AID cooperative agreement no. FAO-0500-A-00-3021-00 to PLAN International for the recipient"s proposal, `For our mothers and children : working together for effective and sustainable child survival programs`

In Bolivia, the project will improve health in 281 rural communities in the provinces of Los Andes, Ingavi, Manco, Kapac, and Jose Manuel Pando, in the Department of La Paz (the first two provinces are included in the ongoing CS VI project, the latter two are new areas); all four provinces are covered by two Ministry of Health (MOH) districts (Manco Kapac and Santiago de Machaca). Activities will be as follows. (1) PLAN will transfer to the two MOH districts implementation of the expanded program of immunization (EPI), oral rehydration therapy (ORT), and growth monitoring/promotion (GM/P) activities, while enhancing current levels of effectiveness so that by the project"s end 80% of children aged 12-23 months will be fully immunized, 40% of women aged 15-49 years will be immunized with TT5, 15% of children aged 12-23 months will weigh below -2 standard deviations of the median weight/age, and 80% of the most recent episodes of diarrhea in children aged 0-23 months will be treated by mothers with ORT. (2) PLAN will also transfer to the MOH districts responsibility for management support systems (referral systems, training and supervision, health information, and logistics) for MOH facilities, community health workers (CHWs), and traditional healers (THs) involved in ORT, GM/P, and EPI. MOH district management teams will be established to operate these systems. (3) PLAN will improve pneumonia control in 40 communities, so that 80% of cases of cough and rapid breathing in children aged 0-23 months will be referred by mothers to CHWs or health services, and 80% of the referrals will be treated using the MOH case management protocol. (4) Finally, PLAN will improve maternal care (including birth spacing) in 40 communities to the point at which 80% of the cases of obstetric hemorrhage and/or infection will be referred to a trained traditional birth attendant (TBA) or MOH facility and 80% of referrals will be adequately treated, 50% of home deliveries will include use of a clean birth kit, and 30% of birthing women will have received at least 3 months of iron/folate supplementation. In the peri-urban slums of the Herrera and Altagracia neighborhoods of Santo Domingo in the Dominican Republic, the project will improve maternal and child health by working with families, grassroots organizations, and local health institutions to ensure that 80% of the children aged 12-23 months have been fully immunized before their first birthday; 80% of the most recent diarrhea episodes in children aged 0-23 months will be treated with oral rehydration solution or home-available fluids, plus continued breastfeeding and/or feeding; 90% of women at delivery will have seen a doctor at least four times and received iron/folate tablets for at least 3 months; 60% of infants will be exclusively breastfed for 6 months; and 80% of the cases of cough and rapid breathing will be identified by the mothers of children aged 0-23 months and referred to a health service. By the project"s end, thirty neighborhood grassroots organizations will support a network of health volunteers, and each will sponsor a "Caring Mothers" Club."