Self-financing primary health care

La Merced will implement the project via a Management Support Unit (MSU). The MSU, which will become autonomous by the project"s end, will consist of a Health Services Division to recruit and train PHC workers and supervisors and define PHC interventions, and an Administrative Division to implement management and logistic systems, including a management information system which will, inter alia, collect data on the project in conjunction with an AID/W research project on self-financing health care systems. Three distinct PHC delivery systems will be established: (1) 149 Level I community clinics, each staffed by 2 health promoters, will provide basic treatment of diseases and injuries. Activities will include environmental sanitation efforts; health education; screening of high-risk pregnancies; child growth monitoring; and provision of standard immunizations and essential medicines. (2) 23 Level II health posts, each staffed by 2 auxiliary nurses, will treat Level I referrals and provide additional preventive and curative services, including the treatment of emergencies and of minor illnesses (e.g., tonsilitis). The 35 basic medications available at the health posts will also be used for resupplying Level I clinics. (3) 6 fully-staffed (with a physician, nurses, and a nurse-midwife) Level III health clinics will treat Level I and II referrals and provide the same as well as additional services, such as hospital care (or referral to Level IV and V health care centers), basic laboratory services, and supervisory services for Level I and II sanitation and maternal child health programs. Training under the project will include pragmatic training for health promoters, health post management training for auxiliary nurses, and training in medical administration for MSU and professional medical personnel. Income from service charges, co-op membership fees, and pharmaceutical sales will make the system self-financing. Some 37,000 rural and semi-urban poor will benefit from the project. Amendment of 05/06/87 increases funding, extends the project by 3 years, and adds three new participating institutions, thus increasing the number of beneficiaries from 37,000 to 68,000. The amendment also expands the project"s operations research component and puts special emphasis on child survival activities. The three co-ops originally participating in the project have been replaced by three communities, acting through quasi-official community bodies.