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Background

Ministry of Public Health and Social Welfare Integrated Supervision Strategy IMCI - EPI Contribution to strengthening the health services in Paraguay Dr. María Elsa Paredes Director, Integrated Child and Adolescent Health Quito, Ecuador - 29 to 31 October 2007. Background.

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  1. Ministry of Public Health and Social Welfare Integrated Supervision Strategy IMCI - EPI Contribution to strengthening the health services in ParaguayDr. María Elsa Paredes Director, Integrated Child and Adolescent Health Quito, Ecuador - 29 to 31 October 2007

  2. Background • In 1997, the IMCI strategy was implemented in 10 of the 18 Regions of Paraguay, with the objective of reducing under 5 mortality (25x1000 LB) and promoting children’s growth and development through health care quality improvements. • Paraguay’s immunization program began in 1980, to reducing morbidity and mortality from preventable diseases by vaccinating all children under 5. This is accomplished by supervising vaccination activities at health centers at all levels of care. • The deficiencies in the health system are considered to be “the main obstacle to improving health outcomes.” The need for strengthening the health system has become a top priority in public policy. • The integrated supervision methodology was proposed in order to optimize the existing human and material resources for improving the quality of healthcare management and services at the regional, district, and local level.

  3. Uniform Work Concept • IMCI-EPI supervision in regions, districts, and health centers is a joint effort between supervisors at the managerial level (national and regional) and providers at the operational level that integrates monitoring and training to focus health worker’s attention on people and their health needs in a comprehensive, integrated fashion.

  4. COMPONENTS OFIMCI-EPI INTEGRATED SUPERVISION • Training • Logistics and supplies • Information • Monitoring • Evaluation Quality procedures in IMCI and EPI

  5. GENERAL OBJECTIVES • Provide feedback on the planning, scheduling, execution, and evaluation of EPI/ IMCI. • Strengthen the technical skills of personnel who offer services, using a comprehensive, integrated approach to care. • Improve management and the quality of health services at all levels of complexity.

  6. DESCRIPTION OFTHE IMCI-EPI INTEGRATED SUPERVISION EXPERIENCE • Framing the issue • Methodology • Implementation • Results • Lessons learned • Obstacles and challenges

  7. Framing the issue • Political and technical advocacy • Mobilization of resources. • Interprogrammatic partnerships. Through:

  8. Methodology • Design the integrated supervision instrument. Each indicator contains three to six conditions that mustbe met for it to be considered achieved • Training of human resources • Team Composition: A national supervisor and a regional supervisor of IMCI/EPI • Includes the monitoring of 10 indicators categorized as: • Service integration indicators • Existing capacity indicators

  9. DOMAIN In order to begin developing the IMCI-EPI integrated supervision strategy, 70 districts in six regions or departments with the greatest concentration of the country’s population (72%) were selected for their low vaccination coverage. The 70 districts have 355 health service centers: 5 regional hospitals, 16 district hospitals, 34 health centers, and 300 health posts, which became the basic unit for analyzing the integrated supervision.

  10. Results • Health services integration indicators • Indicators of improvement of existing capacities for providing health care services • Strengthening health services

  11. Area of Implementation of the IMCI-/EPI Integrated supervision * Has 29 , but 9 were scheduled

  12. Geographical distribution of the Priority Districts in the Supervised Area In the regions of Paraná Itapúa San Pedro Plant Caaguazú Asunción

  13. Supervised health services by level ofcomplexity

  14. Service integration indicators Did the health center have staff trained in IMCI protocols? N = 281

  15. Service integration indicators Differences in application of IMCI protocols according to whether staff has receivedtraining Nº= 281

  16. Service integration indicators Differences in application of IMCI protocols according to whether staff has receivedtraining (2) Nº= 281

  17. Service integration indicators Is improvement in EPI/IMCI observed in the services between the first and the second rounds of supervision?

  18. Service integration indicators Are there differences in the application of IMCI protocols in Alto Paraná Between thefirst and second rounds of supervision?

  19. Service integration indicators Is improvement in EPI/IMCI observed in the services in Alto Paraná between the first and second rounds of supervision ? Necessary Equipment Application of protocols Application of protocols

  20. Improvement indicators for existing capacity in the services Is improvement in EPI/IMCI observed in the services betweenthe first and the second rounds of supervision? Nº= 69

  21. Improvement indicators for existing capacity Is improvement in EPI/IMCI observed in the services between thefirst and the second rounds of supervision? * ORS, amoxicillin, Mebendazole, Albendazole, Salbutamole, penicillin. Benzathine

  22. Improvement indicators for response capacity Is improvement in EPI/IMCI observed in the services between thefirst and second rounds of supervision?

  23. Essential elements of PHC converge based on theexperiences of IMCI-EPI Integrated Supervision

  24. Essential elements of PHC that overlap with the experiences of IMCI-EPI Integrated Supervision

  25. Weaknesses and limitations • The availability of resources qualified to supervise training • Lack of regional involvement in the supervisory process • Difficulties in connecting the results of the supervision with decision-makers for better resource management • Standardization of criteria for applying the instruments and interpreting the results • Failure to structure services as a network

  26. LESSONS LEARNED • Find mechanisms to incorporate integrated supervision into the process of service management and resource allocation. • Organize health services into a network and create stronger local management teams.

  27. Obstacles and challenges • Progressively turning over management of the integrated supervision program to the individual regions and service centers to ensure continuing educational supervision, optimize management supervision from within the services themselves, and improve primary healthcare.

  28. Thank you

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