Special Outcomes, Unexpected Successes, Constraints. ❑ An unexpected outcome was the support of the Municipal Government of Puerto Xxxxxx regarding the cold chain. ❑ An observation of note during the visits to some of the project areas was the lack of children under the age of two. Demographics are changing, with migration of young people to the cities, especially to El Alto and Caranavi. This trend has depleted many communities of infants and young children.
Special Outcomes, Unexpected Successes, Constraints. As mentioned above, water and sanitation projects sponsored by municipal governments and other agencies are contributing to the decrease in diarrheal disease. In some cases CSRA has helped communities advocate with municipal health boards and inter-sectorial committees for the implementation of water and sanitation systems.
Special Outcomes, Unexpected Successes, Constraints. An unexpected outcome was the involvement of the Municipality of Puerto Xxxxxx, which assisted CSRA/MOH to obtain a large quantity of nutritious cereal from Peru, for use in the nutritional rehabilitation program. The municipal government is currently exploring alternatives to produce the cereal locally. Carabuco has followed suit, with the approval of a strategy to import cereals from Cochabamba, a grain-producing region in central Bolivia.
Special Outcomes, Unexpected Successes, Constraints. An important contribution of the CS Project is the ethnographic study, titled “Salud Sexual y Reproductiva en Cuatro Comunidades Aymaras” (Reproductive and Sexual Health in Four Aymara Communities). The study presents points of view from community members and health personnel and recommends ways to overcome these. Some of the recommendations regarding delivery include: presence of the mother, mother-in-law, or father during delivery; heating of the delivery room; availability of a stove so that family members can cook and provide the traditional foods and teas believed to be important; permission for the woman to give birth in a squatting position; and sensitivity to the importance of modesty, such as not taking off the woman’s clothes and keeping her well covered. The study recommends to: 1) hire a socio- cultural facilitator to improve behavior change strategies, 2) make changes in service delivery methods, and 3) use traditional medicines at health centers and teach health volunteers how to use and prepare them.
Special Outcomes, Unexpected Successes, Constraints. In Puerto Xxxxxx the municipal government, CSRA/MOH and the education sector combined efforts and gave reproductive health education to all junior and senior high school students. The use of rural schoolteachers as health educators was very effective, and this strategy could be expanded in other geographic areas.
Special Outcomes, Unexpected Successes, Constraints. The CS Project used the TIPS methodology (Trials in Improved Practices) in the nutrition component to improve feeding practices. Two sessions are held with groups of no more than10 mothers. In the first session mothers explore and reflect on inadequate practices and new practices are proposed and tried. During the second session the mothers share their experiences in adopting the new practice. New practices are then monitored through home visits and during AIN meetings. As a result of TIPS the project improved household recipes using accessible, low-cost foods and strengthened community growth monitoring. Several innovative strategies were used to improve food security. Box gardens were established in households with smaller yards, using tires, terraces, barrels, and sacks to plant the following vegetables: squash, carrots, beets, cucumbers and onions. On-site training was given through agricultural promoters on reproduction of improved poultry and sanitary management; bio-intensive gardens, soil conservation, revolving funds, and garden establishment techniques. Fruit trees, vegetables and guide crops were planted in schools, with the participation of students and teachers. Using the evolving fund methodology, women received loans to develop small economic activities (commerce, food service and the purchase of poultry). Revolving fund management is controlled by community volunteer structures, which hold the funds in joint accounts with CARE. The community structures select the women who will receive loans and are in charge of monitoring credit and payments. Growth-monitoring procedures were improved as recommended during the MTE, as follows: training of new communities and refresher training was given over a 5-day period; expected minimum weight percentiles were reviewed at 30 and 60 days; provision of training in counseling and negotiation about food; action guides and feeding posters for counseling on feeding were distributed to CHWs; improvements were made to the community registration system, allowing for observation of individual and collective nutritional status; and community assemblies were promoted to analyze the growth status of children.
Special Outcomes, Unexpected Successes, Constraints. A special outcome of the breastfeeding intervention was the certification of all 14 Health Posts and the Municipal Health Center as Baby and Mother Friendly Health Units. This is the first municipality in Matagalpa to receive certification for 100% of its health centers.
Special Outcomes, Unexpected Successes, Constraints. Although the strategy to reduce smoke in the home by improving stoves or using gas stoves is a good one, a majority of families continue using wood for cooking. An agreement was made with the Nicaraguan Community Movement through which 100 gas stoves were disbursed by means of a revolving fund. With support from the CUENCAS Project in the municipality, project personnel were trained in the construction of improved stoves. This training has been reproduced in the communities, resulting in the construction of 200 improved stoves.
