There are clear advantages to utilizing such persons compared to providing medical training programs for persons without previous experience in any health-related occupation. Their training can be done in a short time, and they can be sent back rapidly to their accustomed localities to make use of their newly acquired knowledge and skills. On the other hand, it may be expecting too much of an agricultural extension agent or malaria eradication worker to put additional health service burdens on him.

The area to be covered by the $5 million health services loan is the same as that for which a rural sanitation loan of $9 million is planned for fiscal 1976 to provide potable water and sanitary waste disposal facilities to rural communities.

This program will be concentrated in the Departments of Cochabamba, Santa Cruz, and north Chuquisaca in villages of 100 to 2.000 persons. It is expected to benefit as many as 700,000 when in full operation.

The sanitation program is expected to help the Bolivian Government meet one of seven specific public health objectives which it hopes to attain by 1978 that is, to provide potable water systems to 180 rural communities of less than 2,000 inhabitants.

The AID mission in Bolivia believes that expanded environmental sanitation programs and safe water supplies are key elements in better health for Bolivians.

The other objectives which the Bolivians have set for themselves, with a 1978 target date are:

Malaria eradication: To stop the decline of malaria prevention of recent years which has seen cases of malaria go from 387 cases in 1968 to an appalling 4,865 cases in 1973.

Immunization: To provide vaccinations against measles, whooping cough, diphtheria, tetanus, and polio to 80 percent of the children under 5 years of age.

TB control: To give tuberculosis vaccinations to 80 percent of the population at risk between birth and 20 years, an estimated 1.5 million persons.

Maternal/Child Health: To obtain a 20 percent reduction in maternal mortality.

Nutrition: To reduce clinical malnutrition in children under 5 and reduce endemic goiter by 20 percent by providing experimental treatment to 8,000 persons.

The United States has indicated its interest in helping the Bolivian Government in the areas of maternal/child health and nutrition. At the same time, the ambitious program announced by the Bolivian Ministry of Health has been greeted with some skepticism by the AID mission since it makes no provision for a true health system or for the necessary administrative coordination.

POPULATION PLANNING

Until recently, Bolivia had no official family planning policy or officially sponsored family planning clinics.

In recent months, however, the Government has begun to move on this front. The Ministry of Health, with AID assistance, is planning

to open five family planning clinics which are expected to provide services to at least 35,000 women annually by 1978. A mobile health clinic with a family planning component already is operating, and a maternal and child health center at Ayo Ayo was to be opened in

June 1975.

The Bolivian National Family Center (CENAFA) has published five bulletins and five reports on family planning and has conducted some 23 courses and seminars on family planning for members of labor unions, students, nurses, public officials, and health educators.

There are also programs in Bolivia sponsored by such international organizations as the United Nations Fund for Population Activities (UNFPA), the International Planned Parenthood Federation (IPPF), and the Pathfinder Fund.

For fiscal 1976, AID will carry forward a long-range program of help to the Bolivians in family planning. Among activities supported under the program, which is expected to cost $2.5 million by its 1977

termination date, are:

A responsible parenthood program in the Bolivian Ministry of Health's Maternal-Child Health Department;

CENAFA's demographic research and the dissemination of results:

The MCH center at Ayo Ayo;

A population element as part of preventive medicine departments in local universities; and

The Bolivian Association for Sexual Education, a private group fostering responsible parenthood.

The Government of Bolivia is to provide the cost of counterpart personnel and certain facilities costs. To date the Bolivians have contributed about $159,000 of project costs. The amount is expected to increase as the AID funding declines.

NUTRITION

The problems of malnutrition in Bolivia are closely linked with the country's agricultural productivity.

The United States has assisted the Bolivians for a number of years with its nutrition problems through shipments of title II Public Law 480 food commodities. In both fiscal 1974 and 1975, those shipments amounted to $2.2 million. For fiscal year 1976, the amount is to be increased to $1.5 million.

This food benefits an estimated 286,000 children of preschool and primary school age, as well as expectant and lactating mothers.

At present the Bolivian Government is working on a national nutrition program for implementation in fiscal 1977.

4. EDUCATION AND HUMAN RESOURCE DEVELOPMENT

There are small schools all over Bolivia-perhaps as many as a thousand of them built with help from AID through the community development program or through a small special development fund which assists self-help projects benefiting the rural poor. There is great public pressure for education, and a school is often the first thing a

community will ask for. Almost all children in the country spend some time in school.

The result, however, is that many rural children "may have access to a one-room school, offering an irrelevant curriculum through two or three primary grades taught by an ill-trained teacher." 1 The rural drop-out rate for primary school is in the range of 90 percent. Only 40 percent of the people are literate, according to official statistics; more realistically it has been estimated that the functional literacy rate may be as low as 10 percent.

Although 57 percent of Bolivians speak only an Indian languagemainly Aymara or Quechua-the entire school system operates in Spanish. Teachers in Indian areas do use the language of the area with the youngest beginning pupils, but there are no educational materials in Indian languages; all materials are in Spanish.

AID has recently begun to help the Bolivian Government improve its rural education system in a coordinated way. AID's education sector assessment has identified several key problems:

Weaknesses in planning and administration by the Bolivian Ministry of Education;

Irrelevant curricula;

Poor teacher training;
Inadequate facilities; and

Not enough technical and financial resources to meet the demand for primary schooling beyond the third grade.

The AID program in education is concentrating on alleviating these problems.

EDUCATIONAL MANAGEMENT AND DEVELOPMENT

A $9.56 million AID loan authorized in fiscal year 1974 and a $2 million 3-year technical assistance project begun in fiscal year 1975 are helping the Bolivians to

Continue decentralizing the administration of the country's educational system, by establishing district administrative centers at the departmental level;

Improve the Ministry of Education's planning, implementation, financing, evaluation, and other management systems; and

Undertake a comprehensive reform of rural education, with curricula and instructional materials relevant to the needs of rural people.

The program will include work on bilingual education and nonformal education which will enable the Education Ministry to expand its activities in these two areas.

RURAL EDUCATION PROJECT LOAN

AID is proposing to help the Bolivian Government test out a prototype of an improved comprehensive rural education program in a pilot area within the valley/lowland regions where AID is concentrating its agricultural and other assistance programs.

1 Agency for International Development, Fiscal Year 1976 Submission to the Congress, Latin America Programs, p. 19.

A $5 million fiscal year 1976 loan for this purpose would help toTrain rural primary teachers;

Introduce new primary school curricula;

Make rural "nuclear" schools into focal points for both formal and nonformal community education; and

Remodel and expand primary and normal schools.

Through this program, for which the Bolivian Government is expected to pay nearly half the cost, it will be possible to assess the combined impact of new curricula and teaching materials, teacher training, and improved facilities.

The results of this experience could then be used to help improve rural education throughout the country.

RURAL TEACHER TRAINING LOAN

One of the key problems in education clearly is the system of training teachers for rural primary schools. We visited a normal school outside of Cochabamba-the Paracaya Rural Normal School-which illustrates some of the difficulties that stand in the way of better rural primary education.

The purpose of the school is to train teachers for rural areas; however, the curriculum is largely an urban-oriented academic program including subjects like sociology, psychology, philosophy, physics, chemistry, and language. We were told by the AID mission that no agriculture courses were given at the school, but the director assured us that the school had a professor of agriculture and that part of the program consisted of taking care of crops and animals.

Only a few of the students in the school come from campesino families, and most use their training to escape to the cities. They must teach in rural areas for several years, but then they can, and often do, seek openings in urban schools.

The physical facilities are too small and exceedingly primitive. Professors are lodged three to a room. The director of the school described the boys' dormitory as "fit for cows"; we agreed it might make a good barn, but was hardly suited to its present purpose. The school has no laboratories or library.

AID proposes to lend the Bolivian Government $7.5 million to pay for part of the cost of overhauling the rural teacher training system. Under the program:

The country's rural teacher training schools would be consolidated, with eight being expanded, improved, and equipped, and the other seven being converted to secondary technical schools for rural students who do not want to become teachers;

15,000 rural primary school teachers, 400 normal school instructors, and 20 members of the faculty of the Superior Institute of Rural Education would be trained to use new bilingual rural curricula and materials and improved teaching methods; and

The Bolivian Government would increase teachers' salaries, provide textbooks and other materials, and furnish and equip rural teacher training schools.

The program is not geographically limited, and is expected within several years to benefit the bulk of the rural families in the country.

5. CONCLUSIONS

AID in Bolivia is no longer undertaking new activities in areas other than agriculture and rural development, health, population, nutrition, and education.

The main concentration of the AID program is on expanding income and opportunity for the small farmer and the rural poor. However, there is a strong secondary emphasis on quick increases in food production, which has led to several activities focused primarily on farmers at the upper range of the small farmer group and on areas of the country likely to show a more rapid response to assistance programs. One result of this approach may be to increase already existing economic disparities among regions. Another may be to create and widen gaps between small-to-medium farmers who are able to move quickly into commercial farming and the bulk of the small-farm population who are likely to remain for some time at the subsistence level.

Nevertheless, the mission seems to have increased recently the amount of assistance it is prepared to make available for programs to help the poorest people in the rural areas, and it has developed a number of imaginative new projects designed to enable the rural poor to become more productive and to enjoy a better life.