Continually Working Ourselves Out of a Job, One Community at a Time

Continually Working Ourselves Out of a Job, One Community at a Time

Bolivian nurses. {Photo credit: MSH.}Photo credit: MSH.

Building local capacity is a pillar of the United States Agency for International Development's USAID Forward reforms. This post is one example of how USAID worked through Management Sciences for Health (MSH) to build, nurture, and support a local development stakeholder that is still thriving today. The story was written by global health writer John Donnelly, and first appeared in MSH’s book Go to the People in 2011. Cross-posted on Modernize Aid in the Modernizing Foreign Assistance Network (MFAN) blog field feedback series.

“We found a role model” SANTA CRUZ, Bolivia – It was a simple ceremony in the city of Santa Cruz, Bolivia, marking the end of a five-year relationship. It felt, in the words of one participant, “like the cutting of the umbilical cord.” Newly freed were two organizations: MSH and PROSALUD, a nonprofit Bolivian healthcare group. The two had worked intensely together with USAID funding designed to support the local group in building up health systems in Bolivia. Mission accomplished. For MSH, that ceremony in 1990 fulfilled one of its fundamental goals: When its work is over, it leaves behind a locally run center of excellence in health care. For PROSALUD, the ceremony signaled the beginning of being on its own. Now, more than a quarter-century since the start of the relationship, both organizations look back and see they forged an approach to development that allowed a local organization to prosper. “It was a moment of celebration, of joy,” Carlos Cuellar, one of the founders of PROSALUD, said as he recalled the long-ago ceremony. “It was not a moment of concern that one side was losing the opportunity to do more business. From our side, it was a moment of uncertainty because of the many challenges left, but we also thought, ‘OK, we need to be on our own.’” Ron O’Connor, MSH’s founder, says the relationship worked because both sides had the same goal. “Some of the success was due to MSH’s willingness to recognize good people whose strengths we could support and build on,” he said. “There were highly motivated Bolivians concerned about how to get health care to a wide array of people in Santa Cruz, in the lowlands area in Bolivia. What we really did was orient them: help them organize systems of affordable care and preventive medicine. They organized the community in a way that allowed them to begin on a small scale to provide health care for a low fee.” PROSALUD soon started securing its own funding from the US government. Even as it expanded services in Bolivia, it also was advising other nonprofits in other countries on how to operate more efficiently and build stronger health systems. Today, PROSALUD has created a primary and secondary health care model that works in six of Bolivia’s nine departments, operating 27 clinics, five hospitals, and one child development center. All of its clinics have pharmacies, delivery rooms, waiting rooms, and reception rooms. The clinics and ambulance services operate every hour of the year. And while it is primarily known for providing quality services at a low cost, its reach and accessibility has combined to produce extraordinary numbers in health service delivery: more than 6.7 million medical consultations, more than 2.2 million immunizations, and more than 75,000 births. When Cuellar looks back at the start of the relationship with MSH, he sees many factors were in alignment. “We were a group of young people, and we were naïve to believe that we could become an institution and not just a project,” he said. “I was just 30 years old. Most of us were that age. We believed a dream was possible. We were lucky to find a good partner—actually, we found a role model – and MSH was lucky to find people who really believed this was possible; that we could build something that lasts.”


Charles Amos
My relative of 7years, from Guyana, South America, had a heart surgery in India in March 2012, and has developed some problems. She was taken to the Georgetown Hospital, Guyana, and is there for over 5 weeks suffering, since there is no Cardiologist in the country to treat her. There is none in the country and no efforts are being made by anyone to get a Cardiologist into the country. We are a poor family and no one seems to concern. Can anyone in the World save this child from dying. I am begging for help. i took care of her from a baby and it frustrating to see her suffering to death.

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