Bolivia – The international organisation Doctors Without Borders/Médecins Sans Frontières (MSF) has presented Bolivia’s Ministry of Health with an operating manual for managing Chagas disease in rural areas, as part of its closure of operational activities, after over 30 years of humanitarian action in the country. MSF is calling on the Bolivian authorities to increase resources dedicated to Chagas care and increase people’s access to comprehensive care of this disease.
MSF has 18 years of international experience in the treatment of Chagas. During this time, it has provided a timely diagnosis to over 114,000 people, more than 11,000 cases have been detected and around 8,000 patients have received treatment.
After 14 years of Chagas intervention in Bolivia, MSF has ended its operations by sharing this document, which aims to act as a toolkit to guide the Ministry of Health, municipal authorities, and the National Chagas Program in the fight against this disease. Considering that Bolivia is the country with the highest incidence worldwide, Chagas is endemic in 60 per cent of its territory and around 4,440,000 people are at risk of infection.
The Comprehensive Care Manual for Chagas disease in rural areas reflects MSF’s experience in implementing a comprehensive care model in Monteagudo, Chuquisaca, which the Ministry of Health and the National Chagas Program launched successfully with technical support from MSF and financial support from the Municipal Council.
During two years of intervention in this municipality, 32 per cent of the population were screened, i.e. a total of 8,445 people up to November 2016. In 2016 alone, 1,088 people were diagnosed with Chagas, of whom around 58 per cent have started treatment. Much of this achievement is thanks to the simplification of diagnosis through the use of rapid tests. These have improved patients’ access to diagnosis in health centres in remote areas where there is the highest prevalence of the disease.
Currently, 13 of the 16 health facilities in the rural area of Monteagudo are conducting patient screening and in 10 health centres where doctors are based, comprehensive treatment is also provided. In the future, we hope that follow-up treatment can be performed by trained nursing staff, as is done for other diseases such as HIV and tuberculosis.
Thanks to the joint work with the Ministry of Health and the National Chagas Program, it has been demonstrated that it may be possible to integrate this model into health structures, as well as within the SAFCI model (Intercultural Community Family Health). It could be replicated in other regions of the country that also need it and, above all, so that the diagnosis and treatment of Chagas disease can be guaranteed for all patients, as can be done with any other disease. However, for this to happen, resources are required to enable them to respond to the country’s needs.
MSF recognises that there has been significant progress in the fight against Chagas, with significant improvements in vector control and improved access to treatment of the disease. However, despite the existence of Law 3374 since 2006 which declares Chagas disease as a national priority for all provinces in the country, no regulations have been created to date to allow further progress in access to treatment for the entire population, including those with congenital Chagas or in managing complications of this disease, including those cases involving pacemaker implants.
According to data from the Bolivian National Chagas Program (PNCH), 30,454 people were diagnosed in 2015, of which only 10 per cent started treatment, highlighting the fact that only 57 per cent of newborns were confirmed as receiving treatment. To make treatment for the disease accessible to a greater number of people, it is vital to ensure that rapid tests are made available, as well as medicines in hospitals and rural health centres in endemic areas, in addition to technical training for health personnel. In this regard, we are extremely concerned about the potential stock shortages of rapid tests in the country from early 2017 onwards.
Médecins Sans Frontières reiterates its commitment to continue providing technical support, if required, by participating in international platforms about Chagas care, while offering our experience gained over 18 years of fighting this disease, and urges the Bolivian government to provide greater access to diagnosis and treatment, and to invest the resources necessary for comprehensive care of Chagas disease.