Bolivia: case study of scaling-up and impact. Dra. Ana Maria Aguilar Liendo La Paz Bolivia

Transcription

1 Bolivia: case study of scaling-up and impact Dra. Ana Maria Aguilar Liendo La Paz Bolivia

2 BOLIVIA Heart of South America 9 million inhabitants 9 departments 36 ethnic groups 4 main languages

3 Content 1. Present status 3. Malnutrition prevention 5. Impact on mortality & prevalence 7. Barriers and how overcome 9. Factors for success

4 Malnutrition Zero Programme Multisectorial Decentralized Intercultural and community integrated approach Preventive and promotional Focalization by age and geography Measurable

5 Coverage Prevention of stunting, acute malnutrition and anemia Management of severe and moderate acute malnutrition Main focus on children under two years of age Nationwide with emphasis in 166 municipalities

6 Approach Management and prevention of chronic and acute malnutrition included in the Health System through the IMCI NUT strategy. Supplies are covered by public insurance. Health attention is free of charge at MOH establishments. IMCI NUT strategy is implemented in more than 3,500 PHC facilities. PHC health staff is trained in IMCI - NUT

7 IMCI NUT algorythm starts with nutrition evaluation

8 Management of acute malnutrition in the HS Diagnosis Identification of complications With complications Estabilization and referral Without complications Do not accept referral Community management RUTF BASES TÉCNICAS. AIEPI-Nut Clínico Actualización mayo 2009

9 Management of acute malnutrition in the HS Diagnosis All staff in the health system Identification of complications All staff in the health system SAM with complications Estabilization and referral 12 referral units with trained teams SAM Without complications SAM who Do not accept referral Moderate and Mild AM Moderate acute malnutrition Community management RUTF Mild acute malnutrition 3,500 establishments 130 Nutrition integrated units BASES TÉCNICAS. AIEPI-Nut Clínico Actualización mayo 2009

10 Operative actions within a municipality PS CS Nutrition Unit Reference Hospital MAIN CITY CS Gobierno Municipal PS CS

11 Networking PS CS N Nutrition Unit Reference Hospital MAIN CITY CS Gobierno Municipal PS CS

12 Being part of the system means: Medicines and nutrients considered in the norm provided by the insurance: CMV RTUF Micronutrients Antimicrobials Laboratory tests Zinc Reimbursement for attention according to norms

13 Circuit of malnutrition prevention Community IMCI NUT Framework of salud familiar comunitaria intercultural Local health councils Municipal councils for food and nutrition Conditional transfer of money Bono Juana Azurduy May 27, 2009

14 Networking PS CS H 2 Reference Hospital MAIN CITY UNI CS AIEPI Nut de la familia y la comunidad Gobierno Municipal PS CS

15 Networking PS CS CS C IMCI Gobierno Municipal H 2 Reference Hospital MAIN CITY UNI IMCi Follow up Training Nutrition promotion PS CS

16 Networking PS CS CS AIEPI Nut de la familia y la comunidad Gobierno Municipal H 2 UNI H IMCi Follow up Training Nutrition promotion PS UDS SAM management CS

17 Community networking PS Lactancia Materna Ali. Comp. CS H 2 H Nutrition Unit CS AIEPI Nut de la familia y la comunidad Gobierno Municipal UDS PS SAM management CS

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21 Complementary fortified food (NUTRIBEBE) given by municipalities

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24 OCURI: COMMUNITY WORKSHOPS

25 Using local products in training sessions

26 Minister of Water and Environment signing an agreement with municipalities to support water and sanitation in Zero malnutrition program Sucre, Julio de 2009 El viernes 3 de julio se firmó en Sucre el acuerdo para la Implementación del componente agua, saneamiento e higiene del Programa Multisectorial Desnutrición Cero, que será ejecutado en 14 municipios de tres departamentos: Chuquisaca, Cochabamba y Potosí, con el objetivo de contribuir a la reducción de la desnutrición en Bolivia. Rubricaron el Acuerdo el titular del Ministerio de Medio Ambiente y Agua (MMAyA), René Orellana, el Representante de UNICEF en Bolivia, Gordon Jonathan Lewis, y el Supervisor Regional del Programa Multisectorial Desnutrición Cero, Isaac Ortega Lima, así como los alcaldes de todos los municipios. leer más

27 Monitoring and evaluation 2006 baseline 2009 Mid term evaluation 2011 Final evaluation DHSS 2006 DHSS 2008 preliminary report National Health Information System ongoing Community nutritional surveillance Surveillance of conditional cash transfer

28 DHS S Departments Pando /Beni Santa Cruz Tarija Potosi Oruro Cochabamba La Paz Chuquisaca Total Bolivia Acute malnutrition Stunting

29 National information system Mortality rate at reference hospitals Depto Patients Deaths Rate Patients Deaths Rate LP , SC , ,5 CBBA , ,9 Oruro , ,0 Beni , ,1 Pando ,0 Potosi ,9 Chuquis , ,7 Tarija , ,2 Total ,32

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31 Departments Beni Chuquisaca Cochabamba La Paz Oruro Pando Potosi Santa Cruz Tarija Bolivia % of children attending to clinics with SAM O

32 Prevalencia de Desnutrición Aguda en menores de 5 años (peso/talla 1DE) Red 1 Sucre Central 15 Sta. B. Norte Sta. B. Sur V. Hermoso Tejar S. Jose Chuq. Potolo Total

33 Sentinel surveillance SAM EXCLUSIVE BREAST FEEDING

34 Barriers Few human resources Training International networking Norms based on available evidence Advocacy Get support Budget Difficult to place the MOH in a leading role Small experience on monitoring and evaluation

35 Factors of succes Political will Combat malnutrition is a current issue Malnutrition erradication a point impossible to avoid once is in the agenda

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