Effectiveness of the CBC Approach. Strategies for communication for behavior change included: face-to-face education through home visits, group meetings to discuss topics, use of visual aids (cartillas), and the implementation of an intercultural approach based of the results of the ethnographic study mentioned in Section B.2.c. The home visits and one-on-one communication have been very effective, along with use of “cartillas” by HVs as teaching aids. Since many people are illiterate, the use of cards with pictures is appropriate. Group education has not been feasible in all of the project communities. In a culture where people are “busy” with agricultural tasks, on which their survival depends at a subsistence level, it is difficult to get people to spend time in meetings. Even the home visits have to be planned when the family has time. Otherwise, family members will not sit down and engage in a conversation regarding health. As awareness of the importance of disease prevention and timely treatment increases, people are more willing to spend time learning. The implementation of the intercultural approach began in Ancoraimes, and is gradually being expanded to other geographic areas. In order to bridge the gap between traditional Aymara communities and CSRA/MOH physicians and nurses, the CS Project made a series of changes in birthing practices in hospitals, and trained promoters and communities in the use of medicinal herbs to treat common health problems. The intercultural approach was highly effective in opening new channels for behavior change, especially in the number of births attended by health personnel. In Ancoraimes, the number of deliveries assisted by trained staff increased by over 50%, from 84 births in 1998 to155 in the year 2000. During the final evaluation interviews, almost all health volunteers and many mothers and fathers mentioned their delight with the new opportunity to learn how to prepare and use traditional medicines.
