Pan American Health Organization Pan American Sanitary Bureau

Organización Panamericana de la Salud

Pan American Health OrganizationPan American Sanitary Bureau

Regional Office for the Americas of the World Health Organization

Family and Community HealthChild and Adolescent Health


Strengthening the Catholic Health Care Network in the Americas -

using the Integrated Management of Childhood Illness (IMCI) Strategy

Bristol-Myers Squibb Foundation Catholic Medical

Mission Board9 September 2003

New York


Contents

PAHO Organization

Child health situation in the Americas

Integrated Management of Childhood Illness (IMCI) strategy

Evidence to save children’s lives

CMMB/PAHO Project: Action for Family Health

Future perspectives and partnership


Pan American Health Organization

Mission statementThe oldest international health agency in the world.

To lead strategic collaborative efforts amongMember States and other partners to promote equity

in health, to combat disease, and to improve thequality of live of the people in the Americas.



Thousands of children continue to die from diseases that could be prevented or treated

Two-thirds of child deaths could be prevented by using interventions that are available today and are feasible for implementation in low-income countries

Improving children’s health is a priority. Requires:Promoting healthy conditionsPreventing and treating children’s diseases



Poor access to health services and trained personnel • 30% of population without access to

health services

• Clinical evaluation inadequate

• Excessive use of antibiotics

Low coverage of activities for PMTCT of HIV/AIDS

40% of population without access to essential

drugs


Tackles the major killers of children through prevention and treatment by improving skills of health staff, health systems and family and

community practices.


IMCI strategy

IMCI was developed by WHO and UNICEF

Focuses on the child and not on the illness

Is considered the most cost-effective strategy

Facilitates: An integrated approach for early detection

and treatment of childhood illness Prevention of illness (key family practices) Health promotion and follow-up


Main causes of more than 500,000 annual deaths in children under five years of age in the Region of the

Americas

Pneumonia9.0%

Diarrhea7.8%

Other infectious Diseases3.9%

Malnutrition3.1%

Other ARI1.5%

Meningitis1.1%

Anemia0.5%

Peri-Neonatal38.0%

Other (accidents, congenital, etc.)35.0%

Malnutrition is also associated with the majority of deaths from infectious diseases,

diarrhea and pneumonia


DiagnosisTreatmentPreventionPromotion

Lost opportunities

Early detection

Effective treatment

Educational activities

What is IMCI?What is IMCI?Integrated

Management

Health Services Family/community


COMPONENTS OF THE IMCI STRATEGYCOMPONENTS OF THE IMCI STRATEGY

•Planning•Health Policy•Interagency Coordination•Mobilization of Resources

Improving Health Worker Skills

Improving the Health System to Deliver IMCI

Improving Family and Community

Practices• Clinical case

management training

• Pre-service training

• Pediatric societies• Follow-up after

training• Neonatal health

•Essential drug supplies•Health services

organization• Information systems

•Training courses•Growth and child

development•Key family

practices•Social

communication•Community

networks

•Operational research•Monitoring•Evaluation•Impact


Between 1996-2002, 17 countries adopted IMCI

Current progress

4

1996

BoliviaRepúblicaDominican

aEcuador

Perú

9

1997

ArgentinaBrasil

El SalvadorHondurasNicaragua

12

1998

HaitíParaguayVenezuel

a

13

1999

Colombia

16

2000

Guatemala

GuyanaUruguay

17Panamá

2002

Number of countries


Evidence to save children’s lives

Malnutrition is associated with more than 25% of all child deaths

Child mortality could be reduced by more than 20% by intake of vitamin A

Antiretroviral drugs when administered properly could reduce the rate of mother-to-child transmission by as much as 50%

Timely and appropriate care seeking could reduce mortality causes by ARI by more than 20%

Correct home care for diarrhea could save thousands of child deaths cause by acute diarrhea


0

50

28

958893

0

20

40

60

80

100

Comprehensiveassessment

Nutritionalevaluation

Review ofvaccination status

Before (1997; 58 sick children) After (1999; 80 sick children)

Quality of care improves

with introduction of IMCI

Evaluations, pre-and post-IMCI health facility surveys in Bolivia

Proportion of children receiving:


127

70

49

0

20

40

60

80

100

How to give oral medicines At least two danger signs

Before (1997) After (1999)

…and mothers leave the facility better able to care for their child

Proportion of mothers leaving health facility who reported correctly:

Evaluations, pre-and post-IMCI health facility surveys in Bolivia


54.8%

23.8%

35.0%

3.7%

Reduction in the number of deaths from causes targeted by IMCI (1.6 times less)

Reduction in the percentage of deaths from causes targeted by IMCI (6.4 times less)

Proportional Reduction 1996-2000

IMCI No IMCI

Reductions in Mortality from Causes Targeted by IMCI Strategy in Departments in Peru with and without IMCI Implementation, from 1996 to 2000

Source: Regional IMCI Data Base. CA/FCH, PAHO/WHO, 2003.


Trends in mortality from all causes, diarrheal diseases and acute respiratory infections in children under five years of age in 18 countries of the Americas, from 1975 to 2000. Rates per 100,000 and proportional reduction per five-year

period from 1975 to 2000

Source: FCH/CA - AIS. PAHO/WHO, 2003.

Rates per 100.000 population (lines)

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

2

20

200

2000

0

20

40

60

80

100

Proportional Reduction (bars)

All Causes Diarrhea ARI

SCM Diarrhea

IMCI

SCM ARI

IMCI


Comparison of mortality from diseases targeted by IMCI in some countries of the Americas

• 10% of children less than 5 years of the Americas

• 40% of deaths from diseases targeted by IMCI

• 30% of children less than 5 years of the Americas

• 1.4% of deaths from diseases targeted by IMCI

154.1

152.8

132.4

46.7

37.0

CHILE

TRINIDAD Y TOBAGO

COSTA RICA

ESTADOS UNIDOS

CANADA

9065.3

3141.7

2683.2

2301.3

1718.6

HAITI

BOLIVIA

GUATEMALA

ECUADOR

PARAGUAY

Mortality rates per 100,000 live births (2000)


• 3 years

• CountriesDominican

RepublicEl SalvadorHaitíHondurasNicaragua

Action for Family Health2003-2005

CMMB/PAHO

Action for Family Health2003-2005

CMMB/PAHO


Scale-up the capacity of the Catholic health care network to increase coverage and access to:

Three components of the IMCI strategy:

• Training skills

• Health systems

• Community and family

Activities for the prevention of mother-to-child transmission of HIV/AIDS

Provide essential medicines

Project Description Project Description


Catholic Medical Mission Board

Catholic health care network (Pastoral, Caritas, universities)

Ministries of Health

• National IMCI Program

• National Essential Medicine Programs

• National HIV/AIDS Program

Pan American Health Organization

- Family and Community Health Area

- HIV/AIDS Unit

- Essential Drug and Technology Unit

Participating InstitutionsParticipating Institutions


WHO/UNICEFKey family practices

Core set of practices that contribute to a child’s survival and healthy growth at the

community levelPromote physical growth and mental developmentPrevent diseaseFacilitate appropriate home careFacilitate care seeking behaviors


Strengthening collaboration between the health sector and the community

CHW

++++++++

Family

Health services

Family and community

Other sectorsEffective health

system

CMMBCMMB

Catholic church Catholic church

Universities

NGOs

Caritas


Project Advances

Country Catholic health-care network assessments completed

Country planning visits accomplished

Country coordinating teams formed

National agreements being prepared

Development of country projects underway


OCEANO PACIFICO

Diócesis 8Diócesis 8

Comunidades 298Comunidades 298

ClínicasClínicas

Parroquias 346Parroquias 346

UU Campus Universitario 4Campus Universitario 4

UU

UU

UU

UU

A


Monitoring and evaluation

Standardized definitions of indicators

Reporting done on a routine basis to track country performance

Health facility reviews and community survey tools

Use of information/feedback


Value-added partnershipCMMB/PAHO

Bottom-up approach

CMMB comparative advantage lies in its ability to leverage the vast network of faith-based organizations

PAHO technical support and country network

Potential to scale-up local resources to address public health problems


Future perspectives

Increase access to quality health care delivery in high-risk areas, build local capacity and sustain actions

Mobilize financial resources for country and regional expansion

Establish a unique partnership which makes meaningful change and improvement in people’s lives

SAVE …children’s lives !!!


Millennium development goals The Project will implement activities to support

and endorse the Millennium Development Goal of:

• Reducing under-5 mortality by two thirds by 2015.

• Have halted by 2015 and begun to reverse the spread of HIV/AIDS

• In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries

These child survival goals can be achieved, but only if strategies for delivery

interventions are greatly improved and scaled-up.


Lancet Child Survival Series

The first four articles provided a technical basis for a new approach to child health, moving from epidemiology of child deaths to saving lives using currently available interventions

The fifth paper addressed what should be done in terms of leadership, health systems, resources, and public awareness

Lead to debate and action to sustain momentum in child health


Pan American Health Organization Regional Office for the Americas for the

World Health Organization

Celebrating 100 Years of Health

Pan American Health Organization Pan American Sanitary Bureau

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