Building and Operating Clinics
Mano a Mano has developed and implemented a remarkably successful low-cost, community-oriented approach to constructing and operating acute care/public health education clinics in previously un-served rural communities. Capital projects are extremely difficult to fund in Bolivia, since communities and organizations can rarely accumulate sufficient funds at one point in time to cover construction costs and mortgages are not available.
By providing a means to establish a clinic, Mano a Mano plants the seed required to sustain health care, health education and family planning within a village. Its clinics become the community center through which serious community issues can be addressed. 
Mano a Mano's Bolivian counterparts organize residents of impoverished communities to participate in planning for, constructing and operating their health clinics, always beginning with the assumption that villagers are capable, motivated individuals who lack the material and educational resources required to improve their health status. Extensive discussions lay the groundwork for developing formal agreements among the elected community leaders, local county officials, the Bolivian Health Ministry and Mano a Mano, defining prior to construction the contributions and responsibilities of each participating entity.
While Mano a Mano provides funding for construction and skilled labor, community volunteers contribute all of the unskilled labor and any locally available building materials such as sand or gravel. Government officials are now including in their budgets funding for a staff position or for other identified clinic needs; over 98% of the doctors and nurses on staff in the clinics are funded by sources other than Mano a Mano. The Health Ministry designates each clinic as the official health care facility for its catchment area, making it eligible for no-cost vaccinations, some medications and any commodities that may become available to government-operated clinics.
The agreements among participants become the blueprint for ongoing relationships between Mano a Mano, the Bolivian government and the clinic communities. By the time a clinic opens, villagers have developed an intense pride in their accomplishments, a sense of ownership of their new facility and a view of themselves as competent individuals who can make things happen.
Children attending the dedication for the Thaqo Pampa Health Clinic
Health workers learn first aid.
In addition to being staffed by a physician and nurse, Mano a Mano trains community volunteers to become Health Promoters who do community outreach, perform first aid, and assist with health education.
Within the first three years after completion, over 85% of Mano a Mano clinics are financially independent, due to the relationships built with the local community and the government, both locally and nationally. Clinics receive medical supplies and equipment from donations shipped from the US on a regular basis, and doctors and nurses participate in continuing health education classes provided by Mano a Mano three times annually.