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Detailed Implementation Plan (Dip) DETAILED IMPLEMENTATION PLAN (DIP) Providing Child Survival Services to Rural and Peri-Urban Populations in Bolivia Cooperative Agreement No. HFP-A-00-02-00035-00 Project Start Date: October 1, 2002 Project End Date: September 30, 2007 Submitted to: US Agency for International Development Bureau for Global Health Office of Health,, Infectious Disease, and Nutrition Child Survival and Health Grants Program Washington, DC Submitted by: Curamericas 224 East Martin St. Raleigh, NC 27601 Tel: (919) 831-8000 Fax: (919) 821-8087 www.curamericas.org Submitted on April 29, 2003 Curamericas 224 E. Martin Street, Raleigh, NC 27601 Telephone: 919-821-8000 Fascimile: 919-821-8087 Email contact: [email protected] Providing Child Survival Services to Rural and Peri-Urban Populations in Bolivia September 30, 2002-September 29, 2007 Cooperative Agreement No. HFP-A-00-02-00035-00 Interventions: 25% Nutrition (including breastfeeding promotion) 25% Maternal and Newborn Care 20% Control of Diarrheal Disease 20% Pneumonia Case Management 10% Immunizations Beneficiary Populations: 37,100 children under five years of age and women of reproductive age (8,381 are children under five years of age, and 16,581 are women of reproductive age) Names and Positions of the DIP Writers: Sujata Ram, MPH Independent Consultant Tom Davis, MPH Senior Program Specialist, Curamericas Craig Boynton, MPH Country Program Manager, Curamericas Nathanial Robinson National Director, CSRA Hernan Castro Operations Manager, CSRA 1 TABLE OF CONTENTS LIST OF ACRONYMS................................................................................................................3 SECTION A: EXECUTIVE SUMMARY..................................................................................4 SECTION B: CSHGP DATA FORM AND RAPID CATCH INDICATORS..........................7 SECTION C: DIP PREPARATION ........................................................................................13 SECTION D: REVISIONS TO THE ORIGINAL PROPOSAL BUDGET ...........................14 SECTION E: DETAILED IMPLEMENTATION PLAN.......................................................18 SECTION F: ORGANIZATIONAL DEVELOPMENT..........................................................76 SECTION G: SUSTAINABILITY PLAN ................................................................................81 ANNEX A: MAP OF PROJECT SITE....................................................................................84 ANNEX B: RESPONSES TO PROPOSAL COMMENTS AND FINAL EVALUATION....85 ANNEX C: DIP PREPARATION METHODOLOGY, SCHEDULES AND WORKSHOP PARTICIPANTS .......................................................................................................................89 ANNEX D: BUDGET FORMS 424 AND 424A AND BUDGET NARRATIVE ....................96 ANNEX E: FORMAL AGREEMENTS WITH LOCAL PARTNERS ................................103 ANNEX F: BASELINE METHODOLOGY AND QUESTIONNAIRES..............................116 ANNEX G: QUALITY ASSURANCE...................................................................................145 ANNEX H: ORGANIZATIONAL CHARTS ........................................................................147 2 LIST OF ACRONYMS CAI Information Analysis Committee CARE Cooperative for Assistance and Relief Everywhere, Inc. CB-IMCI Community Based Integrated Management of Childhood Illness CBC Communication for Behavior Change CBIO Census-Based Impact Orientation CHW Community Health Worker CS Child Survival CSRA El Consejo de Salud Rural Andino CSTS The Child Survival Technical Support Project DIP Detailed Implementation Plan DILOS Local Health Board DDPC Desarrollo Democratico Participacion Ciudadana EPI Expanded Program for Immunizations HV Health Volunteer IEC Information, Education and Communication IMCI Integrated Management of Childhood Illnesses KPC Knowledge, Practices and Coverage MCH Municipal Health Council MOH Ministry of Health NGO Non-governmental Organization QAP Quality Assurance Project ORS Oral Rehydration Salts PAHO Pan American Health Organization PROPAN Process for the Promotion of Child Feeding SNIS National Health Information and Statistics System TARI Talleres Abiertos sobre Reciprocidad e Cross-culturalidad TIPS Trials of Improved Practices TT Tetanus Toxoid USAID U.S. Agency for International Development WHO World Health Organization 3 SECTION A: EXECUTIVE SUMMARY This document is a detailed implementation plan (DIP) for Curamericas’ new entry Child Survival Project (2002-2007), Providing Child Survival Services to Rural and Peri-Urban Populations in Bolivia. Project activities began on October 1, 2002 and will continue through September 30, 2007. The project’s goal is to reduce child and maternal deaths and morbidity by improving maternal, neonatal, and infant health care services in the proposed project areas. Its program strategies and interventions depend on the active participation of local stakeholders, and incorporate suggestions made by USAID proposal reviewers as well recommendations from Curamericas previous child survival final evaluation (see Annex B for specific responses to DCHA/PCV Child Survival Application Debriefing Summary Sheet and Final Evaluation Recommendations). The target areas for the project will be peri-urban sites, in the municipality of Montero (Obispo Santistevan Province, Santa Cruz department) and El Alto’s District Eight (Murillo Province, La Paz department), which includes the neighborhood of Senkata (see Annex A for project site maps). Currently, Montero’s three active health centers, Villa Cochabamba, Cruz Roja and Clem serve 4,044 households in adjacent communities and each offers a variety of health services that include basic maternal and child health, laboratory facilities and a pharmacy. The El Alto health center recently opened and will be offering similar maternal, child and dental services. It also has a maternal center, in-patient accommodations, and delivery facilities. The primary causes of death and morbidity among preschool children include pneumonia, diarrhea, malnutrition, asphyxia, and sepsis. Pre-eclampsia, hemorrhage, and infections are primary causes of death among women of reproductive age. Bolivia is second only to Haiti in the Western Hemisphere in terms of mortality of children under five years of age. The national under-five mortality rate for Bolivia is 80 per 1,000 live births and the infant mortality rate is 67 per 1,000 live births1. The national maternal mortality rate is 390 per 100,000 live births1. These rates vary widely within Bolivia depending on geography, income, education, and urban/rural location. The proposed service areas are very marginalized, and we expect mortality rates to be well above the national average for these areas. Over 37,100 women, infant and children will be reached by the child survival interventions in the proposed service areas where there are 77 urban and peri-urban neighborhoods. The table below describes the target group population for both project sites at the beginning of the project. Program Site Population by Target Groups (2002) Target Group Montero El Alto (District #8) Total Infants 0 – 11 months 619 890 1,509 Children 12 – 23 months 723 926 1,649 Children 24 – 59 months 2,244 2,979 5,223 Women of Reproductive age (15-49 years) 6,989 9,592 16,581 Total Direct Beneficiaries 10,575 14,387 24,962 Other Indirect Beneficiaries 16,261 21,187 37,448 Total Population 26,836 35,574 62,410 Source: National Institute of Statistics 2002 for El Alto, Actual Census Data from Villa Chochabamba and Cruz Roja in 2001, and Actual Census Data from Clem in 2002, Montero. 1 National Health Information and Statistics System, La Paz, Bolivia. 4 The project goal will be achieved through a focus on several key objectives. These include strengthening the capacity of community health workers (CHWs) and health volunteers (HVs) through training, and increasing access to child survival (CS) services through home visit and clinical consultations; increasing demand for health prevention and treatment services through health education, the Integrated Management of Childhood Illnesses (IMCI) approach, and community maternal and neonatal health care strategies; and, increasing the capacity of project personnel, municipal governments and the MOH to successfully plan, budget, implement and evaluate sustainable community child survival services. These objectives will be achieved by offering five key child survival interventions (with the corresponding estimated level of program effort): nutrition and micronutrients – 25%; maternal and newborn care – 25%; control of diarrheal disease – 20%; pneumonia case management – 20%; and immunization – 10%. Under-five Mortality Rate, FOCAS-Curamericas These interventions will be implemented through a series of Mentoring Project 200 innovative activities designed to further strengthen program 188 180 impact. First, we will implement the census-based, impact- 160 160 160 160 160 140 oriented (CBIO) methodology of primary health care within the 120 118 121 MEI 104 100 101 OBDC U5MR DHS communities that will be served. The under-five mortality rate 80 68 66 60 decreased by almost 75% in our service areas in Bolivia during 47 40 the previous eight years (see graph, right), due in part to our 20 0 2 1999 2000 2001 2002 CBIO methodology. The CBIO methodology ensures that all MEI 188 118 104 66 OBDC 68 101 121 47 beneficiaries are contacted on a routine basis. Community health DHS 160 160 160 160 Year volunteers conduct prevention education sessions and gather
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