PAHO Regional Program on Dengue

Mission | Contact | Areas of Work:

- Integrated Strategy
- COMBI behavioral initiative
- Dengue-Net
- Eco-Clubs

Integrated Strategy (PowerPoint, 3625 KB)

PAHO Dengue Page |  WHO Dengue Page
Associated Links: Dengue-Net | Eco-Clubs
Contact: Dr. José Luis San Martín,
Regional Advisor on Dengue (PAHO/AD/DPC/CD/DEN),
PAHO Country Office in Panamá
(OPS-Panamá).
Phone: (+507) 262-0030 (x223),
Fax: (+1-202) 974-3656.

Mission

• Reduce the morbidity, mortality and social and economic burden caused by dengue outbreaks and epidemics, based on PAHO Directing Council Resolutions CD43.R4 (2001) and CD44.R9 (2003).
• Focus public-health policies on multisectoral and interdisciplinary integration, thus making it possible to develop, implement, and consolidate an Integrated Strategy for Dengue Prevention and Control.

Areas of Work: The Regional Program on Dengue, following the present policy of decentralization and relocation of programs from Headquarters in WDC to inside the countries, was transferred in September 2003 to the PAHO Country Office in Panama, where all regional work is coordinated:

1. Integrated Strategy to Manage Dengue
   As part of PAHO's effort to help cope with this challenge, and based on a new model of integrated work that includes health promotion and the search for new partnerships, the Integrated Strategy for Dengue Prevention and Control was developed, with the goal of creating stronger partnerships so as to reduce the risk factors for dengue transmission, implementing a comprehensive surveillance system, and reducing the populations of Aedes aegypti (vector control). Another goal is to provide better training to laboratories in order in detecting and identifying the virus, strengthen management of outbreaks and epidemics, and include the community as a strong participant in dengue prevention and control actions. These changes should, in turn, reduce incidence rates and case-fatality from the disease.
   Activities
   • Technical cooperation to assist countries in the implementation and execution of the 'ten commandments' (decalogue) of the integrated strategy, resulting from Resolution CD43.R4, and in the implementation of Resolution CD44.R9.
   • Creation of the Working Group on Dengue (GT-Dengue, the Spanish acronym for Grupo de Trabajo/Grupo Técnico Dengue), a new type of technical cooperation formed by a group of experts who will help the countries strengthen their national programs and guide them towards a national strategy of integrated management.
   • Periodic evaluations of the national dengue programs (both internal and external), with the involvement of the GT-Dengue (Dengue Working Group Dengue).
   • Meetings, courses, and workshops for technical/managerial staff to train them on how to best implement and carry out the integrated strategy, in accordance with Resolutions CD43.R4 and the CD44.R9.
   • Production, selection, and dissemination of mass-communication materials and technical and scientific information to strengthen the integrated strategy, in accordance with Resolution CD43.R4.
   Achievements and Projections: To date, the Central American Subregion has prepared their own version of the integrated strategy, along with two countries (Nicaragua and Venezuela). Strategies are currently being prepared by Guatemala, Honduras, El Salvador, Costa Rica, the Dominican Republic and Colombia.
2. Communication for Behavioral Impact (COMBI)
   The new generation of programs for dengue prevention and control falls under the heading of strengthening dengue prevention and control through community participation and health education. Despite the many efforts made by the countries, the desired impact on disease control has not been achieved. In light of this situation, PAHO/WHO—as part of the Integrated Strategy for Dengue Prevention and Control—is incorporating the COMBI (Communication for Behavioral Impact) methodology and aiming it at dengue.
   COMBI is a process that brings into line in a balanced way a variety of communication interventions, to motivate, stimulate, and encourage the population to take into consideration, occasionally adopt, and maintain actions for dengue prevention and control. COMBI incorporates more than 50 years of experiences in health education, communication and behavioral-change theories in a strategy focused on the specific behaviors of individuals and families. COMBI also incorporates the experiences of the private sector, e.g. communication with consumers.
   The methodology effectively integrates health education, information-education-communication (IEC), social mobilization, technical communication with consumers (marketing), and research into training and situation analysis. All this is directed in a timely way at a specific, precise behavioral objective related to health-an approach proving to be highly adequate in preventing, controlling, and eliminating communicable diseases, and in this case applied to dengue. The COMBI methodology recognizes that the final goal is to achieve behavioral change: Somebody ought to be doing something! Activities
   • COMBI Workshops to train multidisciplinary teams.
   • Training on how to prepare COMBI Plans.
   • Technical cooperation to assist in the implementation of the plans once they are prepared, and in monitoring and evaluating them.
   • COMBI Guide prepared, published, and distributed.
   Achievements and Projections: In 2003, the first training workshop was held in Nicaragua, with multidisciplinary teams from four countries (Costa Rica, Guatemala, Nicaragua, and the Dominican Republic). Training on the COMBI methodology was also given to other countries in the Region, in workshops held in Honduras (attended by participants from Belize, El Salvador, Honduras and Panama), Colombia (with participants from Bolivia, Colombia, Ecuador, and Venezuela), Brazil (with participants from four municipalities in the states of Ceará, Maranhão, Minas Gerais, and Rio Grande do Sul) and Trinidad (with participants from the Bahamas, Barbados, St. Lucia, and Trinidad and Tobago).
   The results of these workshops are visible in the 20 COMBI Plans that have been prepared, in one plan that is currently being implemented (in Nicaragua), another in the phase of formative research phase (Guatemala), yet another in the readjustment phase before start of research (Costa Rica), and four more in the process of readjustment and approval by the Brazilian authorities. A Plan for the Andean Region and one for the English-speaking Caribbean has been submitted for approval. A COMBI Workshop is currently being organized for MERCOSUR.
3. Worldwide Dengue Network (Dengue-Net)
   The surveillance network Dengue-Net is a WHO system for standardized epidemiological and laboratory surveillance that responds to the current need to unify and increase the timely availability of basic data on dengue for regional control of the disease. This regional strategy promotes the involvement of all countries in this global surveillance network.
   Activities
   • Workshops to expand the implementation of Dengue-Net (global surveillance network for dengue) in the Region of the Americas.
   • Advocacy in the countries for the adoption of Dengue-Net as a standardized dengue surveillance system.
   Achievements and Projections: Two workshops have been carried out in the Americas: Puerto Rico (2002) and Cuba (2004), with the involvement of countries from the subregions (Caribbean, Central American, Amazon, Andean, Southern Cone). It is soon expected that the number of countries participating in Dengue-Net will soon expand, and there are plans to introduce users to the new Dengue-Net platform updated by Global Atlas.
4. Involvement of the International Network of Eco-Clubs
   The International Network of Eco-Clubs plans to construct a social space for exchange of experiences, which converts young people in the present mode. Its objective is to achieve attitudinal changes among the population regarding the environment surrounding them, by empowering the community to carry out proposals to improve the quality of life for all. Through the proposed alliance between the International Network of Eco-Clubs and PAHO, the following actions have been carried out for the first time in the fight against dengue:
   • Successive charter agreements that since 2001 have allowed for a systematic fight against dengue, with two international encounters and distribution of videos, posters, books and dengue sets.
   • Participation of dengue monitors from the Eco-Clubs in the virtual course, Housing and Vectors: A Dengue-Free Household, promoted by PAHO with support from INHEM-Cuba.