Project Title: Child Survival in San Miguelito Duration: January 2006 Location: San Miguelito, Department of Intibucá, Honduras Executing Organization: W.A.S.H., United States Peace Corps, Honduras Ministry of Health Amount Solicited: $215.00 Summary The program known as Atención Integral a los Niñez en la Comunidad (AIN-C) is designed to provide a community level method of monitoring the growth of children under the age of 2 years. With proper facilitation, AIN-C decreases the likelihood that inadequate growth, resulting from malnutrition and disease, will occur in this important period of development. The program is managed, primarily, by a team of selected monitors who are members of the community. When managed correctly, the weight and length of every child under the 2 years is recorded on a monthly basis and compared to the standard growth rates of children for that age. Children who do not reach adequate growth in a given month are identified and evaluated for signs of poor health and/or growth faltering. Important to this process is the presence of a counselor who works with each parent to evaluate behaviors and ensure that they are committed to assuring adequate growth of their child. Description of the Problem San Miguel Guancapla (San Miguelito) is a rural municipality located in the department of Intibucá. It consists of a small town center and surrounding rural villages and is home to approximately 7,500 people. In this poverty-stricken municipality, diarrhea and respiratory illnesses are very common in children. Lack of education contributes to poor diet and poor hygiene practices. These factors result in malnutrition, poor child growth and development, and reduced level of well being. The AIN-C program is promoted by the Honduran Ministry of Health (MOH) to improve child survival across the country. To manage the AIN-C program on the community level, a team of 3 monitors are selected and work on a voluntary basis. These monitors organize and manage a monthly AIN-C meeting in the community during which every child under the age of 2 years is weighed, growth adequacy is recorded, and the parent or primary guardian receives a consultation which evaluates other aspects important to child health (adequate breastfeeding, vaccinations, vitamin supplementation, etc.). Monitors are trained to work with parents to promote proper behaviors and ensure that parents follow through. Monitors are also trained to identify cases of illness and refer the child to a health center or hospital as necessary. Unfortunately, proper implementation of AIN-C in San Miguelito is weak. Four communities have received a formal AIN-C training by the MOH but it is evident that further training is required. In several instances, monitors were chosen and later backed out for reasons of illiteracy or lack of interest. Those that are implementing the program are completing only weighing activities, omitting the more intimidating yet very crucial counseling aspect. Although it is the responsibility of the monitor to ensure that attendance at the monthly meetings is consistently high, attendance is often very poor. Goals and Objectives In the attempt to improve child survival in the communities of San Miguelito, it is necessary to engage in consistent and adequate child growth monitoring activities. In order to accomplish this, each community that has been previously trained by the MOH to implement AIN-C will receive reinforcement training. Where necessary, new monitors will be recruited that are literate and who demonstrate both interest and commitment their communities and to AIN-C. Reinforcement training will include (1) proper weight monitoring and recording techniques (2) proper consultation techniques (3) identification of illness and referral of sick children (4) evaluation and communication of growth patterns and concerns to the health center. Motivated, trained, and active AIN-C monitors will benefit child survival in community and help fulfill the ultimate goal of increasing the health and well-being of San Miguelito’s community members. Goal To strengthen the effectiveness of child growth monitoring through AIN-C implementation in San Miguelito Objectives 1. Develop AIN-C reinforcement training techniques that address weak areas of the program’s implementation. 2. Provide AIN-C reinforcement training to 3 monitors in each of 4 previously trained communities. Design and Implementation of the Project The workshop will be planned, organized, and facilitated through a collaboration of the Health Center Director, Dr. Juan Flores, and Peace Corps Volunteers, Sara Schaefer and Ann Reisnhauer. All of these individuals have previously been trained in the program AIN-C. The workshop will consist of 2 days; Day 1 including activities designed to review and practice AIN-C techniques and Day 2 encompassing a field trip to a community located within the department, San Jeronimo, in order to observe the proper implementation of the AIN-C program. The proposed project aims to provide reinforcement training to monitors from the following San Miguelito communities: Communities Monitors Segua 3 Cangual 3 Las Cañadas 3 San Antonio 3 TOTAL 12 Monitors Workshop: 2 day workshop, Day 1: Workshop: 8am-3pm. Day 2: Field Trip: 6 am-1 pm, processing Instructors will include: 1. Sara Schaefer, Ph.D. (Peace Corps Volunteer, San Miguelito) 2. Ann Reisenhauer, Ph.D. (Peace Corps Volunteer, La Esperanza 3. Juan Alexander Flores, M.D. (Director, CESAMO San Miguelito) Monitoring and Evaluation A quantitative means to evaluate the workshops will be employed over one year following reinforcement training. Evaluation will take place on a monthly basis in the form of a meeting in the health center. Evaluation components will include 1) attendance at the monthly AIN-C meetings 2) accurate record keeping by monitors 3) proper referrals and house visits in cases of illness and high risk 4) overall decrease in the incidence of inadequate growth in children under 2 years of age. Workshop facilitators will attend the majority of AIN-C meetings in the communities in the subsequent year. Facilitators will observe weighing and parent counseling activities to evaluate quality in which these processes are executed. Expected Outcomes It is expected that through this reinforcement training, monitors will feel better prepared and motivated to implement the AIN-C program correctly. These 4 communities shall experience better child growth monitoring, and as a result, benefit from increased child survival and well-being. New training techniques will be developed and used in the place of techniques that were used in the past and proved to be unsuccessful. If new techniques prove to be successful, MOH personnel will be able to use them in the future to communities that will be trained in AIN-C, as early as the coming year. The intangible effects of the workshop are many. Effects may include a sense of empowerment in the capacity to facilitate AIN-C activities in the community, higher capacity to work in a group as a member of a team, perception of leadership by other community members, and a greater sense of pride in the community as a whole. Budget Item Quantity Unit Price (Lmps.) Total Cost (Lmps.) Materials Charla Paper 100 2.00 200.00 Markers 10 10.00 100.00 Notebooks 12 20 200.00 Pens 50 10 500.00 Photo Copies 100 1 100.00 Meals Lunch 30 (15 x 2 days) 30.00 900.00 Snack 30 (15 x 2 days) 10.00 300.00 Transportation Facilitators 2 50.00 100.00 Field trip to San Jeronimo, Intibucá 15 70.00 1050.00 Miscellaneous T-shirts 12 50.00 600.00 Total (Lempiras) 4050.00 Total (US Dollars) L18.9 =1USD 215.00 Amount Requested for Funding: US$ 215.00