Project Title:  Maternal Health Initiative   Duration:  November 2006 - November 2008   Location:  San Miguelito, Department of Intibucá, Honduras   Executing Organization:  W.A.S.H., United States Peace Corps, Honduras Ministry of Health   Amount Solicited:  $3,248.00   Summary - San Miguel Guancapla (San Miguelito) is a small rural municipality located in Western Honduras.  The municipality has an alarmingly high incidence of maternal and infant mortality.  Properly trained “Comités de Emergencia” (Emergency Committees) within village communities can manage emergencies related to maternal and infant health as well as promote healthy practices in order to prevent such emergencies from arising.  A curriculum to train such committees will be developed and utilized by a local community health program, to provide students with hands-on experience in health promotion and program implementation and, as a result, enable communities to play an active role in the reduction of the mortality of their women and infants   Project Justification - Maternal and infant mortality is a worldwide problem.  More than 500,000 women in poor countries die every year due to problems related to pregnancy and maternal death greatly decreases the chance of survival for the infant.  The majority of these problems would be preventable if these women had access to obstetric services.  Geographic isolation and lack of transportation are major factors that contribute to poor health care access.  A solution to this problem includes the organization and utilization of local and community resources community to create action plans for emergencies related to maternal and infant health.  Additionally, the active promotion of practices that reduce the risk of obstetric complications will also prevent incidence of such emergencies.   Maternal and infant mortality is a high in rural areas of Honduras.  To combat this problem the Honduran Ministry of Health (MOH) is promoting “Comités de Emergencia”, groups typically composed of 5-6 volunteers who are leaders, health volunteers, and mid-wives in their respective communities.  These groups are trained to identify and properly manage maternal and infant health emergencies.  Committee members are responsible for creating and executing plans of action should such an emergency occur which requires transportation to a hospital.  They also are responsible for raising money to have available to loan in emergency situations to cover costs, such as gas and medical care.   San Miguelito is a poverty-stricken municipality in Honduras and maternal and infant mortality rates are alarmingly high in its rural villages.  Although a few “Comités de Emergencia” have previously organized in San Miguelito, these groups are not functioning due to inadequate training, support, and oversight.    In spite of the need for proper implementation of this health initiative in San Miguelito communities, a three-year community health program (Bachillerato en Salud Comunitario) exists in San Miguelito’s high school, Instituto “Rafael Pineda Ponce”.  Graduates from this program normally seek jobs with non-government organizations or the Honduran MOH and work at the community level, educating and promoting government programs and campaigns to combat disease and mortality.  Unfortunately, the program in San Miguelito lacks resources to provide students with a strong education; outdated health manuals are used in place of textbooks and the program provides minimal hands-on experience working in communities.    Objectives   The current project aims to enable students to effectively implement “Comités de Emergencia” in each community of San Miguelito, Intibucá.    Objective 1:  To engage students enrolled in the local community health program in experiential learning through implementation of “Comités de Emergencia” in San Miguelito communities.   Specific Objective 1.1:  Design “Comités de Emergencia” training content to be utilized by students in their third year of the Bachillerato en Salud Comunitario in San Miguelito.   Specific Objective 1.2:  Facilitate student-acquired experience in program implementation in community health.   Objective 2:  To realize “Comités de Emergencia” in each of San Miguelito’s communities that are active and competent in 1) the execution of proper emergency management related to maternal and infant and 2) health education and promotion to reduce incidence of such emergencies.   Specific Objective 2.1: Facilitate initial organization of “Comités de Emergencia” in each of San Miguelito’s 12 communities and provide subsequent training to each group.   Specific Objective 2.2:  Facilitate follow-up and monitoring activities to ensure training information is accepted and properly utilized by “Comités de Emergencia”.   Methodology   The total duration of this project will be 24 months in order to realize active and effective “Comités de Emergencia” in each of San Miguelito’s 12 communities.  In the 2007 school year, third year students will work with 6 communities seeing that groups are organized and functioning effectively.  In the 2008 school year, third year students will work with the remaining 6 communities.   Phase 1:  Development of Training Content (November 2006 - February 2007):    Training content will be developed through collaboration of the Honduras MOH, the US Peace Corps, and Pineda Ponce teachers.  Training curriculum content will include 20 hours of activities designed to organize “Comités de Emergencia” and prepare such groups to execute emergency response, prevention of pregnancy-related complications, data collection and monitoring methods, and finance management.   1. Organization Recruiting of responsible, appropriate, and willing volunteers Group structure Role of individual group members   2. Emergency response Identification and management of complications that can occur during pregnancy, birth, and post-partum Emergency action plans  First aid and use of supplies   3. Prevention High-risk pregnancy Family planning Nutrition for women of reproductive age   4. Data collection methods Community mapping Data collection Monitoring incidence   5. Finance management Community activities to raise emergency fund Maintaining a minimum emergency fund Management of emergency fund   Phase II:  Train Teachers and Students (February - March 2007)   Once content is developed, teachers will be trained by Peace Corps Volunteer, Sara Schaefer, Ph.D. and MOH personnel.  The information will be transferred to third year students during class time.  Resource manuals for the school will be included in the project budget in order to provide students with additional learning and reference materials.   Phase III:  Train 6 Comités de Emergencia (April - May 2007)   In the first year, students will be organized into 6 groups and each group subsequently assigned to one of 6 San Miguelito communities.  Students will design appropriate workshop training content for their community, utilizing knowledge and activities presented in training.  Workshops will be designed around 4, 5-hour days.  During training, each “Comité de Emergencia” will receive a kit with medical supplies and will be trained in their proper use.   Phase IV:  Monitor and Evaluate “Comités de Emergencia” (June - November 2007)   At the completion of training, student groups will organize meetings with their assigned community’s Comité de Emergencia on a monthly basis to monitor activity and progress.  Activities which will be evaluated include finance management, data collection, promotion of incidence prevention and high-risk pregnancy avoidance, and management of emergency situations that may have occurred.   Phase V:  Re-implementation (December 2007 - November 2008)   At the completion of the first year, training content will be adjusted as needed according to feedback acquired throughout the year.  In the following school year, a new group of third year students will be trained by teachers, and remaining 6 communities will be targeted according to methods implemented in the first year and any appropriate adjustments.    Monitoring and Evaluation   Outcomes will be evaluated on two levels; 1) the student level, to determine whether knowledge was received and implemented effectively and 2) the community level, to determine if knowledge was received and put into practice by each Comité de Emergencia.   Outcome 1:  Students 1.1) Students will complete a pre-test to demonstrate prior knowledge related to maternal and infant health and emergency management prior to training, a mid-term test following training, and a post-test following completion of follow-up activities. 1.2) Facilitation of information during workshop training will be monitored and graded. 1.3) Following training workshops, students will complete monthly reports on the activities of their respective Comité de Emergencia.   Outcome 2:  Comités de Emergencia 2.1) Activities in respective communities will be evaluated monthly, over a 6-month period, regarding the following aspects: a. Finance management b. Data collection c. Activities to promote of high-risk pregnancy avoidance d. Management of emergency situations including drills that the students will plan and execute     Project Budget                                                                                     No.   Item   Quantity Cost per unit (Lmps) Total cost (Lmps) Total cost (US Dollars) I Training Manual         1.1 Printing Costs 15 1000.00 15,000.00 794.00 1.2 Travel -- 1100.00 1100.00 58.00   Subtotal I 852.00 II Training Materials         2.1 Paper (per sheet) 200 2.00 400.00 22.00 2.2 Plastic Bins 6 60 360.00 20.00 2.3 Markers 50 10 500.00 27.00 2.4 Towels 25 35 875.00 47.00 2.5 Notebooks 12 80 960.00 50.00 2.6 Pens 200 10 2,000.00 106.00 2.7 Resource books 6     240.00   Subtotal II 512.00 III Training session costs         3.1 Lunch * 160 30 4,800.00 254.00 3.2 Snack * 160 10 1,600.00 85.00               Subtotal III 339.00 IV Other         4.1 Volunteer T-shirts 80 50.00 4,000.00 212.00 4.2 Wooden first aid boxes 12 600.00 7,200.00 380.00 4.3 First aid supplies 12 1,000.00 12,000.00 635.00 4.4 Student diplomas 40 50.00 2,000.00 106.00 4.5 Volunteer diplomas 80 50.00 4,000.00 212.00              Subtotal IV 1,545.00               Total 3,248.00               Total Project Cost Amount Raised 3,248.00 -         Current exchange rate: 1 US Dollar to 18.9 Lempiras   All items have been rounded up to the nearest dollar unit.   *Food items will be included for year 1 because all items will be purchased ahead of time in order to avoid mismanagement of funds.  To finance food items in year 2, students will be required to engage in fund raising activities.       Sara E. Schaefer, Ph.D. President of Health Sector, W.A.S.H. Health Volunteer, Peace Corps Honduras San Miguelito, Intibucá 001-504-912-0931 ses923@yahoo.com