5) Description of health product/service offering: Prevent disability and early death due to diabetes within the excluded communities BENEFICIARIES a) Primary health team of attention. b) Poorest communities in Bolivia The "Program” consists of TWO SERVICES AND ONE PRODUCT: 1) Advanced training in Primary Diabetes care (Strategy promoting qualification and training to doctors/nurses affording first level care including integration to the hospital) 2) Advanced training in Healthy Nourishment Habits (HNH) (Strategy aiming to encourage families and their communities through workshops, food fairs, health communication to improve their life styles, adopt appropriate nourishment and organize self help diabetic groups) PRODUCT: In addition to reading and audiovisual material we published my Books "Diabetes Vida en Equilibrio” and “Nutricion, Salud y Educacion” We also have THREE BACKUP ACTIONS: Surveys to detect risk factors, follow up and control of diabetics at the Health Centers, and accessibility to free or affordable medication. For this purpose we try to obtain donations and help through agreements with public and private institutions attempting to help Rural and marginal communities excluded from the Public Health Services, which causes early disabilities and death

6) Description of innovation: The poor community would benefit if we attack the problem In 2000 DOTA describes a strategic plan about diabetes in America based on: a)Prevention b)Vigilance and its chronic complications c)Education d)Intervention to improve the quality of diabetes care. As in other countries, Bolivia has education programs for self help diabetes groups only. We developed a new integral model: PRIMARY PREVENTION (healthy nourishment habits); SECONDARY PREVENTION (early diagnosis and prompt treatment) TERTIARY PREVENTION Through level integration for early diagnosis and rehabilitation of diabetic complications (cardiovascular pathologies, blindness, kidney failures, lower extremities amputation) In developing healthy nourishment habits we promote the optimization of the human capital. Favoring nourishment security, we will reduce children’s and their family’s malnutrition indicators. NHN sensitizes communities enabling us to introduce our program progressively. The best strategy to reduce costs is to prevent the development of diabetes adopting healthy life styles Our program-s innovation is to ATTACK THE PROBLEM and FOCUS NOURISHMENT whithin the families. Community workshops teach peasants to value their children’s size and weight, enrich their food with traditional products or grow their own vegetable gardens being encouraged to select their food intelligently. Finally, Nourishment Fairs assist to reinstate the old/traditional nutrition My 1996 survey for Argentina, was proposed by the WHO in 2003, with the difference that we included 24 hours “Nourishment Reminder”. We do urine analysis with Multistik at a cost of US$ 0.10 allowing us to check glucosuria or the suspicions of gynecological, urinary, kidney and hepatic problems. Using the services of voluntary university students who, in addition to their learning experience, they commit themselves with their community. We contribute to the H.System improving health and life style for all marginal communities.

7) Operational model: 1] Health Team training in diabetes and Healthy Nutritional Habits (HNH)promoting the first level care to the patient. 2] Health Team Supervision in the field and re-training 3] Family nutritional, diabetes risk factors and other non transmissible diseases vigilance. 4] Surveys are important source to generate awareness of risk. We normally do surveys in schools with the PTAs enabling us to put together health promoters with the senior year students. 5]Organize self help groups. 6]Community workshops on healthy nourishment habits(HNH) and diabetes. 7] Nourishment fairs and street theatres 8] HNH and diabetes mass media diffusion 9] Health Promoters from Universities and schools 10] Public and private signed donation agreements 11] Advocacy for Health 12] Activities process, evaluation and systematization 13] Re-training and supervision are done every three months, although due to lack of resources those are restrictive. We are trying to find financing in order to implement a mobile laboratory and to establish a medication revolving fund which are also important. At this time, we have limited donations. Mechanisms: a) Establish relationships: Due to the high expenses involving work in poor and rural communities, we try to find compatible organizations to use their structure and resources. b) Find volunteers: University students, local social clubs, and others. c) Find resources: Anyone willing to assist financially d) Mass Media diffusion: In order to sensitize the local community involving teachers, local Churches, NGOs. e) Favor empowerment for health development of poor individuals, families and communities.

8) Human resources: 7plus: PATRICIA BLANCO: M.D specialized in Diabetes; Master in Health System and Service management; Medical Auditor; Graduated in Community Development; Public Health Consulting. Experience: 18 years experience in treatment and investigation of diabetes. Created, developed and implemented the program for the Diabetes Primary Csre in Salta Argentina. Diabetes patient for 22 years. CARLOS CANEDO: Licensed in Education Science 10 years experience in rural areas education. (Mining communities in Oruro and Potosi, Cooperatives organization. ADRIANA PINTO: Architect. Three years experience in management and volunteers coordination ANA PINTO: Licensed in Marketing. Two years experience as Program Administrator LUZ ORELLANA: Public Accountant Six years experience as P.A.for NGOs operating in rural communities. CARLOS LÓPEZ: Public Accountant. Five years experience as P.A.in Parochial Schools. JENNY TORRICO:US Ins.Adjuster/Business Mgnt 30 years exp HEALTH TEAMS Supervisors Required to be M.D. or R.N. Minimum two years experience in primary care to diabetic patients.(all we could get) TEMPORARY VOLUNTEERS: University students to do surveys and data base (all we could get)

9) Key operational partnerships: MANO A MANO: Gathers health rural teams and finances training every three months. UNIVERSIDAD CATOLICA: Supplies volunteers for community activities. FE Y ALEGRIA: Rural/boarding schools; organize Health Promotion Schools and community vegetable gardens. FUNDACION SAN LUCAS: Community training/education activities. RADIO CANCHA PARLASPA: Cooperation among Ashoka Fellows for the diffusion of our program. SECRETARIAS DE SALUD: Signed a cooperation treaty ordering assistance to Health Rural Teams. PASTORAL DE SALUD ARZOBISPADO DE POTOSÍ: Organizes local activities. PAHO: Planning several projects: Life Stands and Clubs (areas to detect obesity,hypertension,family histories and affords education for management of risk factors (Free of charge). Apply medical principles on evidence for Public Health intervention. FUNDACION CRISTO VIVE: Works in “Bella Vista” a rural community where we started our program and achieved our goals. GERMAN INSULIN FOR LIFE: Donates treatment for “Bella Vista”. Since we don’t have enough resources, it would have been impossible to reach our goals without those Organizations. AIESEC: We signed an agreement to be afforded a volunteer for five months as of June 4th, for financing development.

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: At this time I try to finance it with my own resources and some donors assistance

          • Earned incomes as a percentage of operating costs: 0

          • Other funding sources: The funding is based on my own financial resources such as profits from the sales of my book about diabetes, and other donations. All members of my teams are free of charges, thus, our initiative is not self sustainable or profitable. The Process of Institutionalization, and the project for the Expansion and Consolidation of the Diabetes Program for this year, contemplates to get resources through external financing, which will allow us to preclude the dependence of the good will of the rural institutions and organizations allowing us to approach the Diabetes Program directly for the Foundation who will manage the resources according to the priorities as established in its Operative Plan.

          • Strategy for long-term sustainability: 1)To encourage the community consider their self management (Social Capital) 2)Have the Government change its policy in order to recognize the diabetes problem reviewing their budget 3)Generate our own resources selling didactic material,implement the medication revolving found,give seminars,get donations and volunteers,afford counseling, create mobile laboratories,cultivate and promote appropriate food affording security and sovereignty for local use and exports such as amaranto and other healthy produce. We could also process instantaneous food aimed at undernourished children and people with celiac diseases with or without diabetes. By law, all Municipalities must distribute breakfast to all the schools so we could also negotiate contracts with them to supply the above food.

11) Current and Future Impact

          • Total number of clients: 32,200

          • Clients in the past year: 20,000

          • Percentage of low-income clients: 80%

          • Impact: Initially, rural health centers didn’t afford care to diabetics. Now 90 centers and 709 trained personnel do so. Rural people lack financial resources (80% don’t have health insurance). The Health Secretary in Potosi has signed a contract with the Foundation to execute the program. Local universities have more students doing thesis in nutrition. The Pilot Health Center of Bella Vista has good control indicators. More organizations ask me to give workshops. Fe y Alegria boarding schools where I gave workshops, resulted that teachers are making healthy menus. Peasants are more receptive, even if they can’t afford to pay for Lab work, medication or to us,they are being selective with their locally grown food, and organize fairs by themselves.

          • Overall "market": We have 90 community health centers in four Departments with 32,200 people scattered in a radius of several miles. We interviewed 761 persons, and found 274 with risk factors. Due to lack of funds, we have not been able to confirm the diagnoses through Lab work but we use testing strips. We may find there would be considerable people at risk. We can only try to prevent the disease through good eating habits education, distribute some medications to the sick people and try to keep our Health Centers with additional supplies. Bolivia has 8,274,325 people out of which 3,108.443 are rural with a poverty index of 82% and 94% are excluded from health care. Diabetic prevalence in the urban area is 7.5%; obesity 22%, hypertension 8.6%. My surveys in the outskirts of my city revealed more than 52% obesity thus it is safe to assume rural areas have higher risk. The rural demand is considerable because no one wants them. All Latin America could benefit with our program. As of October 2003 we spent US$ 25,000 for this purpose, in transportation, and products. No salaries or any other type of remuneration is involved. Out of my own income I contributed US$16,000.00.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: If we secure the required financial help,in the next three years we plan to reach 359,265 poor/rural people; increase our trained health team to 1,148 with some remuneration for their effort; add our community health centers to 489; carry out 34,230 surveys and 10,269 laboratory diagnoses. We also plan to afford treatment and medications to 2,154 diabetics. We could implement the mobile laboratory and the medication revolving fund. The MOBILE LABORATORY would encourage people to be properly tested and have an adequate diagnosis at no cost for those who can’t afford it, but there will be someone else who could afford a reasonable fee, to enable us to generate some income and to cover the cost of the non paying patients. THE MEDICATION REVOLVING FUND would generate some income for its self support as well as increase the capital to be re-invested to the program enabling us to reach our goals providing care to more patients. Medications will be obtained at low prices based on volume and hopefully though donations. Patients would pay for them at the lowest market value, generating gains for the fund.

13) Policy change: To have the Bolivian Government consider legislation to change its present policy by implementing the National plan for chronic diseases and to include diabetes and hypertension to the reportable diseases with the encouragement of the PAHO/WHO and other influential institutions. This could help us to achieve our plans, specially obtaining the cooperation of the physicians in the field.

14) Origin of the initiative: In 1984, prior to becoming a physician I was diagnosed Diabetes 1. I experienced the exclusion of the Bolivian health system. Rural Health Teams have no clue about prevention or treatment. Peasants walk a day to get to a hospital. In 1986 I specialized in diabetes in Argentina. Dr. Julio Sanmillan was forming rural health promoters in diabetes. I took his initiative to form a Plan for Bolivia but authorities refused it. I founded the first Diabetic Association, organizing educational campaigns and camps for diabetic children. In 1996 I returned to Argentina where I developed the Program. In 2002 I returned to Bolivia attempting to apply it but again, it was not considered a priority. In October 2003 I became Ashoka Fellow and started to execute the plan with my own funds. In 2005 I founded VIDA PLENA, which prevention program is in process of consolidation with the primary care.

Contact Information:
Patricia Maria  Blanco
Ashoka Fellow
President
V.I.D.A PLENA FOUNDATION meaning Integral Vision of Harmonic and Total Development
(Fundación)
Bolivia
Website: fundacionvidaplena.