Water for people.pdf - WHO Thailand Digital Repository

4 6 8 / P I L O T C A S E S T U D I E S : A F O C U S O N R E A L - W O R L D E X A M P L E SLake Titicaca Basin, Bolivia and PeruTable 21.3: TDPS population dataPeruBoliviaPopulation 1,079,849 1,158,937% of total 48.2 51.8Average population density (inh/km 2 ) 17.6 15.56Maximum density (inh/km 2 ) 215 245Minimum density (inh/km 2 ) 2.0 2.3Rural population (%) 60.8 47.9Urban population (%) 39.2 52.1Growth rate (%) 1.6 from -1.6 to 9.2Population trends generally decreasing rural decreasingPopulation in poverty situation (%) 73.5 69.8Peru and Bolivia show comparable population situations in terms of numbers, density andthe high percentage of people living in poverty. There are, however, more rural populationsin Peru than in Bolivia.Table 21.4: Population in main citiesMain cities Population % of countrypopulationPuno (Peru) 91,877 4.10Juliaca (Peru) 142,576 6.37El Alto (Bolivia) 405,492 18.11Oruro (Bolivia) 183,422 8.19where they crowd into degraded districts. In 1993 Bolivia’s urbanpopulation grew by 4.3 percent while the rural rate was negative at-0.4 percent. In the same year, the Peruvian side of the TDPSregistered 3.4 percent annual growth in population, while the ruralpopulation grew at only 0.7 percent.EducationThe conditions of structural poverty in the zone are such that thestruggle to survive takes precedence over anything else. Educationis therefore not a priority. The illiteracy rate is 22 percent and isdifferentiated by area and gender. It is higher in rural areas than incities, and within rural areas, it is higher for females. Among theproblems affecting the quality of education are dispersion of therural population and the existence of non-Spanish mother tongues.The Bolivian Educational Reform Programme has been trying toaddress both situations for eight years.HealthHealth problems in the TDPS system are clearly related to endemicpoverty and, by extension, to such attendant problems as poornutrition, lack of clean water and sanitation, a fragile environmentand the absence of leverage to help people improve their lives orlivelihoods. In several cases, the problems are compounded by theexistence of strong and persisting ancient cultural traditions; childvaccination, for example, has only recently been adopted by localpopulations because of legal enforcement. The main healthindicators in the region include:■ high rates of morbidity and mortality, mainly in children;■ low life expectancy at birth (lower than the national average);■ high incidence of infectious, respiratory and gastrointestinaldiseases;■ high incidence of diseases linked to conditions such as waterquality (gastrointestinal diseases) and climate (respiratory diseases);■ deficient nutritional levels in general, both in quantity andquality; and■ health services that are generally poor and mostly concentratedin urban areas.Economic activitiesBolivia, with a human development index of 0.648, and Peru, with0.743, are both in the middle human development range. The GrossNational Product (GNP) is US$116.6 x 10 3 million Purchasing PowerParity (PPP) in Peru and 19.2 x 10 3 million PPP in Bolivia. GNP percapita is US$4,622 and US$2,355 PPP respectively. However, in1993 it was estimated that GNP per capita in the Bolivian sector ofthe TDPS amounted to 35 percent of the national value.Table 21.5: Health dataPeruBoliviaLife expectancy (years) 60.6 58Available hospital beds/1000 inhabitants 1.1 1.3Number of physicians in the area 212 1,128Infant mortality rate/1000 children < 1 year 81 121Children suffering chronic malnutrition (%) 71 84Morbidity (children < 1 year)respiratory diseases (%) 39.6 27nutritional deficiencies (%) 18.5 18diarrhoea and gastrointestinal diseases (%) 18.7 13other (%) 23.2 24Morbidityrespiratory diseases (%) 20 22nutritional deficiencies (%) 14 15diarrhoea and gastrointestinal diseases (%) 7.6 6other (%) 66 57The health challenges facing the basin are significant in both countries.