Addressing Zika: an opportunity to strengthen health services in Paraguay

Left:The QI team at the Regional Hospital in Ciudad del Este, Alto Parana region: DR. Esdilma Jara, Dr. Liza Morel, Dr. Juan Angel Silva, Dr. Carlos Gomez and Dr Maria Luisa Melgarejo, with the ASSIST project technical facilitator Dr. Marlene Espinola.     Right: Two year old Elian Bogado, during an early stimulation session at the Regional Hospital in Ciudad del Este

The quality improvement team for care and support of children affected by Zika at the regional hospital in Ciudad del Este, Paraguay was established in April 2018. For the first time, a team of pediatricians, nurses and other health professionals agreed to worked together to improve the quality of care provided by the hospital. While receiving training on Quality Improvement, Zika virus and its consequences on newborns and newborn screening among other topics, the team started analyzing performance indicators defined jointly with the ASSIST project.  During the assessment they identified 11 cases of babies born with microcephaly at their hospital during 2017 and 2018 and notice that none of them were receiving follow up care.

Motivated by the training and the data, the team started to look for those babies and contacted their families inviting them to come to the hospitals to seek care. However, long waiting hours was the main obstacle for those babies to come. The team decided to implement an improvement cycle, proposing the creation of a “consulting room” specifically designed for high risk babies, assigning medical staff from Monday to Friday to facilitate follow up care for babies with microcephaly. The proposal was approved by the Hospital Director who decided that the service would be open to all high-risk babies.  A physical space was identified not only for the consulting room but also to open an early stimulation room for high risk babies.

With ASSIST support, the consulting room was established and inaugurated in October 2018, and has been offering special care services to all babies born with ZCS but also to all other babies born with any high-risk condition. 7 out of the 11 babies with microcephaly are now receiving care and can schedule their next appointment in advance and have access to all other services available at the hospitals, including early stimulation sessions with psychologists, nurses and psychotherapists. The QI team continues to look for the remaining 4 and is also providing services to babies suffering from other disabilities.

In November 2018, regional authorities jointly with the Paraguayan Minister of Health, Dr. Julio Mazzoleni inaugurated the first early stimulation room at the hospital, the first one in the public health sector in the Alto Parana Region.  Days after the inauguration, Liliana de Romero, a physiotherapist from Ciudad del Este send a message to the USAID Paraguay Mission stating... “I worked in the Alto Parana Region at the ICU in the Regional Hospital, and always thought about the importance of having an early stimulation room there…Thanks for making it a reality…”


Report Author(s): 
Graciela Avila
USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project/URC
ASSIST publication: 
ASSIST publication
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