Expanding indigenous peoples’ access to quality primary health care in Paraguay – World Health Organization (WHO)

Report on Health Equity and Primary Care Advancement in Canindeyú, Paraguay

Introduction: Addressing Health Disparities in Alignment with Global Goals

A collaborative project in the Canindeyú Department of Northeast Paraguay has made significant strides in improving health outcomes for indigenous and rural communities. The initiative, titled “Expanding Access to and Quality of Primary Health Care and Integrated Health Services in the XIV Health Region – Canindeyú, Paraguay, from 2023 – 2025,” directly addresses historical inequities in healthcare access. By focusing on vulnerable populations, the project serves as a practical implementation of the Sustainable Development Goals (SDGs), particularly those related to health, equality, and partnership.

Strategic Alignment with Sustainable Development Goals (SDGs)

The project’s framework and outcomes are intrinsically linked to several key SDGs:

• SDG 3: Good Health and Well-being: The core objective is to advance Universal Health Coverage (UHC Target 3.8) by expanding access to quality primary care. This includes tackling communicable and non-communicable diseases (Target 3.3 and 3.4) and improving maternal health outcomes.
• SDG 10: Reduced Inequalities: By specifically targeting remote and indigenous populations who have historically faced barriers to healthcare, the initiative works to reduce health-based inequalities and promote social inclusion (Target 10.2).
• SDG 17: Partnerships for the Goals: The project exemplifies a multi-stakeholder partnership, uniting the Paraguayan Ministry of Public Health and Social Welfare, PAHO/WHO, and the UHC Partnership to achieve shared development objectives (Target 17.16).

Project Methodology and Implementation

An interdisciplinary and inter-programmatic approach was employed to strengthen the local health system. This strategy was designed to build local capacity and ensure sustainable improvements in line with SDG principles. Key components included:

1. Geospatial Analysis: Innovative use of geospatial data to identify gaps in health facility coverage and strategically guide resource allocation.
2. Capacity Building: Training for health workers, with a focus on managing communicable and non-communicable diseases, thereby strengthening the local health workforce as per SDG 3.c.
3. Strategic Policy Development: Utilization of Health Situation Analysis to inform the design of effective and evidence-based health policies.
4. Modular Essential Conditions Assessment (VCEm): Implementation of this PAHO/WHO methodology to evaluate and improve health service delivery, often through low-cost, high-impact changes such as protocol training.
5. Intercultural Dialogue: Fostering communication between healthcare providers and communities to build trust and deliver culturally appropriate care that respects traditional knowledge, a critical element for achieving SDG 10.

Measurable Impacts on Health and Sustainable Development

The initiative has yielded significant, quantifiable improvements in health service delivery and access, demonstrating tangible progress toward SDG 3 and SDG 10.

• Enhanced Access and Coverage (SDG 3.8):
  • Health insurance coverage across the Department increased by 18.1% between 2022 and 2024.
  • Access to health services for the target population increased by 25.1% during the same period.
• Increased Service Utilization (SDG 3):
  • Comparing the period of April-June 2023 to April-June 2024, primary care visits rose by 10.5%.
  • Overall medical consultations increased by 19% in the same timeframe.
• Improved Maternal Health (SDG 3.1, 3.3):
  • A 29% increase was recorded in the proportion of pregnant women receiving essential HIV and Syphilis testing during their first trimester, a key intervention for preventing vertical transmission.

Conclusion: A Model for Sustainable Health System Strengthening

The success of the Canindeyú project underscores the power of international collaboration and targeted interventions in advancing the 2030 Agenda for Sustainable Development. The partnership between national authorities and international bodies like PAHO/WHO, supported by the UHC Partnership, was instrumental in closing historical access gaps. This initiative serves as a replicable model, demonstrating that a combination of innovative technology, local capacity building, and a commitment to intercultural dialogue can generate lasting transformations in health systems, ensuring that no one is left behind in the pursuit of good health and well-being for all.

Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is improving healthcare. It describes a project called “Expanding Access to and Quality of Primary Health Care” in Paraguay. The project focuses on increasing access to health services, controlling communicable and noncommunicable diseases, and improving the quality of primary care, all of which are core components of SDG 3. The text explicitly mentions increasing “health insurance coverage,” “access to health services,” and the number of “medical consultations.”

SDG 10: Reduced Inequalities

• The initiative specifically targets vulnerable and marginalized groups to ensure equitable access to healthcare. The article highlights that “indigenous communities in Northeast Paraguay have struggled to access the health services they need” and the project aims to “close historical access gaps” and promote “health equity” for “remote and indigenous populations.” This directly addresses the goal of reducing inequalities within a country.

SDG 17: Partnerships for the Goals

• The project is a collaborative effort involving multiple stakeholders. The article states that “The Ministry of Public Health and Social Welfare has worked closely with PAHO/WHO, through the UHC Partnership.” It further details that the UHC Partnership is “supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO,” showcasing a multi-stakeholder and global partnership for sustainable development.

What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   The article is centered on this target. The project’s name is “Expanding Access to and Quality of Primary Health Care,” and it is supported by the “UHC Partnership.” The outcomes directly reflect progress towards UHC, with the article noting that “health insurance coverage increased by 18.1% and access to health services increased by 25.1%.”

2. Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

   The project included “training health workers especially in the control of communicable diseases.” A specific outcome mentioned is a “29% increase in the proportion of pregnant women who received an HIV and Syphilis test,” which is a key strategy in preventing the transmission of these communicable diseases.

3. Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.

   A core component of the initiative was capacity building for the local health workforce. The article mentions the “training of health workers,” which increased their “technical capacity” and empowered them to improve service delivery. Dr. Angie Duarte notes that “providing training to health workers on protocols” is a key activity.

4. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   The project’s focus is on the inclusion of specific, often excluded, populations. The article states the goal is to improve equity and access for “remote and indigenous populations” and “vulnerable populations.” The story of Joaquina Portillo, an “indigenous elderly resident,” exemplifies this focus on inclusion irrespective of ethnicity or age.

5. Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the sustainable development goals in all countries, in particular developing countries.

   The article details a partnership between the Paraguayan government (“Ministry of Public Health and Social Welfare”), an international organization (“PAHO/WHO”), and a multi-donor fund (“UHC Partnership”). This collaboration mobilized financial resources and shared knowledge and technology, such as “geospatial analysis” and the “Modular Essential Conditions Assessment’ methodology,” to achieve health goals.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator for Target 3.8 (Coverage of essential health services): The article provides direct quantitative data to measure this. It states that “health insurance coverage increased by 18.1% and access to health services increased by 25.1%.” It also measures service utilization, noting that “the number of primary care visits increased by 10.5%, and the number of overall medical consultations increased by 19%.”
2. Indicator for Target 3.3 (Prevention of communicable diseases): A specific indicator for progress on preventing mother-to-child transmission of diseases is provided. The article reports a “29% increase in the proportion of pregnant women who received an HIV and Syphilis test during the first trimester of pregnancy.”
3. Indicator for Target 10.2 (Inclusion of vulnerable groups): While not a formal SDG indicator, the project’s success is measured by its ability to reach specific populations. The increases in health coverage and access are explicitly linked to “indigenous and rural populations.” A qualitative indicator is also mentioned: “strengthening trust in public health services among indigenous and rural populations.”

Create a table with three columns titled ‘SDGs, Targets and Indicators’ to present the findings from analyzing the article.

Source: who.int