Future Applications of Lessons Learned. ❑ Continue to expand the census to all project communities and institutionalize the procedure with the MOH and the municipal health boards to assure the continuity of high levels of vaccination coverage for children. ❑ Expand the strategy of tetanus toxoid vaccination for high school girls. ❑ Consider providing health education through the schools regarding the importance of child immunization. It is more difficult to reach older women due to geographic and language barriers. ❑ Develop a communication for behavior change strategy for CS interventions to replace the current focus on giving messages, and assist health workers to make their own “cartillas” and other educational materials. ❑ Consider moving CS activities to additional geographic areas where demographic information shows a significant number of children age 0-23 months and pregnant women. CONTROL OF DIARRHEAL DISEASE
Future Applications of Lessons Learned. ❑ Strengthen linkages between the health facilities and communities to decrease barriers and improve practices in the home and prompt care seeking to address community mistrust and lack of shared values. Emphasize the results of the study on inter-cultural relationships with new MOH staff, and screen candidates for rural positions based on cultural sensitivity indicators. Identify specific behaviors that health personnel should demonstrate in their relations with patients from rural communities, and include these in yearly performance evaluations. ❑ Design and implement a communication for behavior change strategy, appropriate for the local setting, taking into consideration the results of the inter-cultural study. ❑ Prioritize home visits to children who have diarrhea, and train HVs to provide counseling and to make agreements with mothers regarding improved feeding practices and ORT. ❑ Continue supporting municipal governments to sponsor water and sanitation projects. PNEUMONIA CASE MANAGEMENT
Future Applications of Lessons Learned. ❑ Following are some suggestions for improving pneumonia case management:
Future Applications of Lessons Learned. ❑ Continue to expand the census to other communities, along with growth monitoring of all children under age 2, and strengthen the nutritional rehabilitation program. ❑ Use the nutrition intervention as an entry point for community IMCI, and reinforce behavior change in the other CS interventions as part of the home visit and counseling strategy. ❑ Continue training of ANs and HVs in participative educational methodologies to improve communication for behavior change. ❑ Improve quality of care at the Health Sector level through continued support and in-service training in child and maternal nutrition. ❑ Improve the registration process to track child weights, follow-up activities and results, and the administration and record keeping of Vitamin A and iron sulfate. ❑ Improve the supply system for micronutrients. ❑ Make agreements and action plans with each family that has a child with negative growth tendencies, as part of a strategy to prevent moderate and severe malnutrition. ❑ Continue efforts to engage men and local authorities in an analysis of nutrition indicators and creative planning to improve nutritional status, such as home gardens and crop diversification, among others. ❑ Include follow-up of women who have apparently unwanted pregnancies to prevent low birth weight and poor feeding practices, emphasizing self-esteem and value identification. A reflection on values might include: “what values do I have regarding the purpose of life, how can I express these by taking care of myself and by making decisions that will protect my health and the health of others, especially a child whom I choose to bring into the world”. ❑ Consider applying the “Municipal Inter-Sector Model” used in Puerto Xxxxxx to other municipalities. In Puerto Xxxxxx, the municipality has formed an inter-sector committee to address issues in the areas of health, education, infrastructure, transportation, and agricultural production. This municipality has responded to requests from health centers, schools, and communities with allocation of resources. One example is a joint activity between health and education to teach reproductive health to several groups of high school juniors and seniors. ❑ Strengthen efforts to hire more female health workers and to recruit female health volunteers to enhance educational activities with mothers. MATERNAL AND NEWBORN CARE
Future Applications of Lessons Learned. ❑ Continue with the intercultural approach and the implementation of the recommendations of the ethnographic study to improve utilization of services and changes in reproductive health behaviors. ❑ Expand training of men and health volunteers in safe birthing practices, and continue to promote the clean birth kit. ❑ Train ANs in life saving skills. MotherCare (a USAID funded project) developed a training program for level 1 of the Bolivia Health Care System in life saving skills, along with protocols for treatment of obstetric and neonatal emergencies. MotherCare also has a path to survival model for obstetric and neonatal care, which complements the ethnographic study results. The set of educational materials prepared by MotherCare may be of use to CSRA/MOH health facilities. ❑ Continue to promote the use of maternal health cards to track prenatal visits, TT immunization, micronutrient supplementation, delivery and postpartum care. FAMILY PLANNING/CHILD SPACING
Future Applications of Lessons Learned. ❑ Emphasize improving quality in family planning based on the following: information, availability of methods, technical competence, follow-up mechanisms, consolidation of services, and interpersonal relations. ❑ Implement a communication for behavior change strategy to increase family planning users, building upon the successes to date (e.g. home visits, fairs and markets, competitions, and games). ❑ Systematically improve supply system management for contraceptives. ❑ Consider working through MHBs to attain greater synergy between rural schoolteachers and health personnel. Schools provide a captive and receptive audience for health education, and students will soon be mothers and fathers with children of their own. Behavior change is much easier among younger people, and this may be a more cost-effective investment for lasting changes in health behavior.
Future Applications of Lessons Learned. Growth Monitoring ❑ Continue monthly AIN and growth monitoring meetings in each community, along with tracking of children under two to assure their participation in the program, along with expansion to the rest of the communities in the Municipality of Matagalpa. ❑ Continue to build on the AIN strategy to reinforce behavior change in the other CS interventions, based on the IMCI approach. The continual inclusion of new and interesting topics will keep mothers interested and motivated. ❑ Continue training of CHWs in participative educational methodologies. Home Food Production ❑ Food security interventions should be tailored to the geographic area and based on a study of what will work best. If garden and small animal production is to be included, sufficient technical assistance and follow-up is required. ❑ Undertake a diagnosis of microclimates in each region and tailor food production strategies to each geographic area. ❑ Develop criteria for selection of families to participate in food production. ❑ Provide the database of CARE agriculture promoters to development agencies so they can continue to serve the community as volunteers for other projects. ❑ Include irrigation system development in future projects. ❑ Use of wastewater for irrigation of home gardens is a good strategy and should be continued. ❑ Continue efforts to engage men in an analysis of nutrition indicators and creative planning to improve nutritional status, such as home gardens and crop diversification. ❑ Consider using the positive deviance method to identify successful experiences with home food production and include peer education as part of future projects. ❑ Improve communication and coordination among institutions to avoid duplication of effort and adopt agreed-upon strategies based on an analysis of best practices. BREASTFEEDING PROMOTION
Future Applications of Lessons Learned. ❑ Study the situation of support groups and develop a methodology for the groups to evolve as continuous learning groups. ❑ Include training for breastfeeding counselors about how to extract milk and breastfeeding when the mother has to work outside of the home, and breast problems for CHWs. ❑ Lobby to prevent the distribution of powdered milk to new mothers whose husbands have health insurance. PNEUMONIA CASE MANAGEMENT
Future Applications of Lessons Learned. ❑ Include the IMCI approach as part of Integrated Municipal Visits. ❑ Continue to apply the quality of care evaluation every three months and use the results to continually improve service provision and outreach. ❑ Add indicators for the Integrated Municipal Visits to the quality of care instrument, and include supervision of Health Posts and CHWs. ❑ Include a CHW representative on the Municipal Technical Committee, to improve client satisfaction. ❑ Develop a simplified set of protocols for use by CHWs for the evaluation and classification of a sick child. ❑ Promote the establishment of more CMCs to improve the availability of essential medicines, including antibiotics for pneumonia cases. DIARRHEA CASE MANAGEMENT
Future Applications of Lessons Learned. ❑ Mothers’ knowledge of signs of dehydration needs to be reinforced, as this is a key factor in prompt care seeking. ❑ Institutionalize the participation of schoolteachers and the inclusion of health topics in the school curriculum.
