1. MNCH & DISBILITY SEMINAR Vientiane Mayo 2011 REFERRAL AND COUNTER REFERRAL INPUT Dr. Brenda Tapia Nicaragua

2. MNCH & Disability Referral and counter referral  The first steps for development the refererral is to know the local situacion:  Number of service for children care  Where is located the services (health ministry, social ministry, NGO, privates services)  Kind of services ( early stimulation, habilitation, CBR, other: inicial education, nutricional program, vaccination )  Human resources (doctor, nurses, promotor, others)  introduce the refererence of developmet delay, impairment children  Rehabilitation services. Compentences for to work with children

3. MNCH & Disbility Referral and counter referral Project team and partner refflection : How introducing the issue of the disability in the MCH sistem  what do you want to work?  What do you can to work?  What the sistem is prepared for to work?

4. MNCH and Disability Referral and counter referral Motivation, Motivation, and Motivation.  Sensitization of the personal involucred.  Comunication about your project or program. Is important the apropiation at diferents levels.

5. MNCH and Disability Referral and counter referral  Design a refferral flowchart easy touse and realistic.  The best is to incluide the identification and referral of child a risk and childs with impairment in the sistem of health care childhood.  Approved by the sistem

6. MNCH & Disbility Referral and counter referral Nicaragua experience. Point strenghts  Good appropriation of primary level health worker in the importance of early detection of development delay.  Great interest for to work with children.  Regional and municipal health director involucred in the project.

7. MNCH & Disability Referral and counter referral Nicaragua experience. Point weak  The flow chart was complex  The counter refferral is a institutional weakness.  The personal health and services of the more complex level needs to receive specialized training.  The health sistem is not prepared for give habilitation to all impairmet. Ej. hearing and vision.

8. MNCH & Disability Referral and counter referral  REALISTIC  SIMPLE  COMPREHENSIVE  COMPATIBLE WITH THE HEALTH SISTEM  COORDINATE

9.  first level comunitary level