Midwifery course at the University of Chile trains nurses to improve maternal and neonatal health in rural areas. 

The 3-year training course is being offered by the University of Chile, a new WHO/PAHO Collaborating Center. The trained nurses are expected to return to Bolivia by 2010 and use the knowledge acquired to train additional nurses in their own communities. Meanwhile high quality curricular undergraduate midwifery training with life saving skills is expected to develop in Bolivia.

In a joint effort between the NTP and PAHO, with support from USAID, a national meeting was convened in November 2009 in which those responsible for public health programs from the health insurance companies attended. PAHO’s Regional TB Program provided the technical support on the PPM approach and guided the discussions.

Health professionals from Provinces and Municipalities reviewing sub-national infant and neonatal mortality data. 

A Workshop on Country Profiles directed to those responsible for data collection and analysis was carried out with the support of PAHO/WHO and USAID. The goal was to provide participants with the necessary tools to strengthen local and national monitoring and evaluation of infant and neonatal mortality

Strengthening the National Health Authority

The Ministry of Public Health (MPH) of Ecuador identified the challenges for strengthening health system performance in that country namely, lack of leadership, institutional segmentation, fragmentation of services, inadequate model of care, limited state investment in health, insufficient management capacity, inadequate coverage, and low quality of care. As a result, 27% of the population does not have access to care, the public coverage only reaches 49% of the population, and 44.3% of the health expenditure comes directly from households and is higher among poorer sectors of the population, which spend nearly 10% of its annual income on health.

Enhancing quality of health care for mothers and children through evidence-based interventions

For the purpose of applying evidence-based interventions with the participation of the service of pediatrics of the Hospital Humberto Alvarado in Masaya, intense training, and implementation and monitoring of the neonatal IMCI strategy in all municipalities of the Department was carried out. As a consequence, positive results in maternal and neonatal health can already be observed.

Prioritizing and strengthening comprehensive health services actions to achieve MDG4

In July 2005, IMCI (Integrated Management of Childhood Illnesses) was institutionalized by the Ministry of Health as one of the strategies of the Comprehensive Childhood Health Care Model, which was approved in June 2003 to prioritize and consolidate comprehensive health service actions.

Newly Designated Center of Excellence Provides Quality Training on Midwifery

Strengthening midwifery and nursing to improve skilled attendance at birth has been one of the strategies that PAHO and USAID have been promoting and supporting for a number of years. In order to move the initiative forward, PAHO and USAID have partnered with Centers of Excellence and other midwifery and nursing organizations to create the Collaborative Partnership for Achieving Improved Maternal and Newborn Health in the Americas through Nursing and Midwifery, known as the Collaborative Partnership.

Where clinical records did not exist or were insufficient, trained personnel visited the residences of deceased women and interviewed their families, neighbors, and friends in order to identify unnoticed maternal deaths.

USAID and PAHO/CLAP-WR have supported the Ministry of Health of Paraguay in developing RAMOS (Reproductive Age Mortality Survey) methodology in three important regions: Alto Paraná, Central Region and Asunción (including the capital city).

A Basic Health Team making visits in Ecuador.

The Constitution of the Republic of Ecuador, approved in September 2008, determines in Art. 360 that the National Health System shall be organized with a Primary Health Care (PHC) approach and that it shall function through integrated networks that offer universal and equitable health services, under the leadership of the national health authority.

Introducing HMN Diagnostic Tool and PRISM outcomes at the sub national level

The Health Information System (HIS) experience in Peru is unique as the development of the system is being worked simultaneously within the decentralization process.

This project will enhance existing surveillance systems rather than creating a parallel system.

The initiative operates in three Departments, including Antioquia, Caldas, and Valle del Cauca and Bogota District (capital of Colombia), and integrates strategies from the local to the national and PAHO regional levels. The initiative is guided by principles of consensus-building and collaboration across institutions for enhanced maternal mortality surveillance.

Preparing the new midwives to obtain skills that save lives is the goal of the curriculum update.

The finished curriculum is in a modular format that promotes adult self-directed learning. Plans for the future include an effort to train faculty who will staff health science skills labs.

The Regional Task Force was initiated with the technical support of the PAHO Mortality Reduction Initiative team, under the scope of the PAHO-USAID Umbrella Agreement.

International and national partners have been collaborating for more than a decade to reduce maternal mortality and morbidity, and in that time, significant progress has been made and lessons have been learned on a global level.

In the 2009 meeting, funded by USAID, the group of Supranational Reference Laboratories decided to become the Laboratory Working Group on tuberculosis for the Americas to assist PAHO’s Regional TB Program.

One of the priorities for the implementation of the Stop TB Strategy and the Regional Plan for Tuberculosis  2006-2015 in the Americas is to strengthen national laboratory networks to meet the need for diagnosis of pulmonary and extrapulmonary tuberculosis, drug-sensitive or resistant, associated or not with HIV.

From epidemiological data to efficient interventions. 

Health care proffesionals provide information to their colleagues and patients on the appropriate method for hand hygene, based on the WHO Multimodal Hand Hygiene Improvement Strategy.

Delayed Cord Clamping and Immediate Breastfeeding

Delayed umbilical cord clamping (i.e., at the end of cord pulsations, or approximately 2-3 minutes after birth), and immediate breastfeeding are two simple and inexpensive delivery care practices that have the potential to improve the short- and long-term nutrition and health of infants.

Delayed cord clamping, exclusive breastfeeding in the first hour of life, and skin-to-skin contact

As part of a national program to train health workers in the implementation of clinical IMCI to evaluate, classify and treat children between the ages of 2 months and 5 years, all doctors and nurses have been trained under technical support from PAHO in the Masaya LCHCS, where the ministry of health’s Humberto Alvarado Hospital is located.

Building Capacity at the Country Level on the New Stop TB Strategy

One of the goals of the USAID-PAHO cooperation in the area of Tuberculosis is to build capacity at the national level on the new Stop TB Strategy. As part of this initiative, in 2008, Dr. Ailton Cezário Alves Júnior was selected to participate in the PAHO TB Fellowship Program.

Microbiology laboratories are the cornerstone of the quality of care of infectious diseases in Paraguay

The USAID/PAHO technical support provided the opportunity not only to update the laboratory and human resources capacity, but to develop a comprehensive quality assurance of the national surveillance resistance network.

A  series of regional meetings have been developed between tuberculosis and HIV/AIDS programs.

These meetings provide an opportunity for updating both TB and HIV/AIDS program managers on current guidelines for management of TB/HIV co-infection, epidemiological and operational analysis of the situation of TB/HIV co-infection, and review of interprogrammatic action plans and their updating for the subsequent year. The meetings are held thanks to the financial support of USAID.

A national initiative has created awareness of an existing problem and defined strategies for its containment 

To tackle the spread of resistant pathogens, widespread implementation of adequate infection control practices among health care workers is urgent. After the conformation of a National Inter-Hospital Committee on Prevention and Control of Health Care Associated Infections, a national conference was organized around this topic.

The application of Neonatal IMCI by trained medical staff for two mothers who suffered from two of the three most common causes of neonatal mortality: preeclampsia/chronic arterial hypertension and vaginal bleeding.

One of the main instruments that the country will utilize to achieve Millennium Development Goal 4 is the application of Neonatal Integrated Management of Childhood Illnesses (IMCI) with cost-effective interventions based on evidence that have already started to give positive results. 

IMCI-trained doctor’s smart decision to refer an ill pregnant woman saves her and her child

With financial, logistical and human resource support from PAHO and USAID, the Integrated Management of Childhood Illnesses (IMCI) strategy is implemented to help health care providers determine the steps that need to be taken when evaluating a pregnant mother, newborn or child under the age of 5 years. Part of the IMCI strategy indicates when a patient should be referred to a larger, more specialized health facility.

Building networks to tackle problems and share solutions in Latin America

Sixty-six students are enrolled in the six-month course which started in May and will culminate in the elaboration of an EPHF intervention project in November 2009.  Participating in the course are public health leaders in the region, including social security directors, viceministers or national health directors, health secretaries from departments or provinces, and professors from public health schools.

HMN Health Metrics Network diagnostic tool for Health Information Systems and PRISM Performance of Routine Information System Management, developed by MEASURE-Evaluation.

Heath information is recognized as a basic input for public policy formulation, monitoring, and evaluation. 

The Role of the Neonatal Health Collective in favor of Newborn Health

The Neonatal Health Collective was formed by PAHO/WHO, UNICEF, CARE, and PRISM; since its inception, other members have joined, including representatives from the Ministry of Health and from Pediatric and Gynecological/Obstetric Scientific Societies; all members use the framework of the achievements of this Regional Partnership. 

The Follow-up and Monitoring of Neonatal Clinical IMCI instrument was well received in Bolivia and Nicaragua.

It permits verification, documentation and strengthening of the competencies of health workers trained in neonatal IMCI and therefore has great potential for future adaptation.

Enhancing quality of health care for mothers and children through evidence-based interventions

Since 2008, the Department of Granada, 40 kilometers from Managua, the capital of Nicaragua, has been implementing intense training in neonatal Integrated Management of Childhood Illness, after the Ministry of Health launched the national plan for reduction of neonatal mortality.

Doctors and nurses trained in the Integrated Management of Childhood Illnesses (IMCI) act quickly to save a woman with complications early in her labor

Bleeding – one of the most common killers of pregnant women and newborns – would mean a high-risk labor and delivery.  The IMCI strategy, developed by the World Health Organization and implemented partially with funding from USAID, provides medical personnel with specific step-by-step instructions that indicate how a high risk situation should be handled in a local health center and when it should be referred to a hospital that may be better equipped to help.