LAC regional results package : integrated management of childhood illnesses (IMCI), 1997-2001 -- a proposal from the Pan American Health Organization (PAHO) and basic support for institutionalizing child survival (BASICS)

The RP, one of four under the Regional Health Priorities project (5980825), will be implemented by the Pan American Health Organization (PAHO) and the Basic Support for Institutionalizing Child Survival (BASICS) project (9366006) in 8 child survival target countries: Bolivia, Ecuador, Peru, El Salvador, Guatemala, Honduras, Nicaragua, and Haiti. The RP comprises Intermediate Results in four areas: information provision, planning, capacity building, and monitoring and evaluation. First, RP staff will visit the target countries to provide Ministries of Health with information for them to make an educated decision on whether to implement IMCI. IMCI, which was developed by UNICEF and WHO, provides for integrated case management of common childhood diseases, such as malaria, measles, and malnutrition; it also directs health workers to provide two key preventive measures--immunizations and nutrition counseling. RP staff will inform public and private health leaders of the RP strategy and requirements for its implementation (e.g., a functioning drug supply system, review of IMCI clinical course content, associated policy and management tools and guidelines). Four-day subregional orientation workshops will provide senior decision makers more detailed information on these issues. Second, the RP will help countries to develop plans and strategies for implementing IMCI. PAHO and BASICS staff will develop a prototype situational assessment guide to help country managers and planners analyze the infrastructural, organizational, and financial implications of adopting IMCI. PAHO and BASICS will organize three subregional workshops and provide TA to country representatives to develop country-specific IMCI operational action plans and norms. In addition, BASICS will translate into Spanish and field test the methodology it has developed for rapid assessment of health worker performance. The assessment will help planners prioritize the elements needed for IMCI implementation, including health worker training, supervision, and drug supply. Capacity building is at the heart of this RP and will cover four technical areas: management; training and supervision of service delivery personnel; drugs; and caretaker demand and compliance. (1) To improve management, PAHO will develop an IMCI Program Managers course, to include follow-on TA. (2) A number of pre-service and in-service training activities will be conducted. PAHO"s regional acute respiratory infection (ARI) and control of diarrheal disease (CDD) programs will integrate IMCI components into existing ARI/CDD materials and will certify Centers of Excellence where health workers from hospitals and other health facilities can receive hands-on training. PAHO and BASICS will train country representatives in clinical case management, who in turn will train physicians and nurses assigned to major health services. Training will also be provided to health auxiliaries and community health workers. The RP will also develop pre-service IMCI modules to be used in the formal education of doctors and nurses. (3) In coordination with the Rational Pharmaceutical Management project (9365974), RP staff will develop and conduct courses in drug management and drug logistics. (4) The RP will develop community-level approaches to caretaker education and behavior change, drawing on previous USAID-sponsored work in health communications, and will support some limited IEC/behavior change interventions. Also, BASICS will conduct operations research on improving doctors" and nurses" counseling of child caretakers. Finally, several activities will support monitoring and evaluation. The RP will: (1) develop and test evaluation tools for analysis of IMCI implementation; (2) develop a standard IMCI reporting system and software; (3) promote regional information exchange; (4) disseminate the BASICS-developed mortality survey and surveillance methodology; (5) strengthen countries" management information systems; (6) introduce the Health Facility Quality Review methodology already developed by BASICS; and (7) conduct operations research on such topics as IMCI effectiveness and reaching indigenous populations with health care.