One of the country's most pressing public health problems, Chagas accounts for 13 percent of all deaths in Bolivians between the ages of 15 and 75. The disease, which is caused by the parasite Trypanosoma cruzi, can produce fatal inflammation of the brain and heart tissues. The parasite is transmitted primarily by bloodsucking insects, which find an ideal habitat in the adobe and thatched roof houses common in the Bolivian countryside, and by tainted blood transfusions.

Under the $53.7 million program, to which the IDB is contributing a $45 million loan, Bolivia's Ministry of Health and Social Insurance will launch a comprehensive campaign that aims to control disease-bearing insects, treat Chagas disease in children under five, safeguard national blood-bank supplies, and implement an epidemiological surveillance system. The Pan-American Health Organization is providing technical support to the program.

During the program's first stage, teams will attempt to fumigate each of the estimated 700,000 homes within the Chagas endemic area (see map). During the second stage, reinfestation will be controlled by training communities in surveillance and control techniques.

In addition to targeting Chagas, the program will strengthen Bolivia's National Epidemiological Surveillance System with extensive training and information-sharing initiatives. The country's laboratory network will be modernized, and blood banks and transfusion centers will receive equipment and training in quality control measures.

Public education campaigns will be launched to encourage citizens to make voluntary blood donations at centers throughout Bolivia. These measures will help prevent the spread of other serious blood-borne diseases such as hepatitis and HIV/AIDS in addition to Chagas.

The IDB program funds also will be used to finance studies of reform strategies and pilot projects aimed at broadening coverage of health care to Bolivia's most vulnerable groups, particularly in rural indigenous communities.