(11 July 2008) World Population Day is celebrated on July 11 with an emphasis on family planning as a means to improve maternal health, one of the Millennium Development Goals (MDG) that has most lagged behind.
A community health programme in Paraguay has improved equity in access to health services and the health system's capacity of responding to community needs, having a positive impact on local maternal and child care.
Due to its creativity, its impact on the health of the population, and good possibilities of being replicated in the region, the Community Health Programme: Health, Everyone's Responsibility, won fourth place in the 2005-2006 cycle of the "Experiences in Social Innovation" contest, organized by the Economic Commission for Latin America and the Caribbean (ECLAC), with the support of the W.K. Kellogg Foundation.
The programme assists the population of the Fram District in the Paraguayan department of Itapúa, through a model inserted in the Ministry of Public Health and Social Welfare and the Itapúa Department Government network, characterized by its decentralized administration and the active participation of the community, the municipality and the health centre.
Its achievements are impressive: there has been a 74% increase in pre-natal check-ups, a 100% rise in institutional childbirth, vaccination of all of the infant population, infant mortality rates 50% lower than the national average, a 90% increase in pediatric check-ups, and a 35% rise in the use of Family Planning Services, with 75% of fertile women regularly having a Papanicolaou (PAP) exam.
The maternal mortality rate has continued at nearly 0 per 100,000 live births over the past six years. This is an enormous achievement, given that Paraguay - with its average 190 deaths per 100,000 live births, has been the slowest Latin American country in reducing maternal mortality over the past 50 years, and has shown no improvement in the past 15.
A discouraging initial scenario
Before, health care in Fram was exclusive responsibility of the Health Centre, with its centralized administration, lack of personnel, supplies and medicine, limited schedule and no community participation.
The Health Centre professionals themselves, along with community leaders, were the ones pushing for change. A social-sanitary census and a diagnosis of the community's morbimortality were carried out with funds from the NGO Center of Information and Resources for Development (CIRD) and the United States Agency for International Development (USAID), with the support of the Departmental Secretariat of Health, the Sanitary Region, and the Public Health Ministry.
Health indicators were poor: high infant mortality (36 per 1,000 live births in 1996); most childbirth was at home (only 25 births in health centres during the year); low coverage of PAP exams and child vaccination, and scant public confidence in health services. Additionally, only 15% of the population was covered by health insurance.
A model from and for the community
After a participatory analysis of census results, organizers devised a Local Health Plan, as a decentralized programme to meet the most pressing needs of the community. Part of the programme included creating a model of Community Insurance accessible to all Fram residents. This model increased and ensured the flow of resources needed to improve health care, bolstering public confidence in health services.
In addition to contributions from the community itself, local, departmental and national institutions also contributed to the project, making important investments possible: construction of a surgery room and the purchase and maintenance of an ambulance.
As part of this new health care model, a Social Pharmacy was set up to offer low-cost medicine, and a new, "socio-sanitary" women's network was created as a key element in providing information on reproductive health, women's rights and health centre management.
The programme's success has led to its replication in 35 municipalities in Paraguay. The key to its success lies in the way community participation is organized and promoted in seeking solutions to health problems, replacing a centralized and distant model with a decentralized one, of which patients feel a part. It is a model for the creation and strengthening of social capital in benefit of the entire community's health.
For more information, visit the Experiences in Social Innovation site , or contact: anita.callejas cepal.org ; telephone: (562) 210-2387 |
