Factors Affecting Achievement of Program Objectives. The census based methodology and a well maintained registration system were key factors in attaining improvements in immunization coverage. Home visits to give vaccinations has been a huge boost to increasing and maintaining the percentage of children with the full schedule of vaccines, and to providing vaccines by the time a child reaches 15 months of age. Information from the KPC 2001 indicates low drop out rates in Carbauco (3%), Ambana (5%), and Anoraimes (1%), with a somewhat higher rate in Puerto Xxxxxx (9%). Education provided during home visits by VHs and during group meetings has also influenced community acceptance of child vaccination. Radio messages sponsored by PROSIN (a Bolivian government health organization financed by USAID) and the MOH have increased awareness regarding immunizations. The Seguro Básico de Salud (Basic Health Insurance) provides vaccines free of charge. Vaccines have been available in most geographic areas, and cold chain management has been adequate, although not all posts have refrigerators. Training has been given in the repair and maintenance of refrigerators to staff at health centers. In areas without electricity or gas, ANs pick up vaccines at the health center and transport them to communities in a thermos. Specific days are scheduled for this activity and ANs without transport are given a motorcycle to use. Temperatures of refrigerators are monitored and when black outs occur the vaccines are discarded. In Puerto Xxxxxx, the municipal government equips all health facilities with refrigerators and thermoses, and is covering maintenance and gas costs.
Factors Affecting Achievement of Program Objectives. The existence of a census of all households in Carabuco and Ancoraimes has facilitated follow- up of dehydration cases. The majority of health personnel (90%) received clinical training in the Integrated Management of Childhood Illnesses (IMCI) at the Hospital Obrero in La Paz. Key aspects of the IMCI training were replicated with the HVs. These training events better prepared health personnel and volunteers to provide integrated care, including control of diarrheal disease. Educational activities included information on prevention of diarrhea, the relationship between child nutrition and diarrheal disease, and the importance of using ORT to prevent dehydration. In areas where a census did not take place, the mobile health team made continual visits to communities where the IMCI approach was implemented. ORS packets were available during the period of project implementation at health centers, health posts, and in communities through HVs. The ORS packets are provided free of charge to the population. In Ambana, Oral Rehydration “Units” have been established and are implemented by health volunteers. The ORT Unit consists of a community volunteer who has been trained to provide ORS packets, education, and referral of cases of dehydration. The ORT Unit often functions in the home of the volunteer. The health centers in Carabuco, Ancoraimes, Ambana and Puerto Xxxxxx are equipped to treat severe dehydration. Cases that cannot be resolved are referred to Hospital Xxxxxxx Xxxxxxx in La Xxx, which has a formal agreement with CSRA. Several communities have benefited from the construction of water systems that were facilitated by CSRA, and were sponsored by the local municipal governments, “Agua Para el Pueblo” (Water for People), and/or Plan International.
Factors Affecting Achievement of Program Objectives. IMCI training and the use of a clinical history form based on the IMCI approach has helped health facilities improve pneumonia case management. Use of motorcycles to transport sick children to health centers has improved access, and educational sessions in homes and at group meetings have helped to increase awareness. Essential medicines have been available for treatment of pneumonia cases during the implementation of the project. The majority of health centers have made a commitment to provide 24-hour service, assigning someone on duty during nights and weekends. The AN is to be available at his/her home to treat emergencies when not on duty at the health post. The treatment is free of charge to the patient, and costs are reimbursed to health facilities by the Basic Health Insurance. Health volunteers have been trained to count rapid breathing using a chronometer and observe chest in-drawing to diagnose cases of probable pneumonia. The most highly trained HVs are authorized to administer cotrimoxazol.
Factors Affecting Achievement of Program Objectives. The key factor for the achievement of the nutrition objectives was the implementation of growth monitoring in a majority of project communities. This process was greatly enhanced by having census information for all the communities in Carabuco and Ancoraimes, which permitted health personnel to target children for participation in the nutrition component. In Puerto Xxxxxx and Ambana, where not all communities are censused, coordination with local authorities helped to identify children under 2 years of age, and the mobile health unit provided growth monitoring and nutrition education. Personal contact with mothers during home visits enabled health personnel and volunteers to provide effective nutrition counseling. Health personnel and HVs were trained in growth monitoring, Vitamin A supplementation and nutritional counseling. ANs, with the assistance of health volunteers, made follow-up visits to families with children who were not gaining weight. The importance of keeping the child growth card is stressed by CSRA/MOH, and the procedure of keeping duplicate cards has facilitated registration and follow-up. The development of a system for nutritional rehabilitation with criteria and procedures provided health staff with clear guidelines to actually implement the program. Growth monitoring every two months enabled ANs and HVs to assess children’s growth tendencies and assist families to take corrective actions. In Puerto Xxxxxx, the Municipal Government assisted the Health Center to acquire a vitamin rich cereal from Peru, which is being used to rehabilitate malnourished children. Since many families to not have enough food, this strategy could make a difference in the number of families who are eligible to enroll their children in the nutritional rehabilitation program. In Carabuco, the Municipal Government has approved the purchase of a multi-grain cereal from Cochabamba to be used in nutritional rehabilitation. PROCOSI (a network of health NGOs in Bolivia) launched a nutritional improvement project in 1999, sponsored by a USAID funded project, Linkages/AED. This project provided technical assistance to PROSIN regarding child feeding and counseling practices. The PROSIN project works closely with CSRA/MOH services and is promoting the Linkages methodology, which includes an educational flip chart and training for health workers in application of the Observation, Reflection, Personalization, and Action (ORPA) methodology with mothers. ORPA is an educational...
Factors Affecting Achievement of Program Objectives. Formation of women’s’ groups to address reproductive health issues enhanced the process of behavior change. Discussion on maternal health topics was generated by the use of visual aids, socio-dramas, and other participatory methods. Health personnel and HVs received training in reproductive health and were given a manual for home birthing procedures. Clean birth kits were distributed in all of the geographic areas. The Basic Health Insurance covers transport costs for obstetric emergencies and pre and postnatal care. A good referral system is in place with the District Hospital in La Paz to receive and properly treat obstetric and neonatal emergencies. CSRA received assistance from PROCOSI to implement a Reproductive Health Project, which covered the salary of an educator to work with women’s groups and funds for the production of educational materials. CSRA made an excellent selection of an Aymara reproductive health educator, who is very well received by the communities. She has made great headway in gaining trust and motivating behavior change among local women’s groups.
Factors Affecting Achievement of Program Objectives. Contraceptives are distributed by health centers, health posts, mobile health units, and through home visits. Home visits provide a private setting for family planning counseling. All health personnel received training in various sexual and reproductive health topics sponsored by CSRA, the MOH, PROCOSI and Pathfinder (a US PVO). Health personnel have received training in family planning logistics management (FPLM), a JSI (Xxxx Xxxx Incorporated) initiated logistics management program in Bolivia.
Factors Affecting Achievement of Program Objectives. The achievement of the nutrition objectives was enhanced by the implementation of the AIN methodology in 51 project communities. As mentioned above, visual materials developed by Linkages with pictures of bowls and spoons showing the quantity of food required based on the age of the child were reproduced and included in community educational materials. Health personnel, CARE Extensionists, and CHWs were trained in growth monitoring and nutrition counseling. CHWs made follow-up visits to families with children who were not gaining weight, often in the company of the CARE Extensionist or the RAN. The importance of keeping the child growth card is stressed by the MOH, and parents are required to present the card as a requirement for consultations at the health center. Improvements of Vitamin A coverage for children age 12-23 months was enhanced by including administration of capsules as part of the MOH immunization program. Demonstrations were given in each community by CHWs and Extensionists to teach mothers how to prepare Vitamin A and iron rich foods. Monthly growth monitoring enabled CHWs and mothers to assess children’s growth tendencies and assist families to take corrective actions along with improved feeding practices using fruits, green leaves and soy products. The consumption of chicken and eggs increased due to the micro- credit program, and home gardens now produce a variety of fruits and vegetables year round. The use of soy became more popular among project families due to cooking demonstrations, promotion of foods made from soy products at local fairs, classes for school children on nutrition, and promotion of soy during school events. Following is a summary of the findings gleaned from interviews during the Final Evaluation regarding nutritional improvement. ❑ CHWs completed all the recommended activities for the promotion of home food production. ❑ Many men participated as garden promoters and through this activity began to function as health volunteers. ❑ Children are eating food produced in the gardens. ❑ Some families sell extra produce and buy other foods with the money. ❑ Families learned how to make organic fertilizer. ❑ A cooperative was formed to provide credit to families who want to continue with home food production. ❑ Agricultural promoters trained in the CS Project are now working with other projects. ❑ Non-traditional irrigation mechanisms, such as drip systems, were implemented.
Factors Affecting Achievement of Program Objectives. The CS Project implemented several strategies to increase exclusive and prolonged breastfeeding. All 14 health posts and the Municipal Health Center were assisted to become certified as
Factors Affecting Achievement of Program Objectives. The combined efforts of CARE and the MOH to improve the quality of care at health centers, coupled with IMCI training for all MOH technical personnel and monitoring of community case management and referrals were key factors in the achievement of the PCM objectives. Activities in PCM form an integral part of the IMCI strategy currently being implemented throughout Nicaragua. All of the health units have reorganized the flow of patients, the functions of each staff member, and the use of files and IMCI instruments. Integrated Municipal Visits support the work of the Health Posts in that physicians provide direct services to community members. Since 2000, the project began applying the service quality survey guide, a monitoring instrument used by the Municipal Health Management Team three times per year in each of the 14 health posts. The instrument includes: 1) direct observations of consultations provided by health personnel, covering all aspects involved in IMCI strategy application; 2) a post-consultation interview with a mother to determine her level of comprehension of counseling offered on the administration of medication, feeding of the child, and danger signs; 3) verification of the existence of supplies that accompany the IMCI strategy in the health unit; 4) a guide to monitor training applied in the observation of counseling or an educational session. The CS Project has participated in national-level Ministry of Health sessions to validate the country’s Official Community-based IMCI Manual. Based on recommendations of the MTE, a greater focus was placed on IMCI training within communities, preventing isolated training in PCM and CDD and nutrition. The project adapted and reproduced the PAHO Community-based IMCI Procedures Manual. The manual was delivered to 90 Base Houses after re-training was offered to 175 community volunteers. Interviews with CHWs during the Final Evaluation indicated that the new manuals are in use, although some have difficulty understanding the flow charts for classification of a sick child.
Factors Affecting Achievement of Program Objectives. Several strategies enhanced the fulfillment of the CDD objectives. The IMCI strategy was implemented at health posts and at the community level to improve diagnosis and treatment of childhood illnesses, including diarrheal disease. CHWs learned to recognize danger signs and advise mothers regarding home management and immediate referral for severe cases. Eighty-six communities or xxxxxxx have Base Houses equipped with chlorine, oral re-hydration solutions, and referral and educational materials. CHWs received on-going training and supervision in diarrhea case management through workshops and monthly meetings at the Health Post. Messages given by CHWs and MOH staff were reinforced through radio programs and spots including songs about hygiene and use of ORT. Communities received orientation regarding environmental health, especially after Hurricane Xxxxx. Community education given by project staff is based on participatory methods, and is complemented by demonstrations of ORS preparation. Educational activities include information on prevention of diarrhea, the relationship between child nutrition and diarrheal disease, and the importance of using ORT and not antibiotics or anti-diarrheal medicine. MOH support of the Base Houses was a key factor in improving utilization and coverage of services. Parents were instructed to first visit the Base House and then come to the Health Post with their referral slip, in cases of diarrhea without dehydration. This procedure eased the workload at Health Posts and enabled MOH staff to dedicate time to more serious cases. The MOH also promoted the Base House as a place where parents could receive follow-up for a child who had been treated at the Health Post. Participation of schools in health education for students served to reinforce health messages and encourage healthy behaviors. Sixty-four schools participated in the CS Project by giving classes in hygiene and prevention of diarrhea, using CS materials developed or adapted by CARE. School health activities included the preparation of murals, organization of health fairs, and use of socio-dramas, music and theater to convey messages. The Ministry of Education (MED) is very interested in health education and plans to provide continued support and supervision to teachers. The schools coordinated with health posts and CHWs in the organization and implementation of regular community clean-up campaigns. Visits during the Final Evaluation confirm the overall neatness and ord...
