Child survival

To improve EPI management, long- and short-term advisors will help the MOH institutionalize system-wide management procedures and develop a health information and disease surveillance system; the U.S. Centers for Disease Control will help the MOH establish a small disease investigation unit. In a major thrust, the project, WHO, and UNICEF will train EPI managers and medical personnel and provide TA to strengthen training centers and improve training curricula and quality. The project will promote vaccination both nationally and locally and provide cold chain equipment for six major childhood diseases (poliomylitis, tetanus, measles, diphtheria, pertussis, and tuberculosis). To promote early diagnosis and treatment of ARI, the project will introduce a standardized, field-tested treatment regimen and improve related diagnostic and health services and will fulfill all equipment and pharmaceutical needs, including those of the 73 Fever Hospitals. Training of primary health care (PHC) personnel will be complemented by a mass media educational program for mothers, epidemiological data collection, passive disease surveillance, and surveys determining ARI incidence, types, and severity in 5 sentinel governorates. The CN component will: expand/improve education given pregnant and lactating women at MOH clinics regarding weaning foods and iron deficiency anemia (IDA); promote commercial production of acceptable weaning foods, develop guidelines on their use, and undertake related media campaigns; train health professionals in the early recognition and treatment of IDA; and promote distribution and use of iron supplements. Some upgrading of personnel and facilities at the MOH"s Nutrition Institute is envisioned. The CS component will: train and equip 9,000 dayas (traditional birth attendants) in 22 governorates (and their trainers) and improve linkages between dayas and CS programs; train MOH clinical and medical personnel in prenatal and postpartum care; provide small grants to help governorates develop innovative CS delivery schemes; and develop related media campaigns. The project will also consider the relation of Secondary Technical Nurse Midwives to dayas. Participant training will be included in the above four components. Amendment of 9/23/91 extends PACD from 1993 to 1995 and makes the following major changes: (1) adds Hepatitis B vaccination to the EPI component; (2) adds support to the National Control of Diarrheal Diseases Program, including studies and service improvements; (3) deletes activities to market a national weaning food and to develop iron-fortified foods and renovate the Nutrition Institute; (4) aims to integrate the project"s components into a unified maternal/child health program; (5) adds achievement indicators for the ARI, CN, and CS components; and (6) significantly reduces long- and short-term training. (PD-CBK-580)