Strategy of the city of Córdoba: strengthening Primary Health Care in the control of Chagas Disease

By Marcela Marramá 

Undersecretary of Health, Municipality of Córdoba, Argentina. Biochemist from the National University of Córdoba, specialist in Microbiology and Master in Public Health.

The city of Córdoba has become a model of local action, with comprehensive policies that combine health programs, territorial work, education and public-private articulation.

Chagas disease represents one of the main health challenges in Latin America. In Argentina, its history is closely linked to rural development, poverty and internal migration. For decades, control strategies focused on eradication of the vector (the vinchuca), but in recent years the focus has shifted to control of mother-to-child transmission, epidemiological surveillance and public awareness. 

History and general context in Argentina

The detection of Chagas disease in Argentina dates back to the beginning of the 20th century. Starting in the 1960s, the country implemented national vector control programs that succeeded in significantly reducing transmission by vinchuca. However, congenital transmission - from mother to child - remains a major challenge, especially in urban and peri-urban areas.

The progress of control programs in pregnant women, improved serological diagnostics and the decentralization of health policies have allowed Argentina to move towards the elimination of vector-borne transmission in several provinces, including Córdoba.

Specific strategies in the city of Córdoba

Demographic and health context

The city of Córdoba has an area of approximately 576 km² and an estimated population of more than 1.5 million inhabitants. The municipal Primary Health Care (PHC) network is composed of 100 health centers, distributed in different neighborhoods and peripheral areas, which constitute the first level of care within the local health system.

The first level maintains articulation with the second municipal level, composed of the Medical Specialties Directorate, and with the third municipal and provincial level, composed of 7 hospitals. In addition, the first level maintains coordination with the third provincial level, where deliveries take place, guaranteeing continuity and access to more complex services when necessary.

Municipal strategy for the elimination of mother to child transmission

In 2024, the Municipality of Córdoba launched the "Municipal Strategy for the Elimination of Mother-to-Child Transmission of Chagas Disease", in agreement with Mundo Sano Foundation. Its main actions include:

  • Serological screening in pregnant women and women of childbearing age, integrating serological diagnosis in prenatal check-ups and including screening in the Comprehensive Sexual Health Program.
  • Itinerant health mobiles, which visit neighborhood centers and make it possible to perform analyses, ultrasound scans and Chagas diagnosis in the field. We have 4 mobile clinics that visit 3 health centers each, which means that each day we reach 12 health centers with laboratories, guaranteeing accessibility to diagnosis.
  • Integrated epidemiological surveillance, which connects public and private establishments to improve case notification and follow-up.
  • Telehealth, aimed at recapturing positive cases, follow-up and treatment control, allowing continuous and remote monitoring of patients.
  • Training and continuous updating of health teams, ensuring that staff is kept informed about advances in diagnosis, treatment and prevention strategies, strengthening the implementation of the municipal strategy and quality care for the population.

This local strategy focuses on preventing congenital transmission, recognizing that in urban contexts the vector is not the main problem, but rather the lack of timely diagnosis in pregnant women and women of childbearing age.

Strengthening of Primary Health Care (PHC) and territorial work

The strengthening of Primary Health Care (PHC) is one of the most effective pillars to consolidate the control of Chagas disease in Córdoba. At this level, early detection, clinical follow-up and community education actions are concentrated, allowing for a continuous and close response to the population.

PHC is key in a health system because it guarantees accessibility, continuity and coordination with secondary and tertiary levels, optimizes resources and strengthens community participation. Its comprehensive approach makes it possible to implement sustainable disease control strategies, improve maternal and child health and ensure the integration of public, private and community services.

This territorial and PHC approach promotes a more equitable, participatory and sustained health, where Chagas control is no longer an isolated campaign but a long-term public policy. Through proximity to communities and continuous health education, Córdoba is moving towards the elimination of transmission routes and the comprehensive follow-up of affected people.

Impact of control in women of childbearing age

The inclusion of Chagas diagnosis in prenatal check-ups or in women of childbearing age significantly increases the probability of early detection and treatment. This measure not only prevents vertical transmission, but also makes it possible to treat chronic cases that would otherwise go unnoticed. In Córdoba, this approach is integrated with sexual and reproductive health services, becoming a strategic axis for the elimination of congenital Chagas disease.

Awareness-raising strategies

To sustain progress, public awareness is essential. In Córdoba, the main strategies include:

  • Campaigns on social networks and local radios to demystify the disease.
  • Community workshops organized by health centers on prevention and diagnosis.
  • Inclusion of Chagas in the curriculum of municipal schools, promoting early education on the disease.
  • Participation of universities and civil organizations for the dissemination of scientific knowledge in accessible language.

These initiatives seek to make the population aware of the persistence of the disease and to break the idea that Chagas is exclusively rural or that there are no more cases, promoting access to diagnosis and prevention in all sectors of the community.

In conclusion

The experience of Córdoba shows that the control of Chagas disease requires a comprehensive strategy: combining actions with active and timely diagnosis, scientific research, territorial work, community education and specific attention to women of reproductive age. It also highlights the importance of continuous updating of health teams and their active participation in the development and execution of the strategy, as well as guaranteeing accessibility to diagnosis and treatment. Coordination between municipalities and provinces, universities and the public and private sectors is essential to achieve sustainable and effective control. The Cordoba model can serve as a reference for other Argentine and Latin American cities, highlighting the relevance of inter-institutional and community cooperation for the elimination of the disease.