NEEDS ASSESSMENT FOR IMCI MANAGEMENT COMPONENTS GUATEMALA MARCH 9-20, 1998

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1 NEEDS ASSESSMENT FOR IMCI MANAGEMENT COMPONENTS GUATEMALA MARCH 9-20, 998 James (KIp) Eckroad BASICS ActIVIty Code 000-GU-OI-036/000 LC USAID Contract No HRN-C-OO

2 TABLE OF CONTENTS ACRONYMS EXECUTIVE SUMMARY PURPOSE OF VISIT BACKGROUND 2 TRIP ACTIVITIES 2 RESULTS AND CONCLUSIONS 3 RECOMMENDATIONS 5 FOLLOW-UP ACTION REQUIRED 7 APPENDIXES AppendIX A AppendIX B AppendIX C AppendIX D AppendixE AppendIX F AppendIX G AppendIxH AppendIX I AppendIX J AppendIxK AppendIxL Cimca Maxefia-LIst ofillnesses CmIca Maxefia-LIst ofpharmaceutlcals AgroSalud-LIst ofillnesses AgroSalud-LIst ofproducts AgroSalud-Data DIagram AgroSalud-Data DIctIOnary GuateSalud-LIst ofillnesses GuateSalud-List ofpharmaceuticals GuateSalud-Data Diagram GuateSalud-Data DIctIOnary MCI-DefimtIOn ofillnesses List ofcontacts

3 ACRONYMS ARI BASICS CDD IGGS IMCI MOH NGO PCI SIAS USAID Acute RespIratory InfectIOn BasIc Support for InstltutlOnalIzmg ChIld SurvIval Control ofdiarrheal DIseases Guatemalan SOCIal SecurIty System Integrated Management ofclnldhood Illnesses Mlmstry ofhealth Non-Governmental OrgamzatlOn PopulatIOn CouncIl, InternatIOnal SIstema Integrado de AtenclOn de Salud Umted States Agency for InternatIOnal ASSIstance

4 EXECUTIVE SUMMARY ThIS report descnbes activities ofthe consultant's recent tnp to Guatemala to assist the BASICS team m the ImplementatIOn ofthe IMCI methodology m three NGDs The consultant's focus IS on that aspect ofthe ImplementatIOn related to several management Issues crucial to the ImplementatIOn, specifically those havmg to do WIth service delivery mformation systems, drug logistics systems, and cost effectiveness considerations Followmg an mitial assessment and plan made dunng a VISIt m March, the pnmary purpose ofthis VISIt was to collect more detailed mformatlon from each ofthe three NGDs The consultant made an evaluation of each NGO's operation(s) WIth respect to the way they specify and document disease classifications and treatment protocols, the way they morutor health care services, and the way measure and track service delivery mputs, mcludmg personnel, drugs, and other supplies and equipment Several recommendations are set forth on what IS needed m order to provide recommended options on modifications to their mformation and logistics systems, to Improve them as well as to adapt them to the requirements ofthe IMCI ImplementatIOn The pnmary results ofthis consultancy consist ofa senes ofannexes that provide techrucal documentation for the exlstmg database mformation system, as well as listsof disease classifications and pharmaceuticals m use by the orgaruzations In addition, actual copies ofthe databases oftwo ofthe NGDs were obtamed, WhICh WIll make It possible to carry out more detailed analyses on service delivery and treatment patterns PURPOSE OF VISIT The pnmary purpose of this VISIt was to collect more detailed mformation from each ofthe three NGDs m the areas of mformation systems, logistics systems, and cost effectiveness analyses, m support ofthe BASICS mitiative for Implementmg an IMCI methodology WIth three NGDs m Guatemala More specifically, the VISIt was to make a more detailed evaluation of what each NGD has WIth respect to ) the way they specify and document disease classifications and treatment protocols, 2) the way they morutor health care services, and 3) the way they measure and track service delivery mputs, mcludmg personnel, drugs, and other supplies and equipment ThIs mformation WIll be used pnmanly to design and propose, for each organization, specific options for modlfymg and Improvmg these mformation and management systems, while meetmg the basic requirements ofthe IMCI ImplementatIOn The pnmary outputs for the VISIt are a senes oftechrucal specifications documentmg current mformatlon systems Pnor to the Apnl VISIt, these systems WIll be analyzed further m order to develop specifications for the systems modifications

5 BACKGROUND With USAID MIssIOn support, over the past few years BASICS has attempted to encourage the Guatemalan MInIstry of Health (MOH) to budd upon the gains ofusaid's previous PIEITRO project through the adoption ofa strategy ofmtegrated case management for SIck children Though the MOB has recognized that the Integrated care approach IS consistent With the national strategy Incorporated In the government's SIAS InItIatIve, It has decided to focus Its current efforts on ImplementatIon ofsias USAID has thus shifted the focus ofmuch ofits support to the NGO commumty With two significant projects managed respectively by the PopulatIOn CouncIl and PCI Though BASICS IS collaborating WIth these two efforts, the MISSIon has suggested the need for BASICS to focus support to a network ofngos providing health services to the permanent and migratory employees ofagriculturalfincas ThIs network constitutes the thud largest provider ofhealth services, following the MOB and IGGS-the Guatemalan SOCIal SecurIty System The work carried out under this consultancy IS m support ofthe strategy to Implement the IMCI methodology WithIn three selected NGOs An Imtial VISIt was made by the consultant m February to carry out an assessment to determine the management-related requirements for IMCI ImplementatIOn That assessment led to a planof activities which would IdentIfy and help Implement changes In health InfOrmatIOn and logistics systems TRIP ACTIVITIES ThIS tnp covered a two-week penod, from March 9-20, 998 The consultant amved In Guatemala on Sunday, and Monday ofthe first week was spent meeting WIth the BASICS/ Guatemala staffdiscussing the purpose ofthe VISIt and coordinating activities A plan was developed to VISIt the NOOs offices, and appropnate arrangements were made On Monday, along With the BASICS country representative and administrator, a VISIt was made to the AgroSalud office, where a detaded analysis was made oftheir existing InfOrmatIOn system, which covers both health service delivery statistics and drug and medical supplies logistics A request was made and granted for the consultant to take a complete copy ofthe InfOrmatIOn system In order to facilitate the documentationofits design and function, and also to make possible a later analysis ofservice delivery patterns and drug and supply utilization patterns In the afternoonof Monday and during the morning oftuesday, InItIal steps were taken to document the system Later on Tuesday, a follow-up trip was made to AgroSalud to present the results and to check assumptions A SImIlar VISIt to the GuateSalud offices was made on Wednesday, which also resulted In taking possession ofa copy oftheir system for documentation and analysis purposes COInCIdentally, the designer/developer ofthe GuateSalud system was met briefly as he was finishing some maintenance work on the system After leaving the GuateSalud offices, It was discovered that the 2

6 system was developed m the DataFlex database rather than the more common dbaselfoxpro database As It turned out, the run-time engme was not among the files copied, WhICh delayed the ablhty to access the system On Thursday ofthe first week, together With the country representative and admmlstrator, the consultant traveled to Santo Tomas de laumon to VISIt the offices ofchmcamaxefia Smce this NGO doesn't currently have a computenzed mformation system, most ofthe time was spent revlewmg with chmc personnel the types of mformation needed or desired ThIS mcluded outhnmg the structure for a SImple computerized system that would meet the chmc's basic health StatIStICS and supphes logistics mformationneeds, m addition to meetmg the reportmg requirements for evaluatmg the IMCI mtervention On FrIday, over the weekend, and on Monday and Tuesday ofthe second week, time was spent fimshmg the documentation for both the AgroSalud and GuateSalud systems, and carrymg out prehmmary analyses oftheir data On Saturday, Delta Engmeermg Systems, creators ofthe GuateSalud mformation system, provided a technician to mstall the mlssmg files and get the system runnmg On Tuesday, the programmer for the AgroSalud system was contacted by telephone to clarify a few Issues and to mquire about his avalablhty for makmg future modifications to the system On Thursday, the consultant VIsIted the Delta offices to have an additional query engme mstalled that WIll faclhtate future analysis ofthe GuateSalud data In addition, on Tuesday the consultant reviewed two reports from the PopulatIOn CounCIl on studies related to the mtegratlon ofreproductive health services and the cost savmgs resultmg from this mtegration ofservices A meetmg was held With the country representative onthese studies to further understand the results and their relevance for the IMCI mterventlon A VISIt was also mode to the Compulandla computer store to help determm the kmds of software available m SpanIsh, m Guatemala Wednesday, together WIth the BASICS country representative and the AgroSalud general coordmador, a field tnp was made to two ofthe AgroSalud chmcs InformatIOn was gathered on how data was actually recorded and consohdated, and mqumes were made to determme how receptive chmc promoters would be toward certam modlfications On Thursday ofthe second week, debnefings were held With USAID and With the BASICS staff Next steps were discussed, and plans were made for a return trip m Apnl On FrIday, the consultant returned to Boston RESULTS AND CONCLUSIONS Due to the considerable vanation m the level ofsopmstication and degree ofstructure and orgamzatlon m the way that each ofthe NGOs handles the functions ofrecordmg and reportmg 3

7 mformation on their health services delivery, It IS likely that the response WIll be different for each orgarnzation ClImca Maxefia ClImca Maxefia, due m part to ItS broader focus on community development activities beyond health care delivery, has the least well-developed and managed health mformation system Smce It IS a manual system, there IS no large database ofmformation to access, but paper-based reports were analyzed on how data was collected and consolidated There IS a list ofillnesses which vanes somewhat, depend0g on whetherthe care provider was a doctor or one ofthe health promoters (AppendIX A presents the list ofdiagnoses With frequencies ofcases for 997 attended by the doctor, 2598 cases, and by the heath promoters, 364 cases) The classification scheme IS relatively SImple, WIth 9 categones and 5-0 diseases per category, but seems to cover most ofthe diseases encountered Only about 400 cases are classified as other They also have a standard list ofmedlcmes (see Annex B), but do not have data on quantities dispensed, nor mformation on stock-outs nor expired Items Chmca Maxeiia IS open to modlfymg ItS disease classification to meet the requirements of the IMCI methodology and, m fact, were already m the process ofmodlfymg their system They have also contemplated computenzation oftheir OformatIOn system, but do not currently have the resources to carry It out They currently have three Macmtosh computers, one ofwhich has the excess capacity for a modest database system, but the selection ofdatabase software for the Macmtosh IS hmlted, as IS experience m developog MacOtosh database systems One anomaly m the health mformatlon system IS the fact that the process ofrecordmg and storing clirncal histories of patient VISItS IS handled differently by promoters and doctors When the doctor sees a patient, he pulls the patient's climcal records from a family folder, enters the details ofthe VISIt, and returns the records to the file The promoters, on the other hand, do not consult previous chrncal histones and the results oftheir cases are not filed nor saved beyond the consolidation for monthly reports ThIs difference IS hard to explam given the majority of diseases treated by a doctor and promoter are the same, and m many cases, the same patient might see a doctor m one VISIt and a promoter m the next AgroSalud Ofthe three NGOs, AgroSalud manages, m computenzed form, the broadest range ofhealth- and service-related mformation ConsolIdated mformation IS received from each health post m monthly and quarterly reports, and each report contams various sections ofdifferent types of mformation For example, m addition to standard disease reportmg, they also mamtam updated census mformatlon for their catchment area and certam coverage Odlcators, such as for vaccoation (The range and type ofmformation can be seen 0 the Data DIagram m AppendIX E and the Data DIctIOnary m AppendIX F ) 4

8 AgroSalud has an extensive hst ofstandardized diseases, however, their mformation system IS hmited to a reduced hst ofthe more common Illnesses When the monthly-consolidated service statistics arrive at the central office, the system provides for the entry of 8 predetermmed classifications plus an additional I that can be selected from the larger hst The rest ofthe diseases reported for that month must be lumped together m the "other" category (AppendIx C presents the frequencies ofthe most common diseases) It can be seen that otros IS the fourth most frequent classification, mdicatmg that a sigmficant number ofcases are bemg recorded under that category, resultmg m a loss ofmformation The monthly reports from the climcs mclude quantities distnbuted ofcertam program-specific products, mcludmg family planmng methods (see AppendIX D) The climcs do not, however, report on medicmes distnbuted, this mformation IS tracked from the central office The drug logistics system IS not part ofthe health mformation system, but rather, IS a module withm AgroSalud's accountmg system This IS a commercial system developed m FoxPro The files have been made available to the consultant, but the data have not yet been analyzed GuateSalud The GuateSalud computenzed health mformation system does not have the range ofdata found m the AgroSalud system, but It contams more details regardmg health VISItS and mdividual case management It mcludes the abihty to access mformation on mdividual patient VISItS With multiple diagnoses and multiple treatments On the other hand, It doesn't capture other healthrelated vanables, such as catchment area demographics or vaccmation coverage rates, which are mcluded m the AgroSalud system (The structure and type ofmformation can be seen m the Data Diagram m AppendIX I and the Data DIctIOnary m AppendIX J ) GuateSalud mamtams a structured list of Illnesses based on the WHO standardized classification system, WIth modifications to mclude changes m ARI and CDD program approaches It should not be difficult to mcorporate the additional diagnosis classification of the IMCI methodology (See AppendIX G for a list ofillnesses and then frequencies from GuateSalud climcs, and AppendIX K for the IMCI hst ofdefimtions ) Smce the GuateSalud health mformation system mcludes not only patient VISIts and diagnoses, but treatments as well, the system also contams data on drugs prescnbed and dispensed from mventory It IS even set up In such a way that when a particular drug IS prescnbed and not dispensed, It can be assumed that a stock-out SItuatIOn has occurred (See AppendIX I for a list of pharmaceuticals and their classifications and quantities consumed) RECOMMENDATIONS It IS clear that, With a greater or lesser degree ofdifficulty, It Will be possible to mcorporate the IMCI defimtions for diagnoses mto the existmg classification schemes of each ofthe three 5

9 NGOs It IS also clear that each ofthe NGOs IS anxious to Improve upon theu existmg system for morntonng service delivery It IS mcumbent upon the BASICS project to present them WIth options m the form of specific recommendations There are several specific Issues or tasks that must be addressed It IS felt that the standard IMCI form for reglstenng diagnoses results on the back ofthe IMCI assessment forms would create excessive requirements of forms (one per VISIt), would be difficult to consolidate to monthly reportmg forms, and would require a separate form for patients under 5 years old The two NGOs (Chrnca Maxeiia and AgroSalud) that consohdate data before amval at the central offices WIll need to make some modifications to their data entry forms for recordmg data from mdividual VISIts A daily ledger type of form needs to be designed that WIll allow for the registration of key mformation from each VISIt and WIll facilitate consolidation to monthly reportmg forms For the NGOs that consolidate data, It WIll be necessary to reach an agreement on standardization ofage categones The IMCI methodology calls for dlstmgulshmg between those less than 2 months and those between 2 months and less than 5 years ofage There are Important reasons for separate statistics on pennata! age VISItS, and for havmg mformation on the under year old population for vaccmatlon coverage mformatlon, m addition to any groupmgs ofpatients 5 years and older On the other hand, the more age categones there are, the more comphcated the consolidation forms are likely to be The GuatemalaIBASICS project medical staffneeds to come up WIth final recommendations It IS Important that each NGO has a smgle list ofstandardized Illnesses/dIagnoses that mcorporates their current practices, plus the additional requirements ofimci The Guatemala! BASICS project medical staffshould analyze the hsts ofdlnesses for each ofthe NGOs (AppendIxes A, C, and G) and the IMCI ItstofIllness defimtions (AppendIX K), and make recommendations for a standardized hst or lists It may be possible to get the three NGOs to agree to a smgle Itst, or It may be necessary to adapt hsts to each ofthe organizations In a simlar manner, the GuatemalaIBASICS project medical staffshould review the lists of pharmaceuticals for ClIrnca Maxeiia and GuateSalud (AppendIxes B and H), as well as for AgroSalud (whtch has yet to be produced), and IdentIfy those drugs which correspond to IMCI treatments Assurance IS needed that the IMCI drugs are bemg supphed and that there are not Issues ofnomenclature or doses whtch may cause problems In the ImplementatIon It IS m the mterest ofevaluatmg the Impact ofthe IMCI ImplementatIOn that computenzed data be available on health service dehvery and drug logistics and utlhzatlon WhIle the GuateSalud system may be sufficient as It IS, there WIll be some modifications required to adapt the AgroSalud system, and It would be mce to be able to provide Chmca Maxeiia WIth a SImple 6

10 computenzation oftheir InfOrmatIOn An assessment should be made ofthe options, and recommendations should be made based on available resources Wlule It IS unlikely that In the time frame ofthis project, sufficient data WIll be available to carry out a detailed cost-effectiveness analysis ofthe IMCI ImplementatIOn, It WIll be possible to establish patterns ofvisits, diagnoses, and treatments which greatly Influence both the cost and effectiveness ofservice delivery It IS clear that the GuateSalud database IS a nch source of InfOrmatIOn for learning about the diagnostic and treatment patterns existing In their clinics A detailed analysis ofthis data should be carned out, and the results should be used to help Interpolate the the consolidated data available from AgroSalud FOLLOW-UP ACTION REQUIRED The consultant WIll make a follow-up VISIt In Apnl 998 Pnor to that VISIt, he WIll carry out more detailed analyses ofthe AgroSalud and GuateSalud databases, IncludIng the generation ofa list ofpharmaceuticals and quantities used by AgroSalud He WIll also prepare sample data entry forms and standardized Illness and drug lists for discussion WIth the Guatemala/BASICS project medical staffduring the Apnl VISIt Also during the Apnl VISIt, options for modifications to their systems WIll be proposed to the NGOs, and plans WIll be developed for ImplementatIOn 7

11 APPENDIXES

12 q APPENDIX A CiNICA MAXENA-LIST OF ILLNESSES

13 AppendIx A CImca Maxefia-Llst ofillnesses Descrlpcon Promotores Medicos Enfermldades Resplratorlos Amldahtls 2 Asma Bronqulal 3 Bronconeumonla 4 BronqUltls 5 Fanngltls 6RS 7 Neumonlas 8 OtitiS Media 9 SinUSitiS 0 TuberculosIs Enfermldades Gastromtestmales S DA 2 Dlarrea Bactenana 3 Parasltlsmo Intestinal 4 Enfermldad Peptlca 5 GECA Dlarrea Cr6nca Enfermldades Infecclosas ConJuntlvltls 4 2 Dengue Claslco 3 Hepatitis 3 4 Paludlsmo 3 "' 4t.$94 $ 44 5 Flebre Tlfoldea '-:jf;( f~tt. 9 Enfermldades Gentto Urmarls Enfermldades Venenas Infeccl6n Unnanas Leucorrea 38 4 Amenonrea 29 5 Vaginitis 4 6 Prolapso Utenno 7 Cistocele 4 8 Hemorragla Vaginal 27 Enfermldades de la Plel Abscesos ImpetIgo Mlcosls SarcoptloslS 9 5

14 5 Alerglas Dermatitis 9 64 Enfermldades Vlrales Parotiditis Sarampl6n 3 Vancela 5 Enfermldades Artlculares Artntls Reumatoldes Espasmo Muscular Gota 4 Tratamlentos Lavado de Dido 95 2 Extrac clextralio 8 3 Extrac de Ulias 4 Inyecclones 5 Embarazo 26 Enfermldad de los 0Jos Catarata 7 2 Ptengl6n 2 3 DIsminucI6n A V 2 Atenclon Medica Contorl Prenatal 35 2 Contol Nnio Sano 4 3 Traumatlsmo 58 Otros 40 AnemiaDPC 28

15 APPENDIXB CiNICA MAXENA-LIST OF PHARMACEUTICALS (V

16 Jul-30-9a 05 24P James Eckroad Annex B Cfmca Maxefta - List of Pharmaceuticals Medlcamentos Acetammofen Gotas 00 mg fcox 20 ml Acetanunofen Suposltono 20 mg Acetammofen SUposltono 300 mg Aeetammofen Jarabe 20 rng/5ec Acetammofen tabletas 500 mg Adrenahna Amp 2 cc Albendazol tableta 400 (Lornzol) Alfer sulfuaguento 0 % 5 gms Anfasol gotas fco X 0 ml Alfer Nicol gotas Feo X 0 ml Ammofihna amp 2 AmoXlcdma 250 mg fco X 60 ml AmoXlcllma 500 mg capsula Amplcdma 25 mg fco X 60 ml Amplcllma 250 mg fco X 60 ml Amplclhna 500 mg capsula Amplclbna gramo ampolla Analgeslco unguento Anestesla al 2 % c/epmefnna Anestesla a2 % sepmefrma Antttoxma tetamca Ampolla Aspmna 500 mg tableta Antlacldo X galon Baralgma SUposltono Baralgma Amp X 5 ml Basado (doxlllchna 00 mg) capsula BonadoXlna gotas Benzan locjon Broneomat 2 mg expectorante 20 ml Broneomat 4 mg tableta Bromexol4 mg feo X 20 ml Blodm-calcJO feo X 240 ml Blodm hierro feo X 240ml Clordlax Compuesto Clofen gotas oftalmmo Cedoxd C8ja X 8 tabs Canesten creama 30 gramos Cedoxll250 mg feo X 80 ml Cefalexma 250mg, feo X 60 m Complejo B fco X 0 m Cloranfemeol25 mg fco X 60 ml Cloranfemcol 500 mg caps Cloranfemeol gramo lnyec

17 Jul-30-9a 05 24P James Eckroad CIOTUro de POtaSlO Amp Cloroqwna 250 mg tab Daoml tableta Dolofor 2 gramos Amp Dofofor 500 mg Amp Dlyodo 300 feo X 20 rnj Dlyoao 650 tableta Efectme tab 0 mg Epannn fco/amp 250 mg myec EDZltrol tableta Epanun 00 mg capsula Entromtcma 250 mg freo Y 60 ml Entrorruema 500 mg, capsula Estreptomlema feo X 0 m Etambut 0 tabs Expectorante simple Ergotrate 2 mg Entromlcma 200 mg feo x 20 ml Espasmobt Fco X 30 ml Fenobarbltal 00 mg Gas Rebeffco X 30 ml Gentamlcma 80 mg ampolla Genlat N5 Fco x 20 caps Glueonato de calero ampolla HJdantm too mg Hldrato de cloral Hemokem jarabe Hlst-aler jarabe Ibuprofen 400 mg Ichtamol 000 IRS Lanoxm tableta Laslx amp LaSlX 40 mg tableta Lomottl tableta MacroVitam caja X 30 caps MacroVitam fco X 240 ml MacromIcma 200 mg feo X 20 ml Medox Forte en grageas Medox Forte Inyec Feo x 0 rnj Medox Pre-natal gragea Medox Tnple amp 0,000 U Mebendazol too mg feo X 30 m Melabon SUposltono Methergm Ampolla Methocarbamol500 mg tableta Metromdazol 25 mg feo x 20 ml

18 Jul-30-9a 05 24P James Eckroad Metromdazol 500 mg tablets Metromdazol 500 mg ovulos vagmales Mycozol crema 20 gramos Mycozol ovulos vagmales Maxlbron Jarabe fco X 20 ml Mebendazol 00 mg caja X 6 tabs Mlcoderm fco x 30 ml Nacm gotas oftalmlco Nauseol sups Neobol crema Nauseol tableta Nauseol ampolla fco amp 5 ml Neomelubnna amp NJstatma gotas fco X 24 ml OxtblOtlC 25 mg fco x 5 ml OXlbJotlc 250 mg tab Pemcllna Potaslo 250 mg tableta PemclIma Cnstalma 5 000,000 V Pemclma Procama 4, U Pemcllma Benzatlmca,200,000 U Pemclhna Benzatmlca 2, U Pemclhna (umcd 6-3-3) Plperazma 250 rog tableta Plperazma 500 mg Scc PJroxlcam 20 mg tableta (Dohtem) Plrazmamlda 500 mg Probanova Forte ampolla Pohxagel fco X 360 ml ProventJl 7 gms Spray Quadnderm crema Ranltldma 50 mg (Ramtm) Regastrol gotas 4 mg Regastrol tableta 0 mg Rezerpma 0 25 mg tableta Rtfamplcma 300 mg capsula Soldnn OtJCO gotas Syntocmon amp Sedalgma gotas 5mbra 400 mg (caja X 4 tabs) Sulfato ferroso tab Sulfen gatas oftalmlco Terrarntcma oftalmjcma unguento 7 gms Terrarntcma oftalmlcma unguento 0 grns Tnxlcam (plroxlcam) fco X 0 ml Tlmdazol 200 mg fco X 0 ml Tuudazol 500 mg tableta caja x 8 tabs Tetraclcma 500 mg capsula

19 Jul-30-9a 05:25P James Eckroad Tmadenn frasco x 0 ml Tnmetopnm Sulfa Fco x 20 ml Tnmetopnn sulfa fco x 60 m Tnmeto-nn Forte 960 mg Urupulmm mnos 200,000 U Umpu]rnm adultos 400,000 U Vaselma Vancenl68 gms Spray Vancenase 7 gms Spray VlOleta gemclana Vttarnma "A" Vltamlna "A" y "0" Yomesan tableta Productos EqUlpo plextracclon de Sangre EqUlpo p/transfuslon de Sangre Eqwpo de Suero Frasco vaclo cltap de 2 onzas Frasco vaclo cltap de 4 onzas Guantes' # 7 estenles Guantes Desechables Guata de 2' Guata de 3 Guata de 4' Guata de 6' Gaza QUlrurgtca Jennga PI asbca de 2 5 cc Jennga plastlca de 3 cc Jennga plastlca de 5 cc Jennga plastlca de 0 cc Recolectora de Sangre Sonda de AltrnentaClon # 8 Sonda de AbmentaclOn # 6 Sanda Faley Sanda uretral Nelaton Sanda Rectal SondaLevm Tennometro Oral Termometro Rectal Venda Elastica 3' Venda Elastica 5' Yeso de 2' Yeso de 3' Yeso de 4' Yesa de 6'

20 Jul-30-9a 05 25P James Eckroad Desanfedantes y otros Productos Agua Destllada Agua Oxtgenada Alcohol Jabon Sueros y/o soluelores Suero Oral en sobres Dextrosa al 5% 500 rol Dextrosa al 5%,000 ml Dextrosa al 0% 500 ml Dextrosa al 0%,000 ml Dextrosa Vltarrnnado (DextroVlta) Mlxto al 5% 500 mt MIxto al 5%,000 ml Hartman 500 ml Hartman,000 rol Soluclon Uno 500 rol SoluclOn Dos 500 rol SoluclOn fislologlca (sol sahna) Matenales AguJas I M Dtferentes nuneros Algodon Rollo X libra Angtocath de dlferente numero Blstun Bolsa recoleetora de onna CaJlta para heces \\

21 APPENDIXC AGROSALUD-LIST OF ILLNESSES

22 AppendIx C AgroSalud - LIst ofillnesses AgroSalud Enfermldades mas Comunes NINOS <7a o 54 o o 2 oo o o o o o o o Tot Cons Enfermldad 8604 RESPIRATORIAS 6544 DE LA PIEL 5896 DESNUTRICION, AVITAMINOSIS 4768 OTRAS 4356 AMEBIASIS 3606 ACCIDENTES 3292 DE LOS OJOS, OIDOS Y BOCA 372 OTRAS/GASTROINTESTINALES 2234 DIARREA 780 PARASITISMO INTESTINAL 34 PALUDISMO 232 OBSTETRICO 48 TUBERCULOSIS 80 VENEREAS 76 HEPATITIS 46 INFECCION URINARIA INFLAMACION 32 INTOXICACIONES 8 INFECCIOSAS/PREVENIBLES 6 VARICELA 8 DENGUE 6 OTITIS 6 NEURITIS 4 HERIDAS 2 PAPERAS DIABETES o CANCER EN o MORDEDURAS Y PICADURAS o

23 ANNEXD AGROSALUD-LIST OF PRODUCTS

24 AppendIX D AgroSalud - List ofproducts Nornbre INCAPARINA PROTEMAS PRESERVATIVO TRO (SALES) COMPLEJO B PILDORA/LO-FEMENAL TABLETA VAGINAL DIU/T DE COBRE Cantldad

25 APPENDIXE AGROSALUD-DATA DIAGRAM

26 Annex E AgroSalud Data Diagram AgroSalud - Dlagrama de Entldades y RelaclOnes DII.'O n.pas-t:".ato. ~ JlfJf.cr.aa:Lcipios utir". glo...,r.cli ri""... ~ I'~._rllJl - Coa.alta. d. Or t_coa r Llar PREvzw -.~ c0 y I.r.D~i ~r.y.dt~y COJtlI'_Ol "a.t.r..dad por If I a.fe' C o '0>I."Lo...l 04 I L ~T P' JI.todo. d. Ori;atacoB ' ~lta~ J:JPlQ ~JlE.~d.d IWVEMf - 'rodacto. Di.tribaido. ~ 'lldljdt:'ro P.rodacto. (S..-tl>i.tro.) V_DOsr, lictlyid.d d. Var:a. etaa...iloii - Tot..l~d at.n;ta por 'ro.o~ot PJlDJI_'I'JlZ - rota! da ~o.otor.. rrx tr.l PROJlOrOJl Pro.otor J:DUCli - Act!y!"." IId.c.U... PJIOtiJUD -.rogr... J:""cat!.o. SlIlt_lIMB - Sa..eaM...to A_i."t..l V D,. - V"ca "ioa D;.;.r...it..ciO Sal.d.oc..l I -c.iciifi -...Lm.llto. l:li:.':$ D.LuAcioa ~ 9

27 APPENDIXF AGROSALUD-DATA DICTIONARY

28 AppendlxF AgroSalud - Data DIctIonary AGROSALUD - ESTRUCTURAS DE BASES DE DATOS Mantenmentos de Cat&loqos Departamentos Structure for table Number of data records Date of last update Code Page Fleld Fleld Name Type Collate COD DEPTO 2 NOMBRE 3 COD REGION ** Total ** Numerlc Character NumerlC C \SISINFO\DEPTO DBF 9 05/07/97 o Wldth Dec Index Enfermedades Structure for table Number of data records Date of last update Code Page Fleld Fleld Name Type Collate COD ENFERM 2 NOMBRE 3 pas INF ** Total ** Character Character NumerlC C \SISINFO\ENFERM 4 06/04/96 o Wldth Dec DBF Index Flncas Structure for database C \SISINFO\FINCA DBF Number of data records 4 Date of last update 05/07/97 Code Page 0 Fleld Fleld Name Type Wldth Dec Index Collate COD FINCA Numer~c 3 2 NOMBRE Character 20 3 COD DEPTO Numer~c 2 4 COD MUN Numer~c 2 5 ACTIVO Character ** Total ** 29 Metodos de Orlentaclon Famlllar

29 Structure for database C \SISINFO\MET_PF DBF Number of data records Date of last update 04/06/96 Code Page 0 Feld Feld Name Type Wdth Dec Index Collate COD MET Numerc 2 2 NOMBRE Character 20 3 POS INF Numerc 2 4 COD PROD Character 2 5 APP NumerIC 8 6 BASE Character 5 ** Total ** 46 Mun.c.p.oS Structure for database C \SISINFO\MUNICI DBF Number of data records 2 Date of last update 07/05/97 Code Page 0 F.eld Feld Name Type Wdth Dec Index Collate COD DEPTO Numerc 2 2 COD MUN Numerc 2 3 NOMBRE Character 30 ** Total ** 35 Productos (Sumn.stros) Structure for database C \SISINFO\PRODUCTO DBF Number of data records 8 Date of last update 06/04/96 Code Page 0 FJ.eld Feld Name Type Wdth Dec Index Collate COD PROD Character 2 2 NOMBRE Character 30 3 POS INF Numerc 2 ** Total ** 45 Programas Educatvos Structure for database C \SISINFO\PROGRAMA DBF Number of data records 3 Date of last update 04/06/96 Code Page 0 Fleld Fleld Name Type Wldth Dec Index Collate COD PROG Numerlc 2 2 NOMBRE Character 30 3 POS INF Numer.c 2 ** Total ** 35

30 Promotores Structure for database C \SISINFO\PROMOTOR DBF Number of data records 97 Date of last update 02/04/98 Code Page 0 Fleld Fleld Name Type Wldth Dec Index Collate COD PROMO Numerlc 3 2 NOMBRE Character 5 3 APELLIDO Character 5 4 SEXO Character 5 COD FINCA Numerlc 3 6 ACTIVO Character 7 FECHA IN Date 8 ** Total ** 47 Reglones Structure for database C \SISINFO\REGION DBF Number of data records 5 Date of last update 04/06/96 Code Page 0 Fleld Fleld Name Type Wldth Dec Index Collate COD REGION Numerlc 2 2 NOMBRE Character 5 ** Total ** 8 Enfermedades par Mes Informes Mensuales Structure for database C \SISINFO\CURAT_Ol DBF Number of data records 58 Date of last update 2/03/98 Code Page 0 Fleld Fleld Name Type Wldth Dec Index Collate COD FINCA NumerlC 3 2 ANO NumerlC 2 3 COD ENFERM Character 2 4 NINOSI Numerlc 5 5 NINOS R Numerlc 5 6 NINOS7 Numerlc 5 7 NINOS7 R Numerlc 5 8 NINOS2 Numerlc 5 9 NINOS2 R Nurnerlc 5 0 ADULTOS Numerlc 5 ADULTOS R Numerlc 5 2 PP CONS Numerlc 5 3 PP REFS Nurnerlc 5 4 PM CONS Nurnerlc 5

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