Dear colleagues and friends:

I am very pleased to share with you two remarkable articles about a primary health care program in Bolivia that has been in operation for more than three decades now, developed and led this entire time by a remarkable husband/wife team, Dr. Dardo Chavez and his wife, Mitma Claure, who is a nurse. As the article demonstrates, through regular home visits and registration of vital events, they have achieved and documented an under-5 mortality rate that is the same as in the United States. Article 1 provides a detailed description of how the program has operated and the principles of CBIO that they have consistently implemented – from creating a census, visiting all households on a regular basis, linking families in need with the health care they need, and engaging the community in program planning, implementation and evaluation.

This paper is a remarkable example of what can be achieved with dedicated, long-term leadership along with a deep commitment to CBIO principles.

The articles can also be downloaded at:    and

The CBIO approach was developed in Bolivia in the 1980s and remains a pioneering methodology that in my opinion merits careful consideration for program implementation anywhere, including in high-income settings. A copy of the original 1999 article describing it is attached.

Feel free to share this with anyone or any listserv that you think might be interested.

Warm regards and best wishes,

Henry B. Perry, MD, PhD, MPH
Senior Scientist, Health Systems Program
Department of International Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD, USA 21205; 443-797-5202