialogue between health authorities and Indigenous communities, ensuring that interventions were culturally appropriate and community-driven. 
5. Stronger Border Health Services: 
   One of the most impactful aspects of the project was its emphasis on cross-border cooperation. Through SSC mechanisms, Paraguay engaged in bilateral and trilateral exchanges with Brazil and Argentina. A notable example was the bilateral agreement between Carmelo Peralta (Paraguay) and Porto Murtinho (Brazil), which aimed to reduce the reliance of Paraguayan citizens on Brazilian health services by strengthening local capacity. Similarly, missions to Argentina facilitated the exchange of experiences and data on border health initiatives, enhancing regional coordination. 

Strategic Coordination and International Cooperation: 
The project ensured strong inter-institutional coordination, engaging all levels of the Ministry of Public Health and Social Welfare, municipalities, governorates, and local councils. This collaborative approach helped position maternal, neonatal, and child health as priority areas. Bilateral cooperation with Brazil and Argentina was reinforced to reduce the need for Paraguayans to seek care abroad and to support border health initiatives. 

 Lessons Learned: 
Interprogrammatic collaboration, particularly between the Ministry and PAHO, proved vital. A Technical Operating Committee, formalized by ministerial resolution, ensures effective project governance and sustainability. Strengthening human resources through training in essential competencies supports the use of health technologies and information systems, helping identify and address care quality barriers. Community involvement has been key in highlighting gaps and opportunities in healthcare access. 

The project’s alignment with Paraguay’s National Health Policy (2015–2030) and PAHO’s Country Cooperation Strategy (2024–2028) has facilitated its success, improving healthcare access, coverage, and quality in vulnerable and remote populations—leaving no one behind.