The Integral Family Health Program
Several health programs have been designed in Ecuador during different government administrations.
All of them have been well conceived, with World Health Organization (WHO) and Pan-American Health Organization (PAHO) advice. All programs emphasize the prevention of disease, promotion of health and special care of children and mothers. It would be false to state that all these plans have failed. Significant progress has occurred in the health situation of the country as our health indicators testify. Nevertheless, the situation leaves much to be desired and we are far behind in the world and even in Latin America.
The situation was worse in the countryside, especially among the indigenous population. Rural doctors, who serve one year after graduation from the medical school in general, attended the countryside. They were in charge of carrying out the health plan in a health sub-center, usually very poorly equipped; they were in charge of a population between 5,000 to 10,000+ people dispersed in a wide geographic area. This situation made it impossible to perform systematic medical care and the young doctors ended up in the health sub-center taking care of the patients’ demands. They only occasionally had the opportunity to promote patient health or prevention of disease. The lack of resources direct medical practices to merely symptomatic treatment.
This is the reason why health plans, though well designed, do not have the expected results. They carefully explain what to do, but not how to do it. They do not specify strategies nor provide the means to carry out different sub-programs.
To overcome this problem, we believe it is necessary to have a medical team – a doctor and an auxiliary person who lives in the community – in charge of a defined group of families in a specific geographical area. The team will be responsible for the personal attention of every family and will take care of health promotion, prevention of disease, attention to pathology and to maintain the necessary information up to date.
Experience in several countries has demonstrated that the ideal number of families is in groups between 120 and 200 families (600 to 1000 persons). Nevertheless, due to the situation of the country, we believe that, with dedication and enthusiasm, it would be possible to attend between 250 and 300 families (1250 to 1500 individuals).
The family system is very important since at this level the problems are similar and their commonalities assist in discovering solutions.
Program Description
The health program has the thirteen following subprograms:
- Information: It is necessary to gather all current information, even though we have found it leaves much to be desired. Then, the medical team visits the homes to meet the families, verify the information and fill out the family record, which contains health and socio-economical data.
With all this information, a baseline is elaborated and will be used to make health decisions. Also, it will be a reference to monitor and evaluate our intervention. This information is updated every year. - Immunization: all children are immunized according to the norms of the Ministry of Health. Pregnant women are also immunized.
- Growth and Development – Nutrition: Children under five years old are examined regularly, weight and height are recorded, and any detected malnutrition is treated. Nutritional supplements are administered, but we believe that the mother’s education, regarding to food cultivation, preparation and administration, is much more effective and sustainable.
- Integrated management of prevalent childhood illnesses: This strategy is designed to treat the most common diseases of children, such as acute respiratory infections, acute diarrhea, intestinal parasites, malnutrition and any other common disease, in a particular community.
- School Children Health: School children are examined periodically to detect and treat any pathological condition, mainly nutritional problems, vision and hearting defects, intestinal parasites and dermatological conditions.
- Reproductive Health: This sub-program includes
Sexual and reproductive education.
Family planning.
Prenatal and postnatal care.
Child delivery.
Breast-feeding.
Prevention and treatment of sexual transmitted diseases.
Early detection of breast, uterus and prostate cancer.
Gender related problems. - Youth programs: sports and recreation, prevention of drugs, alcohol and smoking addiction.
- Attention of the elderly and handicapped: in coordination with community organizations.
- Oral health: preventive and curative programs.
- Mental heath: preventive and curative programs.
- Attention of general pathology in the town health center 24-7. Patients needing surgery or hospitalization are referred to our Mobile Surgery Program, the Ministry of Health Hospitals and other institutions. A town pharmacy is provided with basic medications. Health posts are opened in every community.
- Traditional Medicine: Information about ancestral knowledge is gathered to be tested as an alternative to academic medicine. A garden with medicinal plants is cultivated next to the health sub-center.
- Environmental health and sanitation are carried out in coordination with governmental institutions.
It is important to emphasize that all programs have a very important educational component for everyone and with a special interest for women. The programs are planned, organized and executed with the participation of the community.
Santa Ana
In October 2001 we started the first integral family health program in Santa Ana.
Santa Ana is a town with a population of 5000 people spread out in an area of approximately 46 km2, located 18 km southwest of Cuenca. Living conditions, as in all rural areas, are very poor.
The health situation showed all the indicators of underdevelopment: high incidences of infectious diseases, high child and maternal mortality; only 30% of children had completed the immunization program and malnutrition was at a rate of 64.7% in the population under 5 years of age.
We divided the area into 4 zones with approximately 300 families, with an average of 5 members for each family. A team, consisting of one doctor and one health promoter from the community, is in charge of each zone and is responsible of carrying out the integral health program mentioned before.
The program was carried out during six years and we had excellent results:
INFORMATION: We were able to maintain during these years, an up to date information about the population and all programs.
IMMUNIZATION: Since the third year, we were able to maintain one hundred per cent immunization in children.
GROWTH AND DEVELOPMENT: Thanks to the individual control of growth and development of children and school population and parents education, we had excellent results (images 1, 2, and 3):
SEXUAL AND REPRODUCTIVE HEALTH: Prenatal and Postnatal care of all pregnant women had been maintained since 2004. Nevertheless, the recommended number of these controls (at least 5 times during the pregnancy) was not reached.( The best year, 2006, was 3.5 times).
Institutional delivery, strongly increased (Image 4) breastfeeding stimulation and sexual education programs also had excellent results.
Other sub-programs also had very good results, though not as tangible as those previously mentioned.
The Family Health Program took place according to the principles of decentralization in the administration of health existing at the time. The program had the participation of the Provincial Direction of Health of Azuay Province, the Municipality of Cuenca and the local government of Santa Ana.
According to the new Constitution of 2010, the administration of health is of the exclusive domain of the Central Government, through the Ministry of Health. For this reason, we had to stop the program.
We have had family health programs in the following locations:
Chordeleg, Nabón, Sinincay and Chaucha.
Results were similar, even though not as dramatic as in Santa Ana, due to the shorter time of our activity. We had to leave these programs for similar reasons. (Annex 5.Spanish only).
Present Family Health Program: Galápagos
The Galapagos Islands are situated about 1000 Km west of the Pacific Ecuadorian coast. They are on the equator about 90* west of Greenwich. There are 13 major islands (from 14 to 4588 sq. Km.); 6 small islands (from 1 to 5 sq. Km.) and dozens of islets and rocks.
The population is about 24,000 people and only five islands are inhabited: San Cristobal, Santa Cruz, Isabela, Floreana, and Baltra.
Charles Darwin visited the islands in 1935 and his observations of the wildlife were an inspiration to develop his theory of evolution.
The Islands were declared a World Patrimony of Humanity by UNESCO because of their extraordinary wildlife, geology, history and natural beauty.
Galapagos is one of the major tourist attractions of the world and is visited annually by thousands of tourists.
One of the hotel chains serving the islands is Red Mangrove, with facilities in Santa Cruz, Isabela and Floreana. The administration has requested Cinterandes to organize a family health program to benefit its employees, providers and families and also take care of health problems that its visitors may have. In September 2010 we visited the islands and verified the possibility to start a program. We plan to initiate it in 2011.