Carios para los Nios de Huancavelica

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Cariños para los Niños de Huancavelica

• A Proposal to
• Reduce Infant and Child Mortality
• in Huancavelica, Peru
• Presented by
• Cariños para los Niños
• Gabriela Campanella
• Tracy Brumley
• jj dunn
• Usman Iqbal

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Problem Statement

• Peru has one of the highest infant and child
  mortality rates in Latin America.
• In Huancavelica, infant and child mortality rates
  are 1.9 and 2.7 times higher than the national
  average. (75 deaths per 1,000 live births. 1,172
  deaths per 100,000 children)
• 54 of child mortality and 35 of infant
  mortality are due to ARI and diarrheal diseases.
• Main reasons for disparity are
• Low utilization of health care facilities
  (although there are many health posts in rural
  areas)
• Health care workers dont diagnose and treat ARI
  and DD correctly. Great fragmentation of health
  system hinders implementation of health policies.
• Low availability of lifesaving drugs
• Mothers dont diagnose and treat ARI and DD
  correctly

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Peru

• Three geographical areas
• Coastal area (well developed)
• Andes (somewhat developed)
• Amazonas (hardly developed)
• Huancavelica in Andes
• Very rural
• One of the poorest departments
• Indigenous groups (Quechua)
• After years of economic slowdown and political
  turmoil, a new stable government now functions.

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ARI and Diarrheal Diseases

• 20 of children in Huancavelica showed symptoms
  of ARI in the two weeks preceding survey.
• Only half of them taken to health facility.
• Diarrhea had a 2 week prevalence of 26, 32 of
  them received no treatment.
• 30 of mothers said children should be given less
  fluid.
• Only 37 of children with diarrhea were treated
  with increased fluid intake.

The town of Huancavelica
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Solution of Cariños para los Niños

• Nepal 59 reduction in ARI related child death
  within first intervention year employing
  community health workers. (Pandey et al, 1989)
• Bangladesh Diarrheal mortality was over 5 fold
  lower in villages having community based ORT
  therapy programs. (Rahaman MM, 1979)

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First prongIncreasing Quality of Health
Facilities

• Train health care workers to increase quality of
  care and ensure all can diagnose and treat ARI
  and DD correctly.
• Ensure that all 280 health posts/centers have
  constant supply of drugs treating ARI and DD.
• Work in close cooperation with Department of
  Health in Huancavelica
• Coordinator of subprogram of MINSA to control
  ARI, Sr. R. Garcia is excited to work together
  with CPN to implement this program
• Division of Drugs of the Department of Health
  expressed great interest of having the expertise
  of CPN help them with the distribution of drugs
  to all health posts

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Second ProngCommunity Work through Churches

• 92 of Peruvian Society belong to Roman Catholic
  Church.
• Church is very active and influential all over
  Peru, especially at grass root level in rural
  areas and among indigenous groups.
• In Constitution recognized as, Deserving
  government cooperation

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Community Work through Churches it works!

• International studies have confirmed that use of
  churches to reach communities is very effective.
• Nigeria Church-based health education programs
  more effective in achieving actual use of ORT and
  SSS than other educational programs (Akpede,
  1996)
• Churches especially reach minority/ indigenous
  groups (Pitkin, 1998)

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Cariños para los Niños

• The Mission of Cariños para los Niños (CPN) is to
  provide life-saving care to vulnerable
  populations, especially women and children in
  Latin America and the Caribbean.
• CPN does this through a multi-pronged approach,
  which includes education and community
  empowerment.

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Experience of Cariños para los Niños

• Over twenty years of experience working with
  communities in Latin America and the Caribbean.
• In 1992, CPN joined Save the Children in a
  cooperative collaboration in Haiti with a focus
  on the children of rural areas.
• In Ecuador we created a community outreach
  program that taught mothers and caregivers how to
  care for a child who is ill with diarrhea.

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Overall Goal

• To reduce infant and child mortality caused by
  acute respiratory infection and diarrheal disease
  in the rural mountain state of Huancavelica to
  the national averages of Peru by the end of the
  three-year project period.

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Objectives

• Perform a needs assessment for health workers in
  selected health posts and centers.
• Set up and perform training programs to ensure
  that every health worker can adequately recognize
  and treat ARI and DD maintain drug stock
  records.
• Ensure that every health facility has a constant
  and adequate supply of basic drugs treating ARI
  and DD that will be dispensed free of charge.

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Objectives (continued)

• 4. Train local women drawn from local churches
  to give regular health education seminars for
  mothers. This will be done in collaboration with
  personnel of the health establishments with the
  intent to increase the level of health awareness
  and trust between parents/mothers and health
  workers.

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Activities for Needs Assessment

• Needs assessment will have two parts
• Survey ? Knowledge and skills
• Observation form ? Treatment and attitudes
  towards patients
• Results will be stratified for each region.

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Activities for Health Care Workers

• 3 Components
• Medical Skills (Video)
• Diagnosis
• Triage
• Treatment
• Drug Education
• Stock records
• Immunizations
• Patient Relations

Aim is to have health care workers from every
health establishment represented at the trainings.
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Activities for Drug Supplies

• Needs assessment to establish supply and demand
  issues.
• Collaborate with MINSA for the procurement of
  drugs.
• Issue quarterly reports to health facilities for
  restocking of supplies.

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Activities for Community Health Education

• Reach communities through churches.
• Recruit and train women to become community
  health educators.
• Aim is to recruit at least one church in every
  district, for a total of 100 churches.
• Important training topics
• Recognition and treatment of ARI
• and DD
• Making of SSS
• Importance of breastfeeding
• Hygiene

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Timeline
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Monitoring and Evaluation

• Each objective will be individually monitored
  based on a number of indicators.

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Indicators for Objective 2

• Number of health workers trained/month
• Number of patient visits/month at each health
  facility
• Number of health care workers who can adequately
  recognize and treat ARI and DD
• Number of improperly filled out drug record
  supply reports
• Number of infant and child deaths due to ARI in
  their community/6 months
• Number of infant and child deaths due to DD in
  their community/6 months

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Indicators for Objective 3

• Completed initial inventories from all 280 health
  facilities
• of health posts regularly completing their
  quarterly drug stock records
• Number of children who are given drugs at their
  nearest health facility

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Indicators for Objective 4

• Number of churches participating
• Number of volunteer women recruited
• Number of volunteer women trained.
• Number of health seminars held altogether for
  all churches.
• Number of health seminars held in each
  church/quarter.
• Number of people attending health seminars.
• Number of women participating follow up training.

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Project Management
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Budget Summary
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Project Sustainability

• Training people from community
• enhance capabilities of CHWs to continue to
  educate and train new people
• Department of Health pledged to provide drugs as
  part of National Health Insurance using our
  established strategies to ensure drug delivery
  and availability
• Increase health establishment utilization through
  proper training developed for this program and
  through community involvement

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Overall Impact
Cariños para los Niños de Huancavelica will
affect
Infants in Huancavelica 13,074
Children 1-4 years 54,086
Prevented deaths 864 per year
Women age 20-49 70,075 34 will be reached
through Church health seminars per year
Improved Quality of Health Facilities
Cost per child US 6.70 Cost per death
prevented US 523 (only taking in consideration
the last year) Cost per child/women US 3.30
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Please help us to care for the children in
Huancavelica.Your help will make a real
difference in the lives of these children.
Any Questions?