Protocolo para abordaje de covid-19 en pueblos indígena originario campesinos y afrobolivianos

Objectives

This protocol provides an intercultural framework to prevent, contain and respond to COVID-19 among Indigenous Originario Campesino and Afro-Bolivian peoples across Bolivia. It seeks to mitigate transmission through comprehensive, culturally respectful health care, recognising communities’ constitutional rights, territorial autonomy, diverse perspectives on health and death, and the heightened risks associated with remoteness, socioeconomic vulnerability and limited access to health services.[1][2][3][4][5]

• Promote health and prevent disease in coordination with Indigenous Originario Campesino and Afro-Bolivian peoples, community leaders and public authorities.[1][3]
• Prioritise communities in the Amazon, Chaco and Andes whose geographic isolation and limited service access impede timely care, pandemic monitoring and control.[2]
• Strengthen prevention through intercultural information, education and communication, official guidance in regional and Indigenous languages, hygiene promotion, physical distancing and mask use.[6][7]
• Apply COVID-19 biosecurity measures to movement into and out of communities, households, productive and economic activities, and culturally specific practices including hunting, fishing, planting, harvesting and shared coca or mate-related activities.[6][8][4]
• Respect collective identity, territoriality, institutions, culture, self-determination, autonomy and self-government of Indigenous Originario Campesino peoples within the Bolivian state.[4][5]
• Incorporate annexed traditional knowledge on medicinal plants, foods and natural products presented as co-adjuvants for respiratory health, while the extracts do not establish these remedies as a substitute for formal COVID-19 case management.[9][10][11][12]

Implementation

Implementation is community-centred and intercultural, led locally by traditional authorities and coordinated with the Ministry of Health through the Vice-Ministry of Traditional Medicine and Interculturality. The protocol combines local prevention and response committees, case notification and isolation arrangements, community communication, movement controls, hygiene measures and cooperation between Indigenous communities, health services and autonomous governments.[6][2][13][14]

• Establish a Local Committee for COVID-19 Prevention and Response under the highest traditional authority of the community or Indigenous people, including health-facility representatives, community social structures, traditional medicine providers and Indigenous population representatives.[13]
• Coordinate local, municipal and departmental authorities, health personnel, Indigenous organisations, non-governmental organisations, churches, educational establishments, international cooperation agencies and other social-action institutions to support prevention, communication materials, supplies and training.[1][7]
• Support health personnel to notify suspected cases, arrange sample collection through municipal governments and mobile health brigades, and establish facilities for isolation of suspected cases and recovery of confirmed cases.[13][14]
• Equip recovery and isolation centres with basic services, water, sanitation, soap, cleaning materials and disinfectants, and coordinate food and hygiene support for confirmed cases from low-income households.[14]
• Seek medical supplies, equipment and materials for health facilities from municipal and departmental autonomous governments. The extracts do not specify a budget, financing source, costed resource plan or funding gap.[14]
• Maintain an updated community register by age and risk condition, prioritising people aged 60 years or over, children under five, pregnant women, people with disabilities, and people with chronic or communicable diseases.[14]
• Report weekly on committee performance to the highest traditional authority. Beyond case notification, community registers, movement records and weekly reports, the extracts do not specify formal performance indicators, targets, evaluation methods or audit arrangements.[14]
• Develop and disseminate information in official, principal and local Indigenous languages through community loudspeakers, radio and other channels, including participation by Indigenous young people.[7]
• Require people entering or leaving communities to record identity, origin, dates, purpose of movement, health status, temperature and signature through entry and exit registers and sworn declarations.[15]
• Regulate entry to and exit from communities, Indigenous lands and territories, and require personnel from surrounding enterprises to declare their health status, use protective equipment, practise hand hygiene, maintain at least 1.5 metres’ distance and avoid unnecessary visits and crowds.[14][8]
• Apply household, community and work-activity precautions, including handwashing, cleaning and disinfection, avoiding physical greetings and shared tools, and maintaining distance and mask use during hunting, fishing, planting and harvesting.[8][16][15]
• Adapt preventive measures for practices involving shared food, drinks, coca, cigarettes, poros, bombillas or other pijcheo, acullico, boleo and poreo items by promoting individual use and physical distancing.[4]
• Use suspected-case, confirmed-case and contact definitions to guide local risk assessment and response, including recognition of close contact through face-to-face exposure within 1.5 metres for more than 15 minutes, direct physical contact or direct care without appropriate protective equipment.[5][16]
• Update prevention and containment guidance as the pandemic evolves through the Ministry of Health and its Vice-Ministry of Traditional Medicine and Interculturality.[4]

Monitoring & Evaluation

Monitoring and accountability rely principally on community-based case notification, registers, declarations and local reporting rather than a specified indicator framework. Local COVID-19 Prevention and Response Committees support notification of suspected cases, maintain updated community registers by age and risk condition, and submit weekly performance reports to the highest traditional authority in the community or region.[13][14]

• Maintain registers that prioritise people aged 60 years or over, children under five, pregnant women, people with disabilities, and people with chronic or communicable diseases.[14]
• Monitor entry to and exit from communities through records of identity, origin, dates, times, reasons for movement, health status, temperature and a signed sworn declaration.[15]
• Require people entering from surrounding productive or economic enterprises to declare that they have not had contact with suspected COVID-19 cases.[8]
• Apply suspected-case, confirmed-case and contact definitions as a basis for case identification and follow-up, including exposure within two days before and 14 days after symptom onset.[5]
• Use local epidemiological risk assessments to identify other relevant exposure situations, including for asymptomatic confirmed cases.[16]
• Apply sanctions under Article 216 of the Bolivian Penal Code for conduct that spreads serious or contagious diseases, causes epidemics or otherwise affects public health; the cited provision indicates imprisonment of one to ten years.[15]

Distance from health services and the remoteness of communities in the Amazon, Chaco and Andes are identified as barriers to effective pandemic monitoring and control.[2]The material does not specify formal indicators, performance targets, surveillance targets, evaluation methods, audit arrangements, reporting formats or a comprehensive accountability framework beyond notification, registers, declarations, weekly committee reports and legal sanctions.[3][13][14][16][15]

Several annexes on territorial distribution, traditional remedies, medicinal plants, food preparations, registered natural products and bibliography provide no additional monitoring, reporting, surveillance or accountability arrangements.[17][18][9][10][12][19][20]

Costing & Financing

No budget, costing methodology, quantified allocation, financing source, funding gap, economic assumption or resource-mobilisation target is specified in the available protocol excerpts.[21][1][3][13][14]

• Seek medical supplies, equipment and materials for health facilities from municipal and departmental autonomous governments.[14]
• Arrange food and personal-hygiene support for confirmed cases from low-income families during isolation.[14]
• Mobilise supplies, communication materials and other resources through partnerships with international cooperation agencies, non-governmental organisations, educational establishments, churches and other social-action institutions.[7]
• Provide recovery and isolation facilities with basic services, water, sanitation, soap, cleaning materials and disinfectants.[14]

The excerpts include operational resource needs, such as mobile health brigades, sample collection, protective equipment, cleaning products, communication materials and educational resources in relevant regional and Indigenous languages, but do not attach financial values or identify committed funding.[13][14][7][8]

Quantities and application times for disinfecting solutions, as well as quantities and durations for traditional plant and food preparations, are technical guidance rather than cost data.[16][15][10][22][11][23][12][24]The territorial, product-list and bibliographic annexes likewise provide no cost, budget or financing information.[17][18][9][19][25][20][26]