5.3 FACING THE NEW CHALLENGES
HEALTH SYSTEMS AND SERVICES
Flood Disasters Flooding on the scale of what occurred in 2005 and 2006 is a relatively new
phenomenon in the country and brought with it a number of new challenges. Our health
care system – both the physical structures and human resources was stretched to its limit and PAHO in collaboration with the Government, NGO’s the international donor
community and other interested groups, have had to find innovative ways to deal with
the health care of residents in the flood communities.
Our approach included looking beyond the recent crisis to a more long term solutions.
The immediate response of PAHO and the Ministry of Health were to send mobile
health teams to communities and shelters during the flood. In addition, manuals were
developed and health workers from health centers and hospitals in all flooded
communities were trained in flood response techniques.
Damaged health centers were repaired. Temporary centers were set-up during the
period of repairs to guarantee access to health care for the flood communities.
PAHO has assisted Guyana in getting the health care system prepared for SARS. In
2004, a plan was developed that included surveillance, control of outbreaks and clinical
management of SARS. Serious attention is also being paid to the threat of the bird flu
pandemic, the outbreak of which has already spread to Asia, Europe and Africa.
DISEASE PREVENTION AND CONTROL
The strategy for the future includes improving the information system for monitoring the
control and spread of the disease in accordance with the guidelines established by
PAHO/ WHO. There are also plans to decentralize the activities to a primary health
care system where all clinical functions would be done at the regional and sub-regional
facilities. There will also be community involvement and patient – a centered
approached in TB Care and Prevention. An important component of the strategy is the
utilization of resources from Global Fund and the European Union.
Lymphatic Filarial PAHO has been in the forefront of the fight against lymphatic filarial. Several initiatives
and strategies have been launched and there have at the very least made the nation
aware of the disease and preventative measures that can be taken to control its spread.
Our future activities include increasing the quality and number of programmes and
simplifying the monitoring process. We would be using information produces and our
experience to determine when to stop MDA. The post-MDA surveillance would improve
to help the early detection of a resurgence of the disease. We hope also to provide a
regular supply of diagnostic equipment and DEC which would help ensure a sustained
programme of tests.
Funding would be provided to implement PELF while the implications and opportunities of integration of PELF are being pursued.
Leprosy Preparation for the future elimination of the disease are well underway. The Leprosy Elimination Public Health Programme is structured to improve the surveillance and epidemiological approach and to establish the histopathological diagnosis of the disease. There will be an increase in the screening of persons in risk groups.
The promotion of basic and operational research will be pursued in order to identify key aspects of Leprosy which would help in the elimination programme.
The major new challenge that PAHO faces in its fight against malaria is the influx of Brazilian miners into Guyana’s hinterland. Previously, it was relatively easy to detect
and monitor the spread of the disease, but cross-border movements have made this very difficult.
In this regard, Guyana has participated in frontier meetings as part of the Amazonian countries network (RAVREDA) to identify common activities to combat malaria. Arising from these meetings, a suggested package to be implemented includes rapid tests,
travelers cards for surveillance and early notification of cases, and the use of long
lasting impregnated bed nets.
MATERNAL AND CHILD HEALTH IN GUYANA PAHO and the Ministry of Health have established a Maternal Mortality Audit Committee
in hospitals to review maternal deaths.
The audit committee will review classify and analyze maternal deaths in the GPHC and
NAPH over the last five years. It will also develop guidelines for the Maternal one
Mortality Epidemiological System and prepare a training programme on the
management of maternal deaths in both maternities.
Perinatal Information System in Hospitals Work on a Perinaters Information System in the hospitals has been completed at a level
which would allow the teaching of SIP and the Supervision of its implementation in
Guyana. The Standard SIP form and Prenatal Passport, with coat of arms, has been
prepared and would be handed to the Printer’s shortly. These include a tutorial on
specialized workshop including clinical form competition in antenatal and delivery care,
data capture and analysis for focal quality assurance, decision making and research.
Visits have been made to the BPS (Banco de Prevision Social), British Hospital,
Hospital Pereira Rossell to observe three settings where SIP is being used for
management, teaching and supervision. BPS deals with Social Security, one is a
Private practice while HPR is a State Hospital. A teaching practice for English speaking
health workers has been held and SIP Core Team members who were also selected were required to prepare their own slides based on a previous set.
Work has also been done on data processing and data merging and report writing. Workshops on dissemination of information, Supervision and data processing would be planned for 2006.
Fully integrated service for sexual and reproductive health
PAHO has initiated the process for the preparation of a Maternal and Neonatal Mortality Reduction Strategic Plan for the period 2006-2009. The Plan would include a SWOT analysis on maternal and neonatal health, a mission statement and the elaboration of strategies. A preliminary workshop would be held and the entire plan would be a collaborative effort of the various health regions.
Mobilize resources to support technical work
Financial resources have been obtained from a number of international donor agencies to promote and support technical work in a number of areas. The American Red Cross had allocated US$80,000 in 2004 for the implantation of community IMCI. Technical and financial cooperation has been negotiated with CLAP for the implementation of the PIS in Guyana. CLAP is sending a trainer from Montevideo.
A workshop on PIS is planned for November, with personnel from the MOH, the Statistical Bureau and the principal maternity wards are expected to participate. US$40,000 has been allocated for the implementation of the PIS.
A project to reduce maternal mortality has obtained technical and financial support. The project would cover the preparation and implementation of the Neonatal Maternal Strategic Plan and a strategy to expand the situation analysis to other regions in the country. This same project initiated a study on domestic violence and its relation to maternal deaths. Resources have been allocated for the contract of a principal researcher to conduct the study.
Resources have also been allocated to conduct a study on maternal and neonatal legislation.
Efforts are also being made to secure resources to contact a consultant who would work with the Ministry of Health to prepare a Strategic Plan on adolescent health in the country.
Funds totaling US$1,500,000 have been secured under the WHO/EU Strategic Partnership Agreement for a period of four years to promote the study of maternal mortality and morbidity and safe motherhood activities.
Political and financial commitment through advocacy and effective partnership in order to strengthen maternal and neonatal health programmes.
A cross-section of organizations have joined efforts to participate in communities
involved in workshops on nutrition, safe motherhood and PMTC. These communities
have also been involved in working groups of the UN.
Informed, educated and organized community would be able to recognize and
take appropriate actions relating to maternal, neonatal and child health problems
Several meetings were held in various parts of the country to discuss and promote
health and health related issues with Regional and local community leaders.
At Karasabai – Region 9 and Linden – Region 10 the meetings discussed the maintenance of healthy markets, cleaning of the communities and safe motherhood.
Meetings with health workers of the GPHC, NAPH, WCDH, Bartica, Berbice, IKarasabai
and Linden discussed the management of the network of services, the maternal and
child programs, the satisfaction of the users, the confidence level of the health providers
with the quality of work, and relations with the community and the level of community
Support was provided to the health team of the MOH (direction of epidemiology) for the
organization and supervision of health teams in the national flood emergency.
Promote involvement of civil society (NGOs, Red Cross) in development of
interventions in Family and Community Health (FCH)
PAHO was involved with the Ministry of Health in advocating and enabling environment for safe motherhood and newborn children in preparation for World Health Day. PAHO also participated in the National Committee for World Health Day which included such activities as the creation of an information base on concepts and safe motherhood interventions, a public gathering and parade organized by the maternal and child health agencies. This latter activity was a great success in New Amsterdam.
Quality of Care with trained Personnel applying clinical (EONC) and IPC/C abilities and skills.
A training needs assessment was developed in GPHC, NAPH and WCDH and is part of the situational analysis report. The assessment included measurement of the knowledge of health workers in the management of the obstetric and neonatal complications, defined the level of (confided) secret and observed the clinical skills used by health workers to perform a review of maternal deaths.
Health professionals were trained in clinical protocols and can solve maternal and neonatal health problems adequately in region 4,6 and 7
A workshop training for post-partum hemorrhage interventions developed and implemented in region 4, 6, 7 and Guyana Nurse College.
Strengthening the Capacity of the MOH to implement cost-effective interventions
for reduction of under-5 mortality PAHO developed guidelines for health providers in the management of children in
national flood emergencies and the management of children, women and pregnant
women in shelters during floods.
The Expanded Immunization Programme
The objectives of the expanded immunization programme are to maintain vaccination
coverage of over 90% in each sub-district and region and to achieve zero cases of
vaccine preventable diseases.
It is also expected to maintain a high surveillance for rash with fever, acute flaccid
paralysis and other preventable diseases and to prevent neonatal tetanus by continuous
vaccination of prenatal mothers with DT vaccine during pregnancy.
The immunization programme is geared to achieve a measles and rubella free country
by 2015. In order to achieve this objectivemall risk groups will be targeted for
vaccination with DT, MMR, Yellow Fever and Hepatitis B vaccine.
Animal Diseases Surveillance The new challenges facing animal disease surveillance will focus on keeping Guyana
free of Foot and Mouth Disease and developing and implementing a Zoonotic Disease
A National Plan of Preparedness for a Bird flu Pandemic is being consolidated while the
Institutional and Legislative Frameworks for Food Control in Guyana are being improved.
Non- Communicable Diseases A Surveillance System on Risk Factors of NCDs is being established. The quality
control system of Cervical cancer diagnosis has been improved while the Cancer
Registry activities has been strengthened. An assessment of Diabetes Care in Health
Facilities would be undertaken.