HEALTH

Program Overview (1997-2005)

A volunteer counselor weighs a child during the monthly Integrated Nutrition Care program (INC) weighing sessions held in a community.  Photo by Miguel Linares, PHR Plus.

Under its strategy that began in 1997 and ended in September 2005, USAID helped El Salvador, working with the Ministry of Health (MOH) and NGOs, to improve decentralized primary health care and reduce child mortality through activities that: (a) expanded rural primary health care services and coverage; (b) enhanced prevention and treatment of respiratory illnesses and diarrhea; (c) improved nutrition and breastfeeding practices; (d) expanded use of the Integrated Management of Childhood Illnesses Strategy; (e) improved the quality of prenatal care; and (f) worked with HIV/AIDS high risk groups on prevention and education.

USAID programs contributed to the following achievements:

• Decrease of infant mortality and fertility rate: from 1998 to 2003 infant mortality declined from 35 to 23 deaths per 1,000 live births, while the total fertility rate (number of children born to a woman) declined from 3.58 to 2.91.

• Improvement of Integrated Health Basic System (SIBASIs) management: USAID’s support focused on seven SIBASIs in Suchitoto, Cojutepeque, La Paz, San Vicente, Jiquilisco, Usulutan, and San Miguel, which resulted in management and service improvement. In addition, a commodities acquisition system has been developed and installed, and functions at the central level in three specialized hospitals and all SIBASIs.

• Implementation of the Integrated Nutrition Care program: USAID supported the training of 1,319 nutrition counselor volunteers for the Integrated Nutrition Care program (INC) run by the MOH.  Under this program, the registration of 13,240 children under age two and 3,310 pregnant women was completed.  Participating communities have also seen improvement in the nutritional status of children under age two.

• Integrated Management of Childhood Illnesses (IMCI): this guideline was updated through the addition of newborn, and growth and development (weight gain) components for children under age two.  Moreover, USAID helped strengthen the nutrition counseling component and trained 30 doctors and nurses on the new INC and IMCI integrated model.

• Delivery plan and maternal attention strategy: One hundred and eighty-eight people within seven SIBASIs attended training on delivery plans, maternal attention and pre-natal units in order to ensure that rural women are assisted by trained personnel during delivery.

• Increase of prenatal care: most of USAID-assisted SIBASIs registered prenatal care coverage of 60-70 percent, compared to the national average of 50-60 percent.

• Breastfeeding counseling training: Thirty-seven new counselors were trained in breastfeeding practices.

• Adolescent attention training: One hundred and four facilitators were trained to provide a more friendly health service to adolescents.

• Construction of water systems: 131,051 people benefited from the construction or rehabilitation of 54 water systems, and 102,573 people benefited from the provision of 19,305 latrines.  USAID supported the construction of 652 hand-pumps and wells that benefit 23,441 people.

• Reforms to Labor Code: USAID provided technical assistance in order to support the Legislative Strategic Alliance “Anti-discrimination Actions for People Living with HIV/AIDS.”  Reforms submitted by the Alliance were included in the Presidential decree-law number 611.

• Counseling and contraceptive methodologies training: One hundred and seventy-nine doctors and nurses from health units and hospitals, as well as health promoters, received training in counseling and contraceptive methodologies to improve the access and quality of family planning services, especially for the rural population.

• Strengthening of SIBASIs logistic system: the SIBASIs logistic system was strengthened in order to ensure the availability of contraceptives at all levels within the reach of MOH.