Presentation on theme: "Ministry of Public Health and Social Welfare Integrated Supervision Strategy IMCI - EPI Contribution to strengthening the health services in Paraguay Dr."— Presentation transcript:
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
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 childrens growth and development through health care quality improvements. Paraguays 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. Background
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 workers attention on people and their health needs in a comprehensive, integrated fashion.
COMPONENTS OF IMCI-EPI INTEGRATED SUPERVISION Training Logistics and supplies Information Monitoring Evaluation Quality procedures in IMCI and EPI
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.
Framing the issue Methodology Implementation Results Lessons learned Obstacles and challenges DESCRIPTION OF THE IMCI-EPI INTEGRATED SUPERVISION EXPERIENCE
Framing the issue Political and technical advocacy Mobilization of resources. Interprogrammatic partnerships. Through:
Methodology Design the integrated supervision instrument. Each indicator contains three to six conditions that must be 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
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 countrys 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.
Results Health services integration indicators Indicators of improvement of existing capacities for providing health care services Strengthening health services
Regions Districts in the Region Priorities Total population District Health Services Integrated Supervision of Health Services Coverage San Pedro Norte118 350840 646094.0 San Pedro Sur8234 100 Caaguazu2012 474,26154 100 Itapúa3020517. 047824857.0 Alto Paraná2011703.507544787.0 Central19161,860,841595288.0 Capital11519.0769 *111.0 Total109704,42557235528179.0 Total country 2326,119,642900 Area of Implementation of the IMCI-/EPI Integrated supervision * Has 29, but 9 were scheduled
Geographical distribution of the Priority Districts in the Supervised Area Paraná Itapúa San Pedro Plant Caaguazú Asunción In the regions of
Level of Complexity ExistingWith two rounds of supervision Supervision coverage Regional Hospital5480.0 District Hospital16 100 Health Center34 100 Health Post30022776.0 Total35528179.0 Supervised health services by level of complexity
Did the health center have staff trained in IMCI protocols? N = 281 Service integration indicators
Nº= 281 Differences in application of IMCI protocols according to whether staff has received training Service integration indicators
Nº= 281 Differences in application of IMCI protocols according to whether staff has received training (2) Service integration indicators
Is improvement in EPI/IMCI observed in the services between the first and the second rounds of supervision? Service integration indicators
Are there differences in the application of IMCI protocols in Alto Paraná Between the first and second rounds of supervision? Service integration indicators
Application of protocols Necessary Equipment Application of protocols Is improvement in EPI/IMCI observed in the services in Alto Paraná between the first and second rounds of supervision ? Service integration indicators
Nº= 69 Improvement indicators for existing capacity in the services Is improvement in EPI/IMCI observed in the services between the first and the second rounds of supervision?
* ORS, amoxicillin, Mebendazole, Albendazole, Salbutamole, penicillin. Benzathine Is improvement in EPI/IMCI observed in the services between the first and the second rounds of supervision? Improvement indicators for existing capacity
Is improvement in EPI/IMCI observed in the services between the first and second rounds of supervision? Improvement indicators for response capacity
Essential elements of PHC converge based on the experiences of IMCI-EPI Integrated Supervision ESSENTIAL PHC ELEMENTSOVERLAP WITH SUPERVISION PROGRAM Comprehensive, continuous, integrated care Coordination of preventative (vaccines) and curative (treatment) medicine during key stages in life. Coordination among all parts of the system; plan for referral and counter referral. Appropriate care Focuses on the whole person, beginning with promotion and prevention (Community AIEPI). Treatment (Clinical IMCI) is based on the detection of problems and timely provision of vaccinations of proven effectiveness (EPI) Pro-equity policies and programs Availability of care and free vaccines at all levels (Immunization Act) and verification of the quality of the service through supervision. Monitoring the scope of coverage at all levels
ESSENTIAL PHC ELEMENTSOVERLAP WITH SUPERVISION PROGRAM Emphasis on promotion and prevention Offers education, counseling, monitored care, and its approaches are based on improvements in key family practices that benefit the health of children and their families Adequate and sustainable resources Monitoring of and follow-up on the availability and supply of drugs, equipment, supplies, inputs, and materials, etc. Appropriate human resources Monitoring the training of staff with technical skills and knowledge in their area of expertise to ensure they meet technical and ethical standards. Optimal organization and management Legal-political and institutional framework for the organization of immunization services and integrated care to improve the health and development of children and their families. Essential elements of PHC that overlap with the experiences of IMCI-EPI Integrated Supervision
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
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.
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.