Study Results Help Improve Growth Monitoring and Promotion in Guatemala

by Elena Hurtado, MPH

An important debate has developed, however, about how to do growth monitoring on a large scale with low-literacy community volunteers. Monitoring of children's growth is commonly done by trained health workers by plotting a child's weight against age on a standardized growth chart and comparing the trend to a normal growth curve. Plotting weight-for-age can be difficult for volunteers with little formal education. A new growth monitoring method, called the Minimum Expected Weight Gain Table (MEW table), has been proposed for use in AINM-C, because it identifies children who are malnourished or at risk of malnutrition simply on the basis of their change in weight from the previous month. The MEW table has been used successfully in community growth monitoring in Honduras and other countries.

To provide concrete evidence on the best monitoring method to use, URC proposed conducting a rapid operations research study to test the two methods of growth monitoring in the Guatemalan highlands. The study was conducted from August-December 2002 with 230 volunteer health promoters from communities in the Ixil Triangle of the Department of Quiché. Promoters were randomly assigned to either an experimental (MEW table) or a control (growth curve) group. Data were collected in both groups on the accuracy of the nutritional classification and the acceptability of the respective growth classification method to health promoters and mothers.

The study also field-tested nutritional counseling cards that had been developed by Calidad en Salud. Preliminary study results were presented to the Ministry of Health, NGO partners, and USAID in early December. The study found that the MEW table was well accepted by the volunteers, who found it easy to use. The MEW table was found to detect a significantly higher proportion of children who were not growing well and therefore at risk of malnutrition. Based on this evidence, consensus was developed at an interagency meeting held in early December 2002 on the following strategy for monitoring and promoting growth in rural, indigenous communities:

The study findings have immediate implications for the finalization of training and counseling materials for 14,000 volunteers in the Guatemala highlands. The results will guide MOH planners in determining the number of training days required to attain an acceptable level of performance. The feedback collected from health promoters and mothers in the study will be used to refine a set of integrated counseling cards related to infant feeding and child health. Calidad en Salud will be supporting the finalization of these materials and implementation of health promoter training in the next six months. A final report of the study results is expected in March 2003.
For more information on URC's work in the Guatemala, contact Dawn Crosby at dcrosby@urc-chs.com, Peggy Koniz-Booher at pkoniz_booher@urc-chs.com or Elena Hurtado at ehurtado@calidad.com.gt.

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URC/CHS Staff Shine in Holiday Service Projects

In December, URC/CHS staff showed true holiday spirit through their participation in two service projects to benefit individuals and families in need in the Washington, DC metropolitan community.

Through Pediatric AIDS/HIV Care, Inc. URC/CHS staff adopted two Washington, DC-area families that are coping with HIV/AIDS, delivering 36 gifts to fulfill their holiday wishes. URC has participated in the Pediatric Care Adopt-A-Family Program since 1994. One of the program's first volunteers, former URC employee, Theresa Hatzell, initiated the first URC giving tree.
Pediatric Care's mission is to provide therapeutic services to children affected by HIV and AIDS. It is the only program in the District of Columbia that offers therapeutic services to help children understand and cope with the reality of living with AIDS and HIV. Pediatric Care's staff provides a complete evaluation of each child's needs in order to create an age-appropriate plan of service that may include individual therapy, group therapy, mentoring, and tutoring. Pediatric Care also helps caregivers by providing individual therapy and assistance to obtain resources they so desperately need to survive. In 2001, through combined support of corporate sponsors, Pediatric Care's Adopt-A-Family program was able to provide gifts to 137 individuals in 36 families (see their website, http://www.pediatric-care.net/, for more information).

A second holiday giving project was initiated by Quality Assurance Project staff member Rachel Jean-Baptiste, who organized a collection of coats and professional clothing to provide gently used business attire to homeless individuals as they attempt to enter or reenter the ever competitive workforce. Thanks to donations from numerous staff in the Bethesda home office, several computer boxes full of warm sweaters, shirts/t-shirts, jackets and various household items were delivered in December to Dress for Success, Career Gear, and Bethesda Cares, Inc., three Washington, DC-area non-profit organizations that serve disadvantaged men and women in our community. Special thanks to URC staff Lucia MacLeod and Susana Echeverria-Corlett for their help behind the scenes.

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QA Project Builds Bridges at ISQua Conference

by Cynthia Young

Five health care experts from URC's Quality Assurance Project made presentations at the 19th International Conference of the International Society for Quality in Health Care (ISQua) held at UNESCO headquarters in Paris, November 6-8, 2002. QA Project presentations addressed the institutionalization of quality assurance, quality improvement, and focused accreditation of health services in developing countries, addressing the overall meeting theme of "Building Bridges and Crossing Boundaries in Quality Improvement."

Tisna Veldhuyzen van Zanten, PhD, Director of URC's International Division, and Diana Silimperi, MD, Deputy Director of the QA Project, led the workshop, "Sustaining Quality Health Care: Institutionalizing QA." The workshop presented the framework the QA Project has developed to help health managers institutionalize quality assurance in developing country settings. The framework describes the elements necessary for institutionalizing quality of care and a road map of the process an organization would follow to sustain quality care. The presentation was based on the QA Project's recently published monograph, Sustaining Quality of Healthcare: Institutionalization of Quality Assurance. Elma Heidemann, Executive Director of the Canadian Council on Health Services Accreditation, provided commentary on the formal presentations.

Rashad Massoud, MD, MPH, Associate Director of the QA Project for Russia, Asia, and the Middle East, presented the workshop, "Quality Improvement Principles and Methods." In the workshop, Dr. Massoud described the fundamental concept of change underlying modern quality improvement (QI), explained principles of quality management, compared QI approaches, and discussed how different QI approaches can be applied in different settings.

Jorge Hermida, MD, MPH, Associate Director of the QA Project for Latin America, presented the experience of a Continuous Quality Improvement (CQI) intervention in hospitals participating in the Free Maternity Program in Ecuador in the presentation "Combined Effects of a CQI Program and Health Sector Reform at the Local Level." His presentation discussed the determinants of health care quality, the effects of interventions at the macro- and micro-levels on quality of care, and the relationship of CQI efforts to health sector reform initiatives in Ecuador.

Joanne Ashton, RN, MN, Senior QA Advisor, and Dr. Silimperi described the development of the National Adolescent Friendly Clinic Initiative (NAFCI) in South Africa in their presentation, "Youth-Friendly Services: A Focused-Accreditation Model." In light of the growing HIV infection rates among adolescents in South Africa, the NAFCI sought to improve the quality of primary health care services for adolescents and make services more accessible and acceptable for teenagers.

Ms. Ashton also presented the poster, "Applying Quality Methodology to Infection Prevention in Developing Countries." The poster explained the principles of defining, measuring, and improving quality in developing countries, with resulting improvements in Eritrean hospital standards and improved use of antimicrobial prophylaxis in Jamaica.

To view a PDF of the PowerPoint slides from the QA Project presentations, click on the respective link below:

Community e-Learning Plaza Opens at New Jersey Center for Human Services

Center for Human Services (CHS) offices in New Jersey, Pennsylvania, and Delaware were selected as locations for five of six East Coast Community Plazas (Plazas Comunitarias) established to provide Mexican migrant students with computer access, English as a Second Language (ESL) and Life Skills training, and web-based educational programming. This e-Plaza initiative offers Mexicans who have emigrated to the U.S. the equivalent of elementary and secondary (high school) degrees from their country. The five Plazas are located at CHS sites in Bridgeton, NJ; Gettysburg, Kenneth Square, and Lancaster, PA; and Georgetown, DE; and will share the privilege of being the first Plazas Comunitarias on the East Coast together with the Pennsylvania State Migrant Education Department.

Opening ceremonies held for the e-Plaza located at CHS in Bridgeton, NJ on November 11th and 12th were covered by the Bridgeton News and the Press of Atlantic City. The Press' article describes observations of Aurora San Román, a Plazas Comunitarias trainer within Mexico's Department of Education. San Román noted that besides allowing Mexicans to obtain degrees from their own country, the program makes it easier for them to obtain educational degrees in the United States. The Mexican high school equivalency test, she points out, covers 90 percent of the same material as the U.S. test. "They would be missing U.S. history and just a little bit of math," said San Román. Because the Center for Human Services offers High School Equivalency degrees, she says, the transition to getting a degree in the United States will be made smoother and easier by participating in the e-learning program. "The Life Skills, English instruction, and Web-based instruction will make the Plazas Comunitarias an invaluable tool to train our migrant students with disabilities and help them to find better jobs," adds Louis Marino, Director of CHS' New Jersey program. The Mexican Consulate in Philadelphia introduced the program to CHS and plans to refer students to the Center.

The Community Plaza at CHS is open during weekdays and evenings and is staffed with personnel to work with children who accompany their parents. Web-based instructional programming is offered to the entire family. Users will be able to access the Mexican government website and take an array of courses from the entire K-12 curriculum of Mexico. The e-learning initiative was developed by Mexican President Vicente Fox and is in line with the recent "No Child Left Behind Act of 2001," from the Bush Administration's educational package which focuses on family literacy, parental involvement in education, and technology integration.

The Press of Atlantic City article notes the comments of CHS' Louis Marino, who oversees the High School Equivalency Program and Migratory Agricultural Workers and Seasonal Farmworkers with Disabilities Service Projects in New Jersey, and Nancy Matias, a social worker with the Disabilities Service Project. Marino plans to use the Spanish media and word of mouth of former migrant workers such as Matias to convey the program's value to the Mexican immigrant population. The program can help workers maintain cultural ties and help parents keep pace with their children's education, he notes. Matias adds that the program is designed for working people, noting the range of hours and staff available to help children.
Opening ceremonies for the four Community Plazas in Delaware and Pennsylvania also took place in November. The program has been operational since 2000 in many institutions in Texas and California.
For more information, please contact, contact New Jersey Program Director Louis Marino at LouisMarino97@cs.com or Project Director Grogan Ullah at gullah@urc-chs.com.

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PHRplus Bibliographic Database Featured at USAID Knowledge Fair

URC's Liz Nugent demonstrated the Partners for Health Reformplus Bibliographic Database at the "Knowledge Management" Open House held on December 5 at the U.S. Agency for International Development Library. The Open House featured USAID's knowledge assets and best practices related to creating and sharing technical information from within USAID and a diverse group of USAID cooperating agencies. The PHRplus database focuses on materials related to health sector reform and health systems strengthening.

The PHRplus bibliographic database was created by a team led by Nugent to consolidate a large number of non-catalogued materials to make them easily accessible to staff, clients, and other interested parties worldwide. A web-based bibliographic software (Inmagic DB/TextWorks) was chosen, and a keyword list to catalogue materials was developed in consultation with staff. Over a one-year period, materials were sorted through, catalogued, and entered in the database as per established guidelines. Access to the database was then placed on the World Wide Web: http://www.dcdata.com/abt/abt.htm.

The PHRplus database currently contains over 5,000 bibliographic citations with close to 1,000 livelinks. The database is maintained by the PHRplus Resource Center, which responds to a large number of research and reference requests and generates numerous bibliographies from citations contained in the database. The web-based database facilitates the information broker role of the Resource Center by making a huge amount of information widely available in a quick and efficient manner.

For more information on URC's work in the PHRplus Resource Center, contact Liz Nugent, M.I.A., at liz_nugent@abtassoc.com. Information on best practices showcased at the Knowledge Management Open House is available at http://www.dec.org/partners/km_fair/knowledge/.

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Staff Accomplishments

Congratulations go to URC staff who have earned professional recognition through certification, service, training, or education:

• Dr. Diana R. Silimperi, Deputy Project Director of the Quality Assurance Project, was elected to the American Public Health Association Governing Council as representative of International Health. Her term of office began in November 2002.

• Ya-Shin Lin, Communication and Research Specialist for the Quality Assurance Project, completed in July 2002 the Competent Toastmaster Manual to receive her CTM certificate from Toastmasters International.

• Nadia Musa, Advanced Information Specialist for the National Clearinghouse for Alcohol and Drug Information (NCADI), in May 2002 received a Bachelors degree in Government & Politics (with a focus on International Relations) and a minor in Psychology from the University of Maryland at College Park . She was also awarded an Advanced Training Certificate in Conflict Management from the Center for International Development and Conflict Management at UMCP.

• In June 2002 Caroline Quijada, Associate Technical Officer of the Partners for Health Reform (PHRplus) project, completed a "mini-med" school course on infectious disease given at the National Institute for Health and received a certificate of achievement.

• Cindy Young, Senior Writer on the staff of the Quality Assurance Project, was re-elected in December 2002 as Vice President of Education for the Vienna, Virginia Toastmaster Club.

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Charles Pecarro, President of University Research Co., LLC, recently announced three major promotions at the company. David Nicholas has been promoted to Senior Vice President, Rashad Massoud has been promoted to Vice President, and Neeraj Kak has been promoted to Vice President of Program Development.

"This recognition acknowledges these officers' strategic efforts to successfully grow our business beyond their immediate responsibilities," said Mr. Pecarro. "Through their leadership, they have significantly expanded our involvement in improving international public health."

David Nicholas, MD, MPH, has been the Director of the Quality Assurance Project (QAP) for 11 years. He was Director of the International Division for nine years, from 1986 to 1997. He joined URC as a Senior Scientist in 1982, working on the PRICOR international health contract. Dr. Nicholas will continue as Director of the Quality Assurance Project. "In his 20 years at URC, he has provided strong leadership, commitment, and vision," said Mr. Pecarro, "David is constantly seeking new frontiers to strengthen public health around the world."

Rashad Massoud, MD, MPH, Associate QA Project Director for Europe, Russia, NIS, Asia, and the Middle East, has been appointed Vice President of URC and Director of the Quality and Performance Institute. Dr. Massoud joined the Quality Assurance Project as a Senior QA Advisor in 1998.

"Rashad is recognized as a leader in international health QA issues and methodologies," Mr. Pecarro said. "His proactive efforts have enhanced our opportunities in international health." Dr. Massoud will seek to expand the Quality and Performance Institute's work in the domestic and international arena. He will continue as Associate Project Director. The Maternal and Child Health Technical Assistance and Support Contract (TASC) Russia program with USAID will be under the Institute.

Neeraj Kak, PhD has been appointed Vice President of Program Development. "Neeraj has demonstrated his exceptional talents in both the domestic and international areas," Mr. Pecarro said. "He has continued to initiate and manage technical QA programs in South Africa and Jamaica, while securing strategic work in Cambodia and Bangladesh."

Dr. Kak has been Director of Program Development since July 2001. He has been associated with the company since 1986 when he served as a Resident Advisor in Indonesia for five years. Upon his return to the United States in 1991, he joined the QA Project as a Senior Scientist. After a brief hiatus from URC, he rejoined the company in February 2000. Dr. Kak will continue as Senior QA Advisor and will provide technical and management support to selected field projects, including in Cambodia.

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CHS Takes Active Role in Migrant & Seasonal Farmworkers Conference

Center for Human Services (CHS) staff and students participated in the National Alliance for Migrant & Seasonal Farmworkers in Vocational Rehabilitation 's (NAMSFVR's) 2003 Conference held in Falls Church, VA on February 24-26, 2003. Conference sponsors were pleased to welcome dignitaries from the Government of Mexico, as well as U.S. Department of Education and Rehabilitation Service Administration staff, and staff from the Migrant & Seasonal Vocational Rehabilitation Projects in 12 states.

The Conference was intended to address the needs of Migrant and Seasonal Farmworkers with Disabilities nationwide and to build bridges and facilitate educational opportunities across local, state, and international boundaries. A particular emphasis was placed on fostering educational opportunities for farmworkers with disabilities living in rural areas.

In keeping with NAMSFVR's goal of making web-based instructional programming widely available to migrant families on a nationwide basis, one of the Conference highlights was on broadening the establishment of Community Plazas. CHS offices in New Jersey, Pennsylvania, and Delaware were recently selected as locations for five of six East Coast Community Plazas (Plazas Comunitarias) established to provide Mexican migrant students with computer access and web-based educational programming. (See Community e-Learning Plaza Opens at New Jersey Center for Human Services)

Louis Marino, CHS New Jersey Program Director, had the honor of introducing Mexican Ambassador and General Consul, Mr. Edgardo Flores Rivas, who gave the keynote presentation on the Plazas Comunitarias concept. Louis also served as a panel member in a Round Table Discussion entitled, "Partnership Building with State Designated Units -Migrant Rural Concerns." CHS Project Director Grogan Ullah served as a panel member on a discussion on Migrant Rural Concerns, and CHS New Jersey's Horacio Garcia (consumer), Rocio Garcia (Intake Counselor) and Marisol Perez (Vocational Liaison) participated in a panel discussion on Consumer/Counselor Perspectives.

According to NAMSFVR, during PY 2000, training and/or coordination of services was provided to over 485 consumers and information related to Vocational Rehabilitation Services and/or the Americans with Disabilities Act was disseminated to more than 23,600 Migrant and Seasonal Farmworkers. Most of these individuals would not have had access to traditional VR services without the support of specialized services such as the ones provided for non-profit organizations such as the Center for Human Services.

For more information on Migrant & Seasonal Farmworkers Programs contact any of the NAMSFVR officers:

Noemi Ortega, President, e-mail: nortega@wsmconline.org, telephone: (509) 374-4455, fax (509) 374-4843

Louis A. Marino, Treasurer, e-mail: lmarino@urc-chs.com, telephone: (856) 575-0857

Grogan Ullah, Secretary, e-mail: gullah@urc-chs.com, telephone: (717) 334-2221.

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A panel of four health professionals from Partners for Health Reformplus discussed their work to strengthen hospitals and increase resources for primary healthcare in developing nations at the seminar, "Hospitals and Health Reform: Linkages with the Primary Care Agenda." The discussion was held recently at the Pal-Tech offices in Washington, D.C., and was part of the American Public Health Association and Partners for Health Reformplus (PHRplus) Partnerships for Global Health Seminar Series.

In the developing countries in which PHRplus works, hospital expenses often use most of the national health budget resulting in fewer funds for primary and preventative care. To address this issue, the panelists presented a wide range of strategies used in Jordan, Eritrea, and Malawi to strengthen hospitals, i.e., to make them more efficient, improve quality, and reduce costs. Patients in developing countries frequently bypass primary care centers to seek primary care services in hospitals, resulting in hospital overcrowding and unsanitary conditions.

"If we can make the hospitals more efficient is it realistic to assume that the cost savings will be diverted to primary healthcare," asked Jack Galloway, URC's Senior Advisor for Field Support Activities for PHRplus, as he opened the discussion. "These advisors all are dealing with a very challenging environment, and are dealing with these challenges in innovative ways," agreed Allen Jones, Director, Education and Global Health Resources, American Public Health Association. PHRplus works to improve efficiency and quality in the healthcare sector.

Panelists included moderator Mary Paterson, PHRplus Senior Implementation Advisor; Dwayne Banks, PHRplus Chief-of-Party in Jordan; Ed Chappy, URC's PHRplus Long Term Advisor in Eritrea; and Peggy Cook, URC's PHRplus Long Term Advisor in Malawi.

In Eritrea, Ed Chappy said their work focused on developing a long-term approach, consolidating four referral hospitals and implementing management development training at three pilot hospitals. Chappy works hand-in-hand with the Minister of Health, whom he calls a "dynamic visionary." Having a close relationship with the Minister enables the project to get things done more effectively, he said, cutting across many of the Ministry's divisions. "The people themselves are interested in developing their country," Chappy said. "They are interested and open to change."

In Malawi, work centers on developing management capacity in a resource-poor setting. "In Malawi, the major challenge is a lack of resources," said Peggy Cook. "We work to help administrative teams understand how to manage amid rationing of supplies. We continually ask, 'What care can we realistically give with the resources we have?'"

Dwayne Banks discussed their work in Jordan to provide intensive internal management training at two pilot hospitals. The pilot hospitals have been delegated responsibility for personnel issues. If this new decentralized responsibility is successful, the pilots may effect civil service laws that impact all hospitals in Jordan. Since 1998, Banks has faced the challenge of working with eight different Ministers of Health and with a highly centralized health system where managerial control is entrenched at the national level.

URC's staff of approximately 15 individuals on the PHRplus Project make an important contribution to the key technical areas of the project, including health reform, health financing, decentralization, health policy reform, hospital strengthening, infectious disease surveillance, and HIV/AIDS. For more information about PHRplus, please contact Jack Galloway at jack_galloway@abtassoc.com.

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The International Journal for Quality in Health Care (IJQHC) recently published the 110-page journal supplement, “Quality Assurance in Low and Middle Income Countries: Experiences from the Quality Assurance Project.”  The special issue is devoted to the Quality Assurance Project’s (QAP) formative work in improving the quality of healthcare in lower- and middle-income countries. The articles illustrate how quality assurance (QA) approaches can be effectively utilized, especially in countries with differing needs and circumstances. University Research Co., LLC is the first organization to publish a supplement by this respected journal.

The Volume 14, December 2002 Supplement presents the results of the project’s operations research studies, evaluations of country QA programs, and methodology refinement efforts. The issue contains 11 peer-reviewed papers written by QAP staff and collaborators.

The Research Study Reports section of the supplement contains six articles highlighting original research designed to answer specific questions about the effectiveness of diverse QA approaches. Articles include: “Implementing a national hospital accreditation program: the Zambia experience,” by Ngoyi Bukonda and Paula Tavrow (co-first authors), et al.; “Methods for assessing quality of provider performance in developing countries,” by Lynne Miller Franco, et al.; “Increasing compliance with maternal and child care quality standards in Ecuador,” by Jorge Hermida, et al.; “The role of research in developing job aids for pneumonia treatment in Niger,” by Wendy Newcomer Edson, et al.; “Distance education with tutoring improves diarrhea case management in Guatemala,” by Rafael Flores, et al.; and “Measuring the quality of supervisor-provider interactions in health care facilities in Zimbabwe,” by Paula Tavrow, et al.

The section on Methodological Approaches describes QAP’s work in developing new approaches to QA program institutionalization and evaluation. Two articles are featured: “A framework for institutionalizing quality assurance,” by Diana Silimperi et al., and “The evaluation of quality assurance: developing and testing practical methods for managers,” by Tessie Tzavaras Catsambas, et al.

The section on Evaluation of Country Quality Assurance Programs reports results and draws lessons from QA program evaluations in Chile, Zambia, and Niger. Articles include: “The Chilean legacies in health care quality,” by Stephane Legros, et al.; “The Zambia Quality Assurance Program: successes and challenges,” by Bruno Bouchet, et al.; and “Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger,” by Stephane Legros, et al.

 “We believe that the results reported in the IJQHC Supplement will add to the evidence base necessary for the design and maintenance of effective programs to improve the quality of care in all countries,” said David Nicholas, QAP Director, and Diana Silimperi, QAP Deputy Director, who served as Guest Editors for the special issue. “Many of these programs, studies, and approaches are relevant for other countries, regardless of their level of development or financial resources,” they noted.

The Table of Contents and article abstracts of the Volume 14 Supplement 1 of the International Journal for Quality in Health Care can be viewed online at: http://intqhc.oupjournals.org/content/vol14/suppl_1/index.shtml

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Calidad en Salud Experienced First Hand

Since 1999, URC has managed the TASC maternal and child health project known as Calidad en Salud (Quality in Health). The Guatemalan Ministry of Health (MOH), the Guatemalan Social Security Institute, and some 94 community-based non-governmental organizations (NGOs) have directly benefited from the assistance provided by URC under this contract. The three service areas that the project supports are: 1) nation-wide family planning services, 2) integrated management of childhood illness (IMCI) in health facilities, and 3) the integrated community health program that promotes family planning, IMCI, and maternal health at the community level. URC assistance in the areas of supervision, logistics, planning and programming, monitoring and evaluation, and financial management and administration further support better management of maternal child health programs. Although the project is ambitious in scope-covering both institutional and community levels-the Ministry of Health and Social Security Institute have achieved significant results in all areas supported by Calidad en Salud.

URC President Charles Pecarro joined International Division Group (IDG) Vice President Tisna Veldhuyzen van Zanten and Calidad en Salud Project Coordinator Rajni Sood in a visit to Guatemala in October 2003 to see how the project's efforts have improved the lives of thousands of Guatemalans. The team visited sites to see how the project has been implemented, starting at the central level and visiting activities in the highland communities.

Apart from visiting the two URC field offices in Guatemala City and Quetzaltenango (Xela), field visits were made to a health center in San Martin Sacatepequez, a health post in Chiquilaja, and to three community centers in San Marcos: Canoa de Piedra, Rancho del Padre and Los Aguilares. Traditionally, these communities have not had access to the most basic of health services. Because of the services now being provided with technical assistance and support from Calidad en Salud and the Government of Guatemala, the reality of these communities has changed. Families in these isolated regions now have access to basic services, including medicines and contraceptives essential for child survival and family planning as well as growth monitoring of their children.

Calidad en Salud has also trained health volunteers to weigh children in their community every month to ensure that their growth meets the norm for their age. Describing the large-scale community mobilization now in place, IDG Vice President Tisna Veldhuyzen van Zanten noted: "Community-based nutrition activities have successfully gone to scale in Guatemala: 13,000 community volunteers are now weighing children in their community every month, providing counseling to mothers on appropriate nutrition and referring those whose growth falters."

URC President Chuck Pecarro also expressed his appreciation for the commitment of Calidad en Salud staff by awarding a certificate in recognition of their work to promoting quality health. In return, the URC team from Bethesda was rewarded with a taste of local cuisine such as tamales, chuchitos, taquitos and frijoles with warm tortillas. Project Director Dr. Rodrigo Bustamante noted, "The visit by URC's President was a great incentive for Calidad en Salud staff. They considered it recognition of their work to improve quality in health. It also was a demonstration to the Guatemalan health authorities of URC's commitment to improve the health of the poorest mothers and children of Guatemala."

Now entering its final year of implementation, Calidad en Salud is scheduled to end on September 30, 2004. At a ceremony on August 20, 2003, the USAID Mission Director personally visited the project offices to express his thanks and to commit complete funding of the contract. The ceremony reconfirmed the commitment of the Guatemalan and U.S. governments under this bilateral agreement to improve maternal and child health in Guatemala. In the words of Glenn Anders, USAID Mission Director, "The changes we have observed in health indicators in Guatemala during the past several years are testimony of the progress achieved within this sector. Today, I can express with certainty and enthusiasm that we feel proud and satisfied with the achieved results."

For more information on URC's work in Guatemala through Calidad en Salud, contact Rajni Sood at rsood@urc-chs.com.

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URC Wins Two Contracts Under USAID's TASC2 Vehicle

URC was recently awarded two contracts under the U.S. Agency for International Development's (USAID) Population, Health and Nutrition Technical Assistance and Support Contract (TASC2) vehicle. These two contracts, Global Health and Tuberculosis, will allow URC to continue the important services it provided to USAID under the predecessor contract - TASC. TASC2's purpose is to establish a worldwide mechanism to support USAID Missions and Bureaus in the implementation of their Strategic Objectives pertaining to the reduction of unintended and mistimed pregnancies, maternal mortality, infant and child mortality, HIV transmission, and the threat of infectious diseases. TASC2 will continue and expand the worldwide mechanism established by the first TASC Indefinite Quantity Contract. TASC2 shall provide cost-effective access to technical expertise and implementation support to meet evolving USAID needs.

As a holder of the Global Health TASC2 contract, URC can offer USAID missions and their counterparts skilled technical assistance to improve health care services in over 64 sub-specialties ranging from issues relating to Anemia to Voluntary Counseling and Testing for sexually transmitted infections (STIs). Under the Tuberculosis contract, URC will be able to assist USAID missions, Ministries of Health, and non-governmental organizations with planning, implementation, and evaluation of Directly Observed Treatment Short course (DOTS). TASC2 is a five-year contract that will run through 2008. For information on the Global Health TASC2 contract, contact Dr. Tisna Veldhuyzen van Zanten; questions about the Tuberculosis contract may be addressed to Dr. Marina Budeyeva.

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URC Wins Three-Year Subcontract for Conference Exhibit Management

URC has won a three-year subcontract from Social and Health Services (a division of ORC Macro) for the management of the Substance Abuse and Mental Health Administration (SAMHSA) conference exhibit program. This program will develop and manage a SAMHSA exhibit for the agency and represent SAMHSA offices and its Centers: CSAP (Center for Substance Abuse Prevention), CSAT (Center for Substance Abuse Treatment), and CMHS (Center for Mental Health Services) at approximately 200 national and/or regional conferences each year. The exhibit will provide national visibility and recognition for SAMHSA's activities with its traditional constituents as well as audiences that are not well aware of the agency's mandate. This is a one-year program with two option years. URC staff member Vipapan Owtrakul is the Project Director for the Exhibit Program.

URC Awarded Contract to Improve Health Care in Albania

 

The United States Agency for International Development (USAID) has awarded a new contract entitled "Improving Primary Health Care in Albania" to the University Research Co., LLC (URC). The three-year contract, valued at $6.5 million, will support USAID's goal to improve the quality of integrated primary health care services and increase service access and utilization.

To meet the proposed goals of the project, URC has assembled a team of international and Albanian partners who bring global and local expertise to the challenges faced by the Albanian healthcare system. U.S. team partners include Bearing Point, the American Academy of Family Physicians, the Joint Commission International, and the National Perinatal Information Center. URC looks forward to including several Albanian organizations on the project team.

The project is intended to provide the Albanian government with technical assistance to respond to the need for quality health care. The team will identify and implement measures to deepen and broaden primary health care reform in Albania in order to ensure quality of and access to integrated primary health services. Project goals include development and dissemination throughout Albania of a primary health care model that delivers integrated and comprehensive services for family planning and reproductive health, HIV/AIDS and sexually transmitted infections, tuberculosis and other infectious diseases. In addition, the project will seek to implement improvements in other aspects of the primary health care system including financing, information systems, and regulation.

URC's Dr. Victor Boguslavsky will serve as the program's Chief of Party. Dr. Robert Rhyne of URC will serve as the Service Delivery Technical Officer and Dr. Catharina Hjortsberg of Bearing Point will serve as Health Sector Reform Expert. URC will be recruiting on a competitive basis the most highly qualified Albanian specialists to work on accomplishing the project's goals.

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WHO Reaches Milestone in Global Efforts to Fight TB

 

On the occasion of World Tuberculosis (TB) Day on March 24, 2003, the World Health Organization (WHO) announced the achievement of a significant milestone in global efforts to fight the resurgent epidemic of tuberculosis: Over 10 million TB patients have now been successfully treated using Directly Observed Treatment-Short Course (DOTS), the internationally recommended TB control strategy.

The announcement comes 10 years after WHO declared TB a "Global Emergency" in 1993. The number of countries that have adopted the DOTS strategy has grown to 155 (of 192 WHO Member States), and more than 60% of the world's population now has access to DOTS services.

The DOTS control strategy has five components: (1) government commitment to sustained TB control; (2) case detection using sputum smear microscopy among symptomatic patients seen at health facilities; (3) proper case management using standardized short-course chemotherapy and direct observation of treatment; (4) strengthened drug management to ensure continuous supply of TB treatment; and (5) a standardized recording and reporting system.

Despite progress, the TB epidemic is still growing rapidly in Africa and in the countries of the former Soviet Union, where it is linked with HIV/AIDS, poverty and social disruption. WHO has designated 22 countries as having a high burden of tuberculosis (in descending order of number of TB cases, these include: India, China, Indonesia, Bangladesh, Nigeria, Pakistan, South Africa, Philippines, Russian Federation, Ethiopia, Kenya, the Democratic Republic of the Congo, Vietnam, Tanzania, Brazil, Thailand, Zimbabwe, Cambodia, Myanmar, Uganda, Afghanistan, and Mozambique.

URC, a STOP TB coalition partner (http://www.stoptb.org), is currently assisting a number of high-burden countries in their efforts to expand quality TB services and overcome constraints to DOTS expansion through our Quality Assurance Project (QAP). In South Africa, URC's technical assistance has strengthened the quality and coverage of TB services in Mpumalanga Province, one of the country's least developed regions. With QAP support, the Department of Health has initiated rapid quality improvement activities to strengthen TB case management and improve access to hospital-based laboratories for clinics that do not have in-house microscopy. Monitoring activities have also been improved, with each facility now analyzing its program data on a monthly basis to determine case holding, smear conversions rates, and cure rates. Based on the success of the program in Mpumalanga, the Government of South Africa have requested URC to provide technical assistance in four other provinces in the country.

In Russia, URC has recently begun a collaborative TB quality improvement project. This project will involve the re-design the tuberculosis care delivery systems in several oblasts, including improving the diagnosis and treatment of TB patients and management of multi-drug resistant tuberculosis. Each oblast will engage facilities at all levels of care to participate in improvements. The oblasts will use a web-based application to communicate with each other throughout the process, to facilitate learning and sharing of experiences.

Other URC projects are also stepping up their efforts to fight TB. URC's Cambodia Health Systems Strengthening Project will enlist urban pharmacists to expand quality TB services. In Bangladesh, URC will work with the USAID-funded NGO Service Expansion Program to integrate TB case management and referral services through a network of 250 NGO clinics.

URC has also provided support for training health providers and program managers in TB case management. In Kazakhstan, URC advised Project HOPE staff and the Kazakhstan National TB Institute in the design and implementation of training in TB program management for its local staff and counterparts in the Central Asian Region. In Bolivia, URC developed a Spanish version of our award-winning computer-based training application for TB Case Management in developing country settings. The TB Case Management CD-ROM trains health workers in all aspects of preventing, diagnosing, and treating TB by using WHO's DOTS approach.
In October, URC will conduct a one-day training course on TB quality improvement at the 2003 International Union Against Tuberculosis and Lung Diseases (IUATLD) Conference this October in Paris (http://www.iuatld.org). The course will use case studies to show how quality improvement concepts and tools can be used by health managers and service practitioners to re-design case management processes to increase case detection, achieve higher patient adherence to treatment regimens, and provide better follow-up of TB patients.

For more information on URC's work to fight the spread of TB, contact Dr. Marina Budeyeva at mbudeyeva@urc-chs.com or Kamden Hoffmann at khoffmann@urc-chs.com.