Country with High Mortality: Bolivia

Introduction: Bolivia

Bolivia is a developing country located in the central part of South America. It is characterized by a comparatively low level of economic development and highly unequal distribution of wealth among its citizens. As a result, it also experiences numerous health-related problems and challenges. Bolivia is selected for the current analysis for the following reasons. First, it is a developing country, and its population has a very low standard of living. Thus, it is necessary to specify the impact of economic conditions on people’s health. Second, it is reasonable to use the example of Bolivia for formulating the broad social and economic implications for the modern global world. The corresponding nursing implication may be formulated.

Location/Geography

Bolivia is located in the central area of South America. Its area is equal to 1.1 million square kilometers. The country consists of the three following major regions. The first one is the Andean region that is located in the southwestern part of the country and occupies slightly less than 30% of its territory (Reinertson, 2015). The region is usually associated with the well-known Lake Titicaca. The second one is the Sub-Andean region that occupies the central part of the country and is intermediate between the western and eastern regions. It is the smallest region with approximately 13% of the country’s territory. Bolivian valleys prevail in the given region. The third one is the Llanos region that is located in the northeastern part of the country. It is the largest region, and it constitutes approximately 60% of the country’s territory (Reinertson, 2015). Small plateaus prevail in this region. Thus, various regions in Bolivia are characterized by different climate and geographical conditions.

Population

The country’s current population is approximately 10.5 million people although the overall density is very low. The current population trend is positive as it is presented in Fig. 1 (World Bank, 2015).

Figure 1. Dynamics of Bolivian Population

Figure 1 demonstrates that the current trend is almost linear. Thus, it is possible to predict future population-level based on current dynamics.

Government

Bolivia constitutes the presidential democratic republic. The government is exclusively responsible for exercising executive power. Legislative power is exercised both by the national parliament and the government. The Judiciary branch is declared as being completely independent of the government. The current President is Evo Morales. He was elected in 2006 and then reelected in 5 years. The National Congress consists of two Chambers: the Chamber of Senators and the Chamber of Deputies. The former includes 27 seats, while the latter includes 130 seats. The local government is divided into nine major departments. Socialist parties play the dominant role in the political life of Bolivia.

Economy

The GDP of Bolivia in current prices exceeds $34 billion (World Bank, 2015). However, if the purchasing power of USD is considered, the Bolivia’s GDP exceeds $50 billion. It means that the prices in Bolivia are much lower in comparison with developed countries. The rates of GDP growth are presented in Fig. 2 (Trading Economics, 2015).

Figure 2. Bolivia’s GDP Growth Rates

Figure 2 shows the country’s economic development. It experiences neither a sustainable growth nor the prolonged recession. In general, it demonstrates that the government is unable to organize the proper use of national scarce resources. Moreover, the dominance of the socialist parties is observed in the substantial government’s involvement in all major spheres of the national economy. As a result, the rates of adopting innovations are very low. The economy is mostly labor-intensive, and the productivity of labor is low. Bolivian economic policies tend to become more responsible. In particular, the national budget is characterized by substantial surpluses within the last several years. The dynamics of the country’s GDP per capita is presented in Fig. 3 (Trading Economic, 2015).

Figure 3. Bolivia’s GDP per Capita Dynamics

Figure 3 shows that despite the existing inefficiencies in the national economic policy, the country experiences the gradual improvement of the population’s living standards. However, the current GDP per capita is equal to approximately $6,000, and it is still much below the average level. One of the major economic indicators that demonstrate the potential for future economic growth is the dynamic of unemployment. It is presented in Fig. 4 (Trading Economics, 2015).

Figure 4. Dynamics of Bolivia’s Unemployment Rate

Figure 4 demonstrates that the level of unemployment in the country tends to decline consistently. It means that the country has considerable opportunities for further economic growth. However, it is also important not only to maintain the current dynamics of unemployment but also to establish the correct allocation of labor resources among all spheres of the national economy.

Bolivia orients to developing the modern infrastructure as its current level are unacceptable. For such reason, the country participates in the large-scale borrowing from various developed countries. Although it contributes to improving infrastructure in the short-term, it creates serious problems in the long-term as the country’s indebtedness tends to increase rapidly. At the same time, Bolivia tries to increase its foreign reserves to maintain the accepted level of financial and economic stability (Trading Economics, 2015). In general, the country experiences the positive dynamics of the majority of the economic indicators, but its overall level of economic development remains much below the average one.

State of Health

The state of health in Bolivia is unsatisfactory as it is much below the generally acceptable level. The current life expectancy at birth is equal to 65 years for males and 70 years for females (WHO, 2015). The probability of dying before 15 and 60 years is 247 per 1,000 for males and 172 per 1,000 for females. The total healthcare expenditure per capita is approximately $370, and it does not allow providing a satisfactory level of care for Bolivian citizens. Total healthcare expenditures constitute approximately 6% of the national GDP (WHO, 2015). Such a level is insufficient even in relative terms.

Bolivia is characterized by a difficult situation observed in relation to diseases. The most common cause of death among children under 5 is acute respiratory infections (16%). Prematurity, birth asphyxia, and congenital anomalies are also highly widespread (13-15%). The situation with AIDS/HIV is satisfactory as it constitutes less than 1% of deaths (WHO, 2015). The current level of immunization among 1-year-old children is approximately 90%, and it corresponds to the average level in South America. The major cause of deaths among adults is ischemic heart disease (10.3%), lower respiratory infections (9.9%), stroke (8%), and diabetes mellitus (4%) (WHO, 2015). Moreover, the number of patients with ischemic heart diseases and diabetes mellitus tends to increase recently.

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The major groups of diseases include maternal, neonatal, nutritional, cardiovascular, and diabetes. The current probability of dying in Bolivia before 15 is 20% for males and 16% for females. The probability of dying before 70 is 62% for males and 51% for females. The probability of dying between 15 and 49 for females from maternal causes is 8%, and such percentage is very high. It demonstrates that substantial problems exist in the healthcare sphere in Bolivia. The probability of dying between 30 and 70 for both sexes from 4 major noncommunicable diseases is 18%, and such level is also unsatisfactory (WHO, 2015).

One of the major problems in Bolivia is domestic violence. The recent research shows that approximately 70% of women in Bolivia experience some form of abuse (Bureau of Democracy, Human Rights, and Labor, 2007). Moreover, the situation is very serious as the majority of women face abuse on a regular basis. Although the Bolivian government passed the law that introduces a severe punishment for various forms of women’s abuse, they are not enforced properly. The majority of cases of violence are still unreported, including marital rape that is also outlawed according to the recent law.

Road traffic accidents also constitute a serious problem in Bolivia. They are the 11th major cause of deaths in the country. The annual number of deaths exceeds 2,000. It is approximately 3% of the total deaths in the country. The death rate is 21.16 per 100,000 of the population. In this regard, Bolivia is considered the 62nd in the world ranking (World Health Rankings, 2015). The situation is unsatisfactory in comparison with other developing countries. In general, the overall state of health in the country is low. The prevalence of serious diseases is high, and the population is unable to rely on preventive medications as the living standard is inadequate. The situation shows that the state of men’s health is worse in comparison with that of women in Bolivia. Males face higher health risks in all age groups. The prevalence of domestic violence creates difficulties for the democratic transition of the country and establishing a safe social environment for all individuals regardless of their gender or social status. The government is unable to minimize the problem of high rates of road traffic accidents, although it is untypical for developing countries.

Culture/Traditional Medicine

Bolivia is characterized by a unique culture. As it borders with different countries (such as Chile, Brazil, Paraguay, Argentina, and Peru), its cultural development is influenced by them. At the same time, there are large numbers of new cultural elements of the Native American population in Bolivia. The country is famous for its dances and clothes. Dances are highly popular in Bolivia as they contain both traditional and modern elements. The most well-known dance is Caporales that is often performed by a large number of participants. The pollera is the most popular type of traditional clothing of Native Americans. However, its spreading tends to decline as young people experience the influence of globalization and prefer the European or North American style.

Like other South American countries, Bolivia is known for its festivals. The annual carnival of Oruro is the most influential in the country’s cultural life. The major attention is paid to folkloric dance and events. Bolivia appreciates its culture and tries to maintain the existing variety of all cultural groups. Bolivian festivals attract tourists from all over the world. The country tries to develop its cultural potential to strengthen its international positions. The national cuisine is influenced by Spanish cuisine, as well as various modifications initiated by immigrants from different countries and continents. In general, the Bolivian cuisine is very diverse and includes such staples as rice, corn, wheat, and beans. Nowadays, it is not always possible to determine the ultimate origin of a specific dish. Moreover, Bolivians do not only use the experience of other countries but also adjust it to their traditions and culture.

The impact of traditional medicine in the country is substantial. The reason is that the majority of the country’s population (51%) is indigenous. In the southern part of the country, approximately 55% of the population prefers traditional medicine over all other available alternatives (WHO, 2015). On the one hand, it corresponds to people’s cultural beliefs and values. On the other hand, it is inexpensive and available for the representatives of all social classes and groups. As the demand for such services is high, their supply is also significant. Currently, there are approximately 5,000 healthcare providers that specialize in traditional medicine (WHO, 2015).

Although traditional medicine has been practiced for a long time, it was legally recognized only in 1985. There are several major traditional medicine regulations in Bolivia. The government requires all practitioners to possess the official license for continuing their practices. The position of the Doctor of Chiropractic degree is established to encourage the scientific approach in the given field and mention the most productive and talented practitioners (WHO, 2015). Herbal medicines are also regulated in the country. Moreover, Bolivia organized training programs for future practitioners through a network of allopathic medical schools.

Healthcare System and Delivery

The Bolivian healthcare system mostly consists of governmental health-related agencies. They perform a general analysis of the current health situation in the country and make proposals about its improvement. The Ministry of Health and Sports occupies the central part of the Bolivian healthcare system. It examines the major health risks and develops policies for mitigating them. In particular, the Ministry analyzes the spreading of HIV/AIDS in the country and implements policies for minimizing its effects. In general, its actions are comparatively efficient as the mortality rates associated with HIV/AIDS constitute less than 1% in the general structure (WHO, 2015). Other health regulatory organizations concentrate on providing licensure of healthcare providers and controlling their adherence to the existing norms and regulations.

Bolivia has a low number of nurses: approximately 1 per 1,000 people (World Bank, 2015). As the current population is approximately 10 million people, the number of nurses is 10,000, and it is insufficient for satisfying the needs of the entire country’s population. The number of physicians in Bolivia is much lower, but such a situation corresponds to the general trend in the world. The fraction of physicians is 0.5 per 1,000 people (World Bank, 2015). Bolivia does not have the nursing education system at the national level. Nurses receive their education on a decentralized basis. The Ministry of Health and Sports performs licensure of nurses and healthcare providers and controls the quality of their services and the adequacy of professionals’ qualifications. Bolivia is not characterized by the developed network of nursing organizations. The country mostly relies on its international nursing relations with American and other nursing associations. The following nursing associations perform some of their operations in Bolivia: the Academy of Medical-Surgical Nurses, the Association of Nurses in AIDS Care, the National Association of Neonatal Nurses, etc.

Health Priorities

It is reasonable to specify the major health priorities of Bolivia using the above information and the general health trends. Health priorities refer to the most important spheres and areas that should be addressed at the national level for maintaining the sustainable health development of the nation. The first health priority is increasing health standards among children. Such a fraction of the population is one of the most unprotected in Bolivia, and it faces considerable risks. The most common causes of death among children include acute respiratory infections, prematurity, birth asphyxia, and congenital anomalies (WHO, 2015). Thus, Bolivian practitioners should concentrate on increasing health standards for children. The current problem is closely related to economic issues as difficult economic conditions do not allow enjoying the corresponding economic opportunities for various population groups.

The second priority is minimizing the spreading of major diseases among Bolivian adults. Different groups of diseases include maternal, neonatal, nutritional, cardiovascular diseases, and diabetes. Bolivian experts have to investigate the existing trends and determine the proper interventions for every group. In such a way, the general positive effect can be maximized. The third priority is dealing with domestic violence. The unprecedentedly high spreading of domestic violence in Bolivian society (approximately 70% of women experience it regularly) creates substantial problems for establishing a free and democratic environment. Moreover, it negatively affects the health of women and children. The fourth priority is the existing non-proportionality between gender groups. Despite the prevalence of domestic violence, the states of health among women are much higher in all age groups in comparison with men. Such a situation is unacceptable as it destroys the gender balance of the nation.

Nursing Implications

The above health priorities demonstrate that there are large numbers of unsolved health-related problems that should be addressed in Bolivia. Their complex solution requires the proper and close cooperation of various agencies and professionals. However, the role of nurses in the given context is high as nurses possess both deep theoretical knowledge and well-developed practical skills. As the first priority refers to promoting health standards among children, nurses should investigate the problem from various perspectives. On the one hand, they should increase the awareness of the population about the major risks that exist in relation to their children. It may be expected that higher awareness and responsibility will lead to the more correct approach of adults in relation to their children (Meekers, Pallin, & Hutchinson, 2013). On the other hand, nurses should use their qualifications for advocating the corresponding legislative changes at the national level. It is necessary to increase the percentage of GDP directed to healthcare needs. In such a way, healthcare providers will be able to create better conditions for children.

The second priority regarding the major diseases spreading among Bolivian adults is also serious. Nurses should promote closer cooperation with international organizations that specialize in a particular field. For example, numerous nursing and other healthcare organizations specialize in providing care for patients with diabetes. Their experience and methods used may be highly relevant for Bolivian nurses. It seems that the cooperation between organizations should be organized both on a centralized and decentralized basis. The government should create the proper conditions for information exchange and professional development among nurses and healthcare professionals. At the same time, nurses should demonstrate their incentive for increasing cooperation with foreign colleagues. The higher competition among nurses will contribute to introducing a higher amount of innovations.

The third priority of the domestic violence prevalence should be addressed systematically. There are two major aspects that should be considered while working on a given problem. The first one is the legal aspect. All proven facts of domestic violence, including marital rape, should be punished severely. The severity of punishment should depend on the seriousness of the crime. The second aspect is ethical. The potential aggressors should realize that their behavior is immoral and contradicts basic individual liberties. Violence in all its forms is inadmissible in the free society. Victims should also oppose aggression using all available means (Meekers, Pallin, & Hutchinson, 2013). If aggression occurs, they should contact government authorities immediately.

The fourth priority is the existing health disparities between men and women. As men are characterized by poorer health in all age groups, nurses should develop a specific program for promoting men’s health. The greatest attention should be paid to preventing the occurrences of the major diseases. Such a method is affordable for the largest fraction of the Bolivian population. The focus should be placed on traditional medicine as it is highly popular in the country, especially among people with low income. In general, nurses should participate actively in addressing all the above priorities due to their central role in the healthcare system.