SYNERGY ONLINE: Bulletins and News Briefs from The Canadian Society for International Health: [log in to unmask] ---------------------------------------------------------------------PAHO SEEKS CANADIAN PARTNERSHIPS for the Plan for the Regional Implementation of the Integrated Management of Childhood Illness (IMCI) Strategy in the Countries of the Region of the Americas, 1997-2000 --------------------------------------------------------------------- * Development Of Materials And Instruments * Coordination Structures And Operational Plans * Personnel Training On IMCI & PEPIN * Monitoring And Evaluation Activities * Data Base System And Information Dissemination Working Proposal for the Canadian Cooperation EXECUTIVE SUMMARY The implementation of the Integrated Management of Childhood Illness (IMCI) strategy in the Region of the Americas has become an alternative to improve childhood health care at the first level of health services and the community level in order to reach the goals established in the "World Summit for Children of 1990." Background Acute respiratory infections, diarrheal diseases, malnutrition and intestinal parasites continue to be important health problems that affect children under five years of age in developing countries. Malaria and measles, at the same time, equally contribute to the burden of disease and death for this age group in many of these countries. Together, these problems are the cause of the majority of deaths that occur annually in children under five. The burden that this morbidity represents in the health services requires a great amount of human and logistic resources that are not always available. Combining this burden to those previously mentioned, the lack of standardized criteria for the management of these cases decreases the quality of care, resulting in an overuse of diagnostic technologies and medications. This, in turn, increases the cost of health care and exposes children to potential risks, such as the development of resistant bacteria from the unnecessary use of antibiotics. Components IMCI Designed as a care strategy to be utilized in basic health services, IMCI predominantly includes the major causes of illness and death in children in developing countries (see Annex 1). Systemized through a flow chart of algorithms, IMCI includes standardized diagnostic and treatment methods adapted to the needs and norms of each country. The basic objectives of IMCI include decreasing mortality and morbidity together with improving the quality of care for children. Also included in the strategy are health promotion and prevention aspects, namely counseling for parents, immunization against measles and other vaccine preventable diseases, the control of risk factors (such as those related to breastfeeding and adequate nutrition), and the special component of the Standardized Protocol for the Control of Intestinal Parasitic Diseases in Children (PEPIN). PEPIN The PEPIN component, an integrated IMCI action, is directed towards children between 2 and 14 years of age within community and health services. This component consists of making initial diagnosis of intestinal helminthiasis in selected sentinel sites in accordance with areas of high prevalence of these infections. The objective is to establish an epidemiological profile to implement monitoring and the later evaluation activities of the intervention. The PEPIN protocol provides massive treatment with a single dose of mebendazole at least two times a year for three years, at the community school-based or health services level. Other elements of the protocol are prevention, which include the improvement of hygiene and environmental sanitation as well as health promotion, communication and education activities targeted to the community through parents, teachers and community leaders. Purpose and requirements The extension of IMCI the implementation has been limited to the institutional level because resource allocation has been restricted. Inter-country and sub-regional activities are proposed to be financed by USAID and activities at the institutional level (health services) will be financed by the Spanish Cooperation Agency. In the PEPIN component, the Regional IMCI Unit has investigated the feasibility of organizing activities with non-governmental organizations and private sector cooperation, particularly in the provision of medications and health education. One of the most important stages in the IMCI strategy and the PEPIN component implementation process is its application at the community health workers (CHW) and at other community based personnel levels. This issue is not yet included in our current resource allocation. PAHO does not have the necessary financial resources to provide assistance at this level nor the development of instruments to fulfill the three basic IMCI objectives (decreasing mortality and morbidity together with improving the quality of care for children). The present proposal is directed to prioritize the implementation of IMCI with emphasis on the PEPIN component at the community level and strengthening the participation of all sectors within the implementation process. Methodology The proposal considers planning and organization of the child health care in the health facilities as principal project activities. At the community level, emphasis will be placed on health promotion and education using the resources and skills of the private sector organizations and non-governmental organizations. To accelerate the implementation process, the active participation of diverse international organizations is being sought and, in particular, collaboration with Canadian cooperation agencies, through their country level counterparts and/or other non-governmental organizations financed by Canadian agencies. It is envisioned that this participation could be through direct technical assistance for the organization, planning, and execution of activities at the regional, national, and district levels, and in specific activities such as the distribution of materials, health personnel training, counseling for research, and the provision of supplies for the application of strategies. In view of the countries' emerging demand to receive technical and logistical assistance necessary to implement these strategies, and officially incorporate them into national maternal and child health policies, the PAHO Regional IMCI Unit of the Communicable Disease Program is taking this opportunity to apply interventions to play a significant social and economic impact on the populations of the countries in the Region of the Americas IF YOU ARE INTERESTED IN COLLABORATING IN THIS PROPOSAL, PLEASE CONTACT THE CANADIAN SOCIETY FOR INTERNATIONAL HEALTH FOR FURTHER INFORMATION: Canadian Society for International Health 170 Laurier Avenue West, Suite 902, Ottawa, Ontario K1P 5V5 Telephone: 613-230-2654 Ext: 302; Fax: 613-230-8401 E-mail: [log in to unmask]; www: http://www.csih.org --------------------------------------------------------------------- This document is available, with full formatting and accents, at: Ce document est disponible, avec les accents et la mise en page a: http://www.csih.org/syn_indx.html