This two year project documented the process of implementation of WHO-recommended ARI Case Management and Health Education Program for children 0-4 years old in Pasay City. Process documentation (PDR) was utilized. The foci of observation included the health center staff, volunteer healthworkers and mothers. PDR showed that the ARI case management program was acceptable to both health providers and mothers. With regard to ARI case management, compliance of the health center staff with the standard protocol for management was good. Counting respiratory rate (RR) was done by midwives in most cases, and physicians relied on them on this matter. Over - and underdiagnosis by midwives was relatively low (15.1% and 5.5% respectively). Except for taking over the physicians' role when the latter is not available, nurses have no clear cut role in the program. Volunteer health workers were found to be "trainable" regarding ARI case management , but they did not adequately perform the ARI tasks assigned to them. Mothers, who were "users" or "intermittent users" of the primary health care system, generally complied with the ARI case management prescribed at the health center. However, incomplete compliance with antibiotic treatment for moderate ARI (11.4%) and non-compliance with hospital referral for severe ARI (33.3%) were observed. With regard to child assessment, over-and under diagnosis were low (8.1% and 9.4% respectively) as compared to the assessment by trained observers.
To document the implementation process of the ARI case management and health education (ARI-CM/HE) program by health care providers in an urban community