Guayaramerin, with a population of some 41,000, is in the north-east corner of Bolivia on an Amazon river tributary that forms the border with Brazil. Most people make a living from small holdings producing Brazil nuts and rubber. Demand for the latter has fallen sharply, but family income is about US$50 per month, thanks in part to increased trade in lumber with Brazil. Poverty, malaria and leishmaniasis largely account for the high morbidity, mortality, and infant mortality rates. Services are very few. The 20-bed hospital and eight health posts are staffed by auxiliary nurses but they have no medical equipment, supplies or medications.

San Lorenzo is a dusty village of 5,000 people in the department of Tarija in southern Bolivia. In its treeless, arid landscape, most of the 13,000 rural population make a meagre living growing potatoes, wheat, fruits and vegetables or herding beef cattle. The average family income in town is US$100 a month; in the rural areas, families survive on about US$25 a month.

Health status in San Lorenzo is among the worst in Bolivia. Infant mortality is 85 per 1,000 live births. Approximately 60 per cent of the population has tested positive for chagas disease which leads to high morbidity and mortality. Although there is a hospital in town, it has no water and no equipment. For care, patients have to travel to Tarija, an expensive 30-minute bus ride away.

San Lorenzo (Department of Tarija) and Guayaramerin (Department of Beni) were chosen for the two model projects, according to specific criteria developed in cooperation with the Ministry of Health. These included the absence of similar programs, and the extreme poverty and poor health status of the areas.