Public health emergency preparedness is essential to mitigate pandemics effects, especially in low-resource contexts. This retrospective analysis evaluates planning and response capacities, available resources, and care management, among indigenous communities living in rural areas of the Gran Chaco Region of Santa Cruz Department, Bolivia, during the first wave of the Covid-19 pandemic. Authors derived and pooled original data from local databases on positive cases, deaths, tests executed, and vaccination registers. The population was administered two surveys by convenience sampling of healthcare facilities of rural communities insisting in four municipalities of the Province and to heads of communities, accordingly. Data collection period was from May 2022 to June 2022. The first Covid-19 case in the area was recorded on April 17, 2020, and the maximum peak of daily records during the first wave was 113 cases in September 2020. A total of 39 healthcare facilities were surveyed, insisting in 117 communities. Data from the healthcare facilities survey showed that 50% were prepared for the pandemic. Although approximately 85% of the pooled received information from the MoH on the contact tracing methodology, 65% received practical guidance on the clinical management of patients. 58% of the facilities arranged temporary beds, 71% in different locations (e.g. schools). Most facilities were supplied with equipment such as pulse-oximeters (79%), oxygen cylinders (75%), and antibiotics (63%). Only eight per cent of respondents stated the equipment was present before the pandemic began, while 46% received it afterward. 69% of respondents reported unpreparedness for the following wave. Rural communities of the Chaco were largely unprepared and suffering from pre-existing resource challenges for communities’ care. Although the first wave arrived six months later than the rest of the world, half of the responders reported an adequate preparedness level, and public policies did not address the region with appropriate interventions.