Conclusions and Recommendations Xxxx Xxxx was an exciting, successful project that pioneered innovative approaches to improve child health, particularly SECI and H/PD, and learned a lot about when and how to apply these approaches in rural Bolivia. The project successfully met nearly all of its objectives and surpassed many, as presented in the Results Summary Table. Vaccination coverage increased dramatically, the numbers of acute respiratory infections seen by health services and Promoters increased by 224% from 2001 to 2003, nutritional status improved in the majority of children participating in the H/PD sessions and 54% of children with diarrheal diseases received more liquids, compared with a baseline of 21%. 85% of children received Vitamin A compared with the project objective of 50%10. In 2000, only 13% of children received a checkup at the health center within their first week of life. In 2004, 41% of children received a check up within their first week. Community members, health personnel, SC, and APROSAR attribute these achievements to several factors including: • SECI planning together sessions raised awareness and knowledge about communities’ health problems and status using simple-to-understand tools and processes so that community members, authorities, and health personnel understood the information and could discuss and plan ways to improve health status together. • CB-IMCI increased community access to trained Promoters who helped families learn to identify danger signs and problems during home visits and community meetings and served as an important bridge to the formal health service. In some cases, Promoters provided basic health services (cotrimoxazole for ARI, ORS for diarrhea, paracetamol). • Increased presence of health personnel in communities due to SECI sessions, better coordination with Promoters and communities and, at times, assistance with transport and/or gasoline from Wawa Sana for supervisory and program visits; • The recently introduced universal health insurance (“SUMI”) likely contributed to improved economic access by making health services free to children under five years old and pregnant women. • Program management was notably strengthened since the MTE to focus more on team efforts to coordinate actions, decentralize financial monitoring, monitor progress during monthly (local) and quarterly (all project areas) quality circle meetings. One objective that Wawa Sana did not meet, due to policy and cost structure constraints as previously described, was for 80% of Promoters to have had adequate supplies of ORS. Health personnel, Promoters, community members, and SC and APROSAR staff all strengthened their technical, organizational, and management capacities to identify health problems, set priorities, work together to plan and take action to address these priorities, and monitor their 10 No reliable baseline data existed for comparison.
