Common use of Contributing Factors for Objectives Not Fully Achieved Clause in Contracts

Contributing Factors for Objectives Not Fully Achieved. Although the results of the KPC for recognition of danger signs and care seeking exceed baseline levels (46% and 53% respectively), there is still a large proportion of mothers who have no knowledge regarding home practices and timely treatment of pneumonia in young children. Although child death due to pneumonia dropped from 13 cases to 6 between 1998 and 2001, pneumonia continues to be the leading cause of death in the Bolivian Altiplano. Contributing factors include the cultural barriers mentioned in the discussion of CDD above, and the difficulties regarding transport and access. An infant with pneumonia may easily die if not treated with antibiotics promptly, and by the time a mother realizes the child needs treatment, there may be no means of transport from isolated communities. Although the CS Project has established a procedure for transportation by motorcycle or ambulance for emergencies, geographic factors (such as a lack of access roads in certain areas) and communication difficulties continue to be barriers to prompt care. Not all health centers have a sufficient number of motorcycles and ambulances, and some of the health posts do not have access to radio communication. Regarding quality in pneumonia case management (PCM), the checklists originally planned in the DIP were only partially implemented. The Pneumonia ToolBox mentioned in the DIP was not used. Quality in PCM has been addressed through the IMCI approach, which has been implemented during the past two years as part of the MOH strategy.