Immunization Program.

Background

Several health programs have been designed in Ecuador during different governments.

All of them have been well conceived, with the World Health Organization (WHO) And the 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 affirm 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 is worse in the countryside, especially among the native population. The countryside is, in general, attended by rural doctors who serve one year after graduation of the medical school. They are in charge to carry out the health plan in a health sub center, usually very poorly equipped; they are in charge of a population between 5,000 to 10,000 and even more, population dispersed in a wide geographic area. This situation makes it impossible to perform a systematical medical care and the young doctor ends up in the health sub center taking care of the patient's demands. Only occasionally, they have the opportunity to do promotion of health or prevention of disease and the lack of resources orient the practice to merely symptomatic treatment.

Immunization Program

This is the reason why health plans so 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 that 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 of pathology and 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 the common affective strings help to find their solution.

Program Description

The health program has the thirteen following subprograms:

1 - Information: It is necessary to gather all the current information, even though we have found it leaves much to be desired. Then, the team visit 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 our health decisions. Also, it will be a reference to monitor and evaluate our intervention.

This information is updated every year.

2 - Immunization: all children are immunized according to the norms of the Ministry of health and using vaccines provided by this Ministry. (Fig 7) Pregnant women are also immunized.

3 - 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 provided by the Ministry of Health are administered, but we believe that the mother's education, regarding to food cultivation, preparation and administration, is much more effective and sustainable.

4 - 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.

5 - 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.

6 - 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.

7 - Youth programs: sports and recreation, prevention of drugs, alcohol and smoking addiction. 8 - Attention of elderly and handicapped: in coordination with community organizations

9 - Oral health: preventive and curative programs.

10 - Mental heath: preventive and curative programs.

11 - Attention of general pathology: the town health center is open 24h. a day. 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 have been opened in every community.

12 - Traditional Medicine: Information about ancestral knowledge is being gathered to be tested as an alternative to academic medicine. A garden with medicinal plants is cultivated next to the health sub-center.

13 - Environmental health: and sanitation will be carried out in coordination with responsible 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