Pan American Health Organization Pan American Sanitary Bureau

1. Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas of the World Health Organization Family and Community Health Child and Adolescent Health

2. Strengthening the Catholic Health Care Network in the Americas - using the Integrated Management of Childhood Illness (IMCI) Strategy Bristol-Myers Squibb FoundationCatholic Medical Mission Board 9 September 2003 New York

3. Contents • PAHO Organization • Child health situation in the Americas • Integrated Management of Childhood Illness (IMCI) strategy • Evidence to save children’s lives • CMMB/PAHO Project: Action for Family Health • Future perspectives and partnership

4. Pan American Health Organization Mission statement The oldest international health agency in the world. To lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of live of the people in the Americas.

5. Child health situation in the Americas • Thousands of children continue to die from diseases that could be prevented or treated • Two-thirds of child deaths could be prevented by using interventions that are available today and are feasible for implementation in low-income countries • Improving children’s health is a priority. Requires: • Promoting healthy conditions • Preventing and treating children’s diseases

6. Child health situation in the Americas • Poor access to health services and trained personnel • 30% of population without access to health services • Clinical evaluation inadequate • Excessive use of antibiotics • Low coverage of activities for PMTCT of HIV/AIDS • 40% of population without access to essential drugs

7. Brings it all together Tackles the major killers of children through prevention and treatment by improving skills of health staff, health systems and family and community practices.

8. IMCI strategy • IMCI was developed by WHO and UNICEF • Focuses on the child and not on the illness • Is considered the most cost-effective strategy • Facilitates: • An integrated approach for early detection and treatment of childhood illness • Prevention of illness (key family practices) • Health promotion and follow-up

9. Main causes of more than 500,000 annual deaths in children under five years of age in the Region of the Americas Malnutrition Meningitis 3.1% 1.1% Other ARI Anemia Other infectious Diseases 1.5% 0.5% 3.9% Diarrhea 7.8% Pneumonia Peri-Neonatal 9.0% 38.0% Other (accidents, congenital, etc.) 35.0% Malnutrition is also associated with the majority of deaths from infectious diseases, diarrhea and pneumonia

10. What is IMCI? Integrated Management Health Services Family/community Diagnosis Treatment Prevention Promotion Educational activities Lost opportunities Effective treatment Early detection

11. COMPONENTS OF THE IMCI STRATEGY • Planning • Health Policy • Interagency Coordination • Mobilization of Resources Improving Health Worker Skills Improving the Health System to Deliver IMCI Improving Family and Community Practices • Essential drug supplies • Health services organization • Information systems • Clinical case management training • Pre-service training • Pediatric societies • Follow-up after training • Neonatal health • Training courses • Growth and child development • Key family practices • Social communication • Community networks • Operational research • Monitoring • Evaluation • Impact

12. Current progress • Between 1996-2002, 17 countries adopted IMCI 17 Number of countries 16 Panamá Guatemala Guyana Uruguay 13 12 Colombia Haití Paraguay Venezuela 9 Argentina Brasil El Salvador Honduras Nicaragua 4 Bolivia República Dominicana Ecuador Perú 2002 1996 1997 1998 1999 2000

13. Evidence to save children’s lives • Malnutrition is associated with more than 25% of all child deaths • Child mortality could be reduced by more than 20% by intake of vitamin A • Antiretroviral drugs when administered properly could reduce the rate of mother-to-child transmission by as much as 50% • Timely and appropriate care seeking could reduce mortality causes by ARI by more than 20% • Correct home care for diarrhea could save thousands of child deaths cause by acute diarrhea

14. Quality of care improves with introduction of IMCI Proportion of children receiving: Evaluations, pre-and post-IMCI health facility surveys in Bolivia

15. …and mothers leave the facility better able to care for their child Proportion of mothers leaving health facility who reported correctly: Evaluations, pre-and post-IMCI health facility surveys in Bolivia

16. Proportional Reduction 1996-2000 54.8% IMCI No IMCI 35.0% 23.8% 3.7% Reductions in Mortality from Causes Targeted by IMCI Strategy in Departments in Peru with and without IMCI Implementation, from 1996 to 2000 Reduction in the percentage of deaths from causes targeted by IMCI (6.4 times less) Reduction in the number of deaths from causes targeted by IMCI (1.6 times less) Source: Regional IMCI Data Base. CA/FCH, PAHO/WHO, 2003.

17. Trends in mortality from all causes, diarrheal diseases and acute respiratory infections in children under five years of age in 18 countries of the Americas, from 1975 to 2000. Rates per 100,000 and proportional reduction per five-year period from 1975 to 2000 Rates per 100.000 population (lines) Proportional Reduction (bars) 2000 100 80 SCM Diarrhea SCM ARI 200 IMCI 60 IMCI 40 20 20 2 0 1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000 All Causes Diarrhea ARI Source: FCH/CA - AIS. PAHO/WHO, 2003.

18. Comparison of mortality from diseases targeted by IMCI in some countries of the Americas Mortality rates per 100,000 live births (2000) 9065.3 HAITI 3141.7 BOLIVIA 2683.2 GUATEMALA 2301.3 ECUADOR 1718.6 PARAGUAY 154.1 CHILE TRINIDAD Y TOBAGO 152.8 132.4 COSTA RICA ESTADOS UNIDOS 46.7 37.0 CANADA • 10% of children less than 5 years of the Americas • 40% of deaths from diseases targeted by IMCI • 30% of children less than 5 years of the Americas • 1.4% of deaths from diseases targeted by IMCI

19. Action for Family Health 2003-2005 CMMB/PAHO • 3 years • Countries • Dominican Republic • El Salvador • Haití • Honduras • Nicaragua

20. Project Description • Scale-up the capacity of the Catholic health care network to increase coverage and access to: • Three components of the IMCI strategy: • Training skills • Health systems • Community and family • Activities for the prevention of mother-to-child transmission of HIV/AIDS • Provide essential medicines

21. Participating Institutions • Catholic Medical Mission Board • Catholic health care network (Pastoral, Caritas, universities) • Ministries of Health • National IMCI Program • National Essential Medicine Programs • National HIV/AIDS Program • Pan American Health Organization • - Family and Community Health Area • - HIV/AIDS Unit • - Essential Drug and Technology Unit

22. WHO/UNICEFKey family practicesCore set of practices that contribute to a child’s survival and healthy growth at the community level • Promote physical growth and mental development • Prevent disease • Facilitate appropriate home care • Facilitate care seeking behaviors

23. Strengthening collaboration between the health sector and the community ++++++++ CHW Health services Family Other sectors Effective health system Family and community NGOs Caritas • Universities CMMB • Catholic church

24. Project Advances • Country Catholic health-care network assessments completed • Country planning visits accomplished • Country coordinating teams formed • National agreements being prepared • Development of country projects underway

25. Diócesis 8 A Parroquias 346 Clínicas OCEANO PACIFICO Comunidades 298 U Campus Universitario 4 U U U U

26. Monitoring and evaluation • Standardized definitions of indicators • Reporting done on a routine basis to track country performance • Health facility reviews and community survey tools • Use of information/feedback

27. Value-added partnershipCMMB/PAHO • Bottom-up approach • CMMB comparative advantage lies in its ability to leverage the vast network of faith-based organizations • PAHO technical support and country network • Potential to scale-up local resources to address public health problems

28. Future perspectives • Increase access to quality health care delivery in high-risk areas, build local capacity and sustain actions • Mobilize financial resources for country and regional expansion • Establish a unique partnership which makes meaningful change and improvement in people’s lives • SAVE …children’s lives !!!

29. Millennium development goals • The Project will implement activities to support and endorse the Millennium Development Goal of: • Reducing under-5 mortality by two thirds by 2015. • Have halted by 2015 and begun to reverse the spread of HIV/AIDS • In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries These child survival goals can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.

30. Lancet Child Survival Series • The first four articles provided a technical basis for a new approach to child health, moving from epidemiology of child deaths to saving lives using currently available interventions • The fifth paper addressed what should be done in terms of leadership, health systems, resources, and public awareness • Lead to debate and action to sustain momentum in child health

31. Pan American Health Organization Regional Office for the Americas for the World Health Organization Celebrating 100 Years of Health