Building alliances for improving newborn health in Latin America and the Caribbean.

The regional Latin American and Caribbean (LAC) Neonatal Alliance and national neonatal alliances in Bolivia, El Salvador, and Peru were studied through in-depth interviews and a review of publications. Findings were analyzed to distill successful strategies, structures, and tools for improving neonatal health by working through alliances that can be replicated at the regional or national level. The studies found the following factors were the most critical for successful outcomes from alliance work: inclusion of the Ministry of Health as a leader or primary stakeholder; a committed, diverse, technically expert, and horizontal membership; the presence of champions for neonatal health at the national level; development of a shared work plan based on feasible objectives; the use of shared financing mechanisms; the use of informal and dynamic organizational structures; and a commitment to scientific evidence-based programming. The relationship between the regional and national alliances was found to be mutually beneficial.

Bolivia programme evaluation of a package to reach an underserved population: Community-based maternal and newborn care economic analysis.

To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to inform innovative alternative models, better equipped to tackle stagnant inequitable access to care.

Building alliances for improving newborn health in Latin America and the Caribbean / Alianzas para mejorar la salud de los recién nacidos en América Latina y el Caribe

The regional Latin American and Caribbean (LAC) Neonatal Alliance and national neonatal alliances in Bolivia, El Salvador, and Peru were studied through in-depth interviews and a review of publications. Findings were analyzed to distill successful strategies, structures, and tools for improving neonatal health by working through alliances that can be replicated at the regional or national level. The studies found the following factors were the most critical for successful outcomes from alliance work: inclusion of the Ministry of Health as a leader or primary stakeholder; a committed, diverse, technically expert, and horizontal membership; the presence of champions for neonatal health at the national level; development of a shared work plan based on feasible objectives; the use of shared financing mechanisms; the use of informal and dynamic organizational structures; and a commitment to scientific evidence-based programming. The relationship between the regional and national alliances was found to be mutually beneficial.

Se estudiaron la Alianza de Salud Neonatal para América Latina y el Caribe a escala regional, y las alianzas nacionales de salud neonatal de Bolivia, El Salvador y Perú, mediante entrevistas exhaustivas y un análisis de las publicaciones. Se analizaron los resultados para extraer las estrategias, las estructuras y las herramientas eficaces para mejorar la salud neonatal trabajando mediante alianzas que puedan repetirse a escala regional o nacional. Los estudios descubrieron que los factores más decisivos para obtener resultados exitosos del trabajo mediante alianzas fueron los siguientes: la inclusión de los ministerios de salud como líderes o interesados directos principales; una afiliación comprometida, diversa, técnicamente experta y horizontal; la presencia de promotores de la salud neonatal a escala nacional; la formulación de un plan de trabajo compartido basado en objetivos factibles; la utilización de mecanismos de financiamiento compartido; el uso de estructuras organizativas informales y dinámicas; y un compromiso con la programación científica basada en datos probatorios. Se observó que la relación entre las alianzas regionales y nacionales resultaba mutuamente beneficiosa.

Autopsia verbal: una herramienta para determinar las causas de mortinatalidad y mortinatalidad en la comunidad / Verbal autopsy: a tool to determine the causes of stillbirths and stillbirths in the community

Este estudio realizado en redes de salud urbanas y rurales de Bolivia (El Alto, Potosí y Cochabamba), tuvo los siguientes objetivos: conocer las causas biológicas y sociales de mortinatalidad y mortalidad neonatal; identificar la proporción de muertes evitables y analizar el proceso de cada muerte neonatal.

El amor no mata / Love does not kill

Describe con datos sobre el avance vertiginoso del SIDA en el mundo; e induce a plantearse algunos lineamientos de prevención

Mortalidad materna: un llamado de atención para todos / Maternal mortality: a reprimand for all

La respuesta para ala evitabilidad de la muerte materna sólo puede consebirse en el marco de la acción mancomunada de los diferentes sectores involucrados en el tema. En este sentido, la Revista Juanita & Giovannino ha sido pionera en desarrollar una experiencia piloto, de observatorio permanente sobre las muertes maternas e infantiles, a través de técnicas de investigación secillas, que permitan la discusión de los casos de muerte materna y las formas de evitarla en el futuro

¿Existe una educación sexual? / ¿Existe sex education?

A manera de iniciar el debate, queremos reflexionar sobre temas como sexualidad, genitalidad, sexo y educación, para sentar las bases de una propuestas sobre orientación sexual

Una experiencia de preparación de material educativo comunitario / An experience of preparation of community educational material

Se trata de una experiencia exitosa con un material de bajo costo, que por su formato permite intruducir modificaciones cada cierto tiempo, pero sobre todo, se trata de un material elaborado-y que se sigue elaborando-de manera colectiva