Empower Bolivian Women to be Local Health Leaders

by Etta Projects

We want to congratulate you on helping us complete the project Empower Bolivian Women to be local Health Promoters!!   This program not only makes healthcare available in rural villages but it gives women a leadership role in their villages and we have learned they embrace that role.  In every community we have ever worked health promoters feel empowered to begin other changes in their communities.

We want to share a story with you that demonstrates the power of what these women can accomplish. A part of the first year of health promoter training is the workshops on hygiene, sanitation and clean water systems and how those effect our health.  Trainings occur with groups of women from several villages at once (typically 3-4) because we have learned that learning together each group helps the other tackle various problems. Trainings rotate from one village to the next with every workshop, encouraging sharing and helping very secluded women experience other villages.   Etta Projects had completed a sanitation program 4 years earlier in the village of Paisaje. Every family there uses Ecological Composting Latrines.  As the health promoter group was learning about sanitation and discussing the dire issues caused by pit latrines,open defecation, and the lack of dignity for women one group of health promoters shared that they use ecological composting latrines. They then were able to show and demonstrate use and care and recommend this method to their fellow participants. The health promoters from the village of La Reforma were so impressed with the Ecological Composting latrine that they advocated to the leaders of their community to seek just such a solution for their village.  This advocacy led to contacting Etta Projects and soliciting for a sanitation project. These women, once understanding the effect of poor sanitation on their families and communities, took action. One could call them not only health promoters but health activist! They also are working to create a trash plan and animal containment plan for their community.

As we, thanks to your generosity, can close this project, please know it continues to change lives everyday through acts such as wound treatment, delivery of babies, dispensing of antibiotics, monitoring of blood pressure, hydrating children with diarrhea, and advocating for action for other issues that impact women, children and whole communities. These women become leaders of change. They are empowered by their knowledge and skill and you helped them take on a role they are respected for.  This pride in their new role motivates and empowers them to take the next step. Thank you.

If you are a recurring donor your gifts will be shifted to our next project on Global Giving. Believe it or not, it is an Ecological Composting Latrine project.  Just another way to improve health and empower women and girls. One of the features of an ecological latrine is the dignity and privacy it allows for women and girls.  Check it out on Global Giving or just ask any Health Promoter… 

House Visits
House Visits
Teaching reproductive health in local High School
Teaching reproductive health in local High School
Generational possibilities
Generational possibilities


Working as a team
Working as a team

This is a bit of a different report for our global giving donors. Sometimes even donors want to know what mistakes have been made or lessons learned. We want to share one of the ways we have altered the program over time to make it more sustainable.

In remote rural villages of Bolivia, healthcare is not available in most communities, with the closest clinic frequently being many miles away. Even basic medicines are not available in these communities. In order to address this void, Etta Projects created a community Health Promoter Program in the region. The program trained health promoters, who would be the first point of contact for community members’ healthcare needs (both emergency and preventative). These promoters would be in charge of a first-aid kit, keep a record of patients they attended to, treat minor illness and common ailments, monitor pregnancies and malnutrition, stabilize emergencies, educate and be connected to the closest clinic for patient referrals.

For our training methods, we considered the intensity of the medical training and the varying levels of education of participants. In 2011, these considerations led us to limit those in the training program to two health promoters per community so that our doctor could provide more hands-on training and support. This was where we failed. We were focused on ensuring that the participants would, as individuals, get a thorough training, but we neglected to take the larger-scope context of economics into consideration. Because of the long-term time investment it takes to train health promoters, not only did we limit the communities’ access to the very care we were hoping to provide, we failed to design a sustainable program that would replace health promoters when necessary.

We learned our lessons through the community of San Lorenzo, where the only two elected health promoters both left the village shortly after graduating the program. The two women had worked hard, studied and practiced healthcare for three years (2011-2013). They were valued practicing educators and healthcare providers for their community.

One of the women, Teofila, had proven responsible and trustworthy in her duties until personal circumstances forced her to leave the small town for the closest city in order to seek employment that could support her and the children in her care. With Teofila’s departure, the other health promoter, Yuvinka, became the sole community healthcare provider and became crucial in defining her community’s needs; advocating for increased and better healthcare access and giving voice to the invisible population of impoverished farmers. In order to feed her three children, she also worked as a laborer in the sugarcane fields. When the harvest ended in 2013 she went to the city to seek further employment. Fortunately for her, she was able to secure a job in a veterinary clinic using her medical knowledge and skills and now earns much more than when she lived in San Lorenzo. Unfortunately, Yuvinka’s departure left the community without a health promoter to educate and serve.

The situation in San Lorenzo would be different today if we had considered the possibility of health promoters leaving the community or becoming unable to perform duties. We needed to recognize the potential that, for various personal and economic reasons, people may leave the village, either temporarily or permanently, leaving a void of trained healthcare promoters in the intended location. San Lorenzo has since selected a new health representative and is starting from scratch, using the nearest clinic’s doctors and Etta Projects’ training manuals to prepare the first replacements. As training is designed to take three years, though, it will be a long time before the community of San Lorenzo has their own community-elected health promoters again.

Since the inception of the program, we have learned that the health promoter participants significantly help each other during the training process and the ratio of participant to training doctor is much less of a concern than we had initially thought. Because of this new insight, and because it has become apparent that imposing a limitation of two health promoters is not sustainable, we have begun to encourage as many participants as possible from each new community we collaborate with. In 2014, Etta Projects is working with four new communities and, because of our lessons learned from San Lorenzo, we are currently training thirty participants from only four villages. We expect this to increase the longevity and sustainability of the health promoter work.

This time around, we have recognized that some participants will drop out of the program and our program coordinator has included this projection in her plans. We also now see that the empowerment that our training provides may result in our promoters seeking stable employment opportunities outside of the community, which we view as a side effect of success that we now plan for. With the accessibility of healthcare in remote, rural Bolivia as our mission, we have taken away important lessons that will guide us in our current and future projects. We will make efforts in this project to ensure that valuable healthcare knowledge is dispersed among many community members so that the residents have more consistent, reliable access to health care and education. As an organization, we will remember San Lorenzo as a reminder to consider a more holistic view of the peripheral factors that will contribute to the successes and potential failures of our projects.

Engaged participants
Engaged participants
The health promoters for 4 villages
The health promoters for 4 villages
Congrats to Health Promoters Enna and Roxana
Congrats to Health Promoters Enna and Roxana

Recently two community health promoters, Enna and Roxana, from the rural Bolivian village El Fortín accomplished what was previously unfathomable for them.  These two courageous women advocated fiercely to local municipal officials for the need to prioritize their community’s health in government plans.  The process was long and difficult, and it consisted of many meetings with different representatives from the municipality.  But their perseverance paid off when the government approved the promoters’ petition to repair their community’s health center.  Within a week a construction crew was at the health clinic changing the locks on the doors, fixing the entrance and drainage canals, changing the light bulbs, and installing new windows and equipment.  The promoters’ request also secured regular weekly visits from a doctor to their health center.

On June 11th the first medical teams started to work at the clinic.  Every Tuesday since then the same doctor has come to work alongside the health promoters to attend to patients.  The promoters’ efforts have completely transformed community health in El Fortin!!!

Etta Projects’ health program does much more than merely provide rural areas with access to medical supplies and equipment.  It goes beyond teaching local women how to prevent and treat common illnesses.  Etta Projects’ health program also gives health promoters the expertise to diagnose the most pressing health concerns in their communities and petition to their government for solutions to address these concerns. Health promoters, like Enna and Roxana, learn how to develop sustainable projects that can be transformed in to real action.

Etta Projects recently expanded our health program to a third district in Bolivia!  We are proud and humbled to report that we currently offer training to 60 local health promoters from 19 rural villages!!!!  Thank you for your continued support to grow this important program!  And congratulations to the amazing Enna and Roxana!


Health Promoter, Enna, from El Fortin
Health Promoter, Enna, from El Fortin

Common to every rural village in Bolivia is free-roaming dogs.  They account for 99% of cases of rabies transmission world-wide (WHO, 2004).  Last month the Ministry of Health launched a Canine Vaccination Campaign and turned to the Community Health Promoters (trained by Etta Projects’ Health Program) to lead the movement.  For two full days, the Community Health Promoters made house visits to educate their neighbors about the social and health problems associated with free-roaming dogs, including fecal contamination, bitten children, spread of rubbish and diseases such as rabies.  In addition, the promoters took to the streets and vaccinated every dog in all 15 participating villages!  Check out the photo of Health Promoter, Enna Cardosa from El Fortin, making house visits and vaccinating dogs while toting around her small child.  Like so many other community health promoters, nothing will stop these courageous, dedicated women to improve the health conditions in their villages.

In addition to the Canine Vaccination Campaign, the Community Health Promoters also led the Las Americas Campaign.  In partnership with the Ministry of Health and Etta Projects, the Health Promoters organized and administered free vaccinations to all children under the age of five.  

Etta Projects has continued to provide training to the 45 health promoters. Most recently they have learned about reproductive health, teen pregnancies and domestic violence.  The program has continued to gain momentum and we are set to launch another health promoters program in the Municipality of Warnes, adding 16 new health promoters to the program!  Villages in District 8 of Warnes will soon have trained local women responding to the health needs in their villages.  The women leaders will learn about first aid, women’s health, children’s health, hygiene & sanitation promotion, and public health care policies.  The villages will also receive distribution of fully-stocked first aid kits and participate in a series of community health activities.

We thank you for your generous contribution to this program.  On behalf of the women leaders, the community families, and all of the street dogs, thank you for your support!

Marta, Health Promoter with Yovana and Luis
Marta, Health Promoter with Yovana and Luis

During the rainy season, roads that run through rural Bolivia become virtually impassable.  After a heavy rain it is nearly impossible to travel down the dirt road, for example, that connects the eight villages in what is commonly referred to as La Banda of the Municipality of Minero.  It usually takes days of sunshine before the road can be used again.  In rural areas like La Banda, the rain affects much more than a day of outdoor activity and play.  The weather impacts access to schools, health centers and services as well as economic livelihood.

For the past three years, Etta Projects has been training community-elected local women to serve as community health promoters.  They have received training in first aid, nutrition, women and children’s health, and hygiene & sanitation promotion.  The health promoters play an important role in responding to the health needs of their community year-round, but perhaps their job becomes most important during the rainy season.

At 11 a.m. on January 6th, Yovana began showing signs and symptoms of labor- severe back pain, cramping and diarrhea.  She immediately turned to her community health promoters, Marta and Calendaria.  By noon, the health promoters called the ambulance and the women waited and prayed that despite the heavy rain and impassable roads the ambulance would be able to arrive to the village to bring Yovana to the hospital.

While they waited for the ambulance, Marta and Calendaria put the lessons learned from the women’s health unit into practice. They held Yovana’s hand, kept her calm and led her through breathing exercises.  It was not until almost 12 hours later that the ambulance finally arrived to the village.  By this time, Marta and Calendaria were not about to leave Yovana’s side so all three women boarded the ambulance and started the commute to the hospital.  About half way there, Yovana was ready to deliver.  With no other options, Marta and Calendaria were forced to deliver the baby in the ambulance.  When they arrived to the hospital the doctor said the promoters did a “flawless” job.  Today both mama and baby - Luis Fernando Duran, 4,400 kg.- are doing well! 

The support that Marta and Calendaria gave to Yovana and Luis Fernanado is just one out of countless moments that proves both the need for and the effectiveness of Etta Projects’ health promoter program.  These women health leaders understand the health needs in their community, and they also understand the gap between their village and the available health services.  They are uniquely positioned to effectively respond to community health needs.  These women are known as community health promoters, but we like to refer to them as community heroes!

Roads in La Banda
Roads in La Banda
Roads in La Banda
Roads in La Banda

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Organization Information

Etta Projects

Location: Port Orchard, Washington - USA
Website: http:/​/​www.ettaprojects.org
Project Leader:
Pennye Nixon
Port Orchard, WA Bolivia

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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.

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