National Plan for Infant Survival and Development - SUPERVIVIR

SUPERVIVIR emphasises the influence of people's behaviour in health, and the necessity of action that promotes and improves health, taking into consideration that changes in behaviour are obtained through education and the consequent modification of knowledge, attitudes, and practices. Of equal importance was the development of basic health services. Based on these principles, the plan worked through a combination of strategies, among which community participation, interpersonal communication, and education and training stand out:

Health Watchers:
This social group working for the survival of children was mostly composed of secondary students, but also included community members, the Red Cross, the Scouts, the Catholic Church, the National Police, the Communitarian Homes of Welfare, the NGO Save the Children, the main workers' unions of the country, and all those who wanted to voluntarily belong.

The work of the Health Watchers (Vigias de la Salud) consisted of visiting families with children below five years of age or pregnant to help them identify illness or death risks, to provide them with information to prevent or to deal with health problems once they appear. For example: they received information about how to prepare oral serum to avoid dehydration by diarrhoea, how to prevent accidents, when to vaccinate their children, the care that should be taken with influenza, the need to play and to offer affection to the children, and finally, the importance of the attending prenatal clinics for pregnant women.

It was also the function of the Health Watchers to give direction on the health services offered by the state - among them vaccination - and to channel to these centres the children and the women who required services.

Training:
In order to fulfil this mission, the Health Watchers received training on health and communication issues. With this aim the "Health Watcher's Manual" was designed - which contains a chapter on vaccination - with which more than 350,000 secondary students and professors, community mothers and other Watchers and members of the health personnel of the country have been trained annually.

This education was carried out through multiple training courses and was supported by educational printed materials, games, and supervision and service manuals. The students of all the secondary education establishments in the country were trained through “Behaviour and Health” classes over the course of 2 years - in the eighth and ninth grades.

Social mobilisation:
In 1986, the motivation generated by the Watchers created demands by families for permanent services of vaccination. The decisions on mobilisation and social participation were centred on supporting the image of the Watchers before the community, and in imparting interpersonal education for the promotion of permanent routine vaccination through the linking and participation of diverse sectors including government, private, and international entities.

Social Marketing:
The labour of the Watchers was complemented by the use of mass communication avenues to spread information and to propagate educative messages.

The promotion of SUPERVIVIR in television and radio included three phases: presentation of the national plan to the population; presentation of the Watchers informing who they were and their technical endorsement by the health sector; and support to the components of the plan through simple, short, precise and direct messages. The vaccination component was promoted with the message "All children must receive all vaccines before the date of their first birthday".

National Vaccination Crusades:
As a complement to the regular vaccination programme, special days were designated to increase coverage with the support of diverse institutions, the community, and mass media promotion.

Fortification of the Expanded Programme on Immunisation:
The Expanded Programme on Immunisation (EPI), or Programa Ampliado de Inmunizaciones (PAI) was adopted by Colombia in 1979. The purpose of this programme was to reduce the deaths and the incidence of diseases that can be prevented by immunisation. The diseases that are targeted by the programme were: Polio, Tuberculosis, Tetanus, Diphtheria, Measles and Pertussis.

Strategies used by SUPERVIVIR to support the EPI were:

• Focusing on health problems using risk criteria, and giving priority to the urban and rural marginal groups, or extreme poverty groups.
• The establishment of local community focus points, so that each municipality would develop its own plan according to its characteristics and with the participation of the community.
• The strengthening of the health services infrastructure to be able to meet the demand generated by the Plan.
• The development of coordination, monitoring and evaluation mechanisms of the Plan.

Immunisation and Vaccines, Children, Health.

Among the biggest achievements of SUPERVIVIR was community mobilisation in favour of children's health, the coordination between programmes, and the diffusion of simple but vital messages for child survival

In the 1984-1990 period the rate of infantile and maternal mortality, neonatal mortality, and the deaths of minors of 5 years of age caused by diarrhoea and acute respiratory infection decreased remarkably.

In addition, the vaccination coverage in children below one year pf age increased in significant percentages: Polio 92%, DPT (Diphtheria, Tetanus and Pertussis) 78%, Measles 73%, Tuberculosis 98%.