5) Description of health product/service offering: • Our main beneficiaries are children under 15 years old who are at risk of suffering from a burning accident, through the training of community promoters and heads of households. The goal is to equip them to implement prevention activities in high risk communities due to their marginalization and limited medical education. • Our methodology consists in opening a seeding group with 20 community promoters who attend a training to be able to replicate their experiences in the communities. Every four months, they have to open new groups. We monitor the activities carried out by the participants of the seeding group who work in the states of Queretaro, Hidalgo, San Luis Potosí, Estado de México y Guanajuato. It is expected that the initial group can be in charge of diverse groups instead of IANINQ, when the project matures. • Poverty makes burning accidents more likely to happen as small children must often stay alone or under the care of other young children. In addition to the risk of physical damage and possible handicapping sequels, a significant number of psychosocial causes linked to poverty such as dysfunctional families, addictions, domestic violence, etc emerge with burning accidents. This factors worsen during teenage years, not only for victims but also for the brothers and youth that live with the victim. In these cases, the issue is typically psychosocial. Because these kids find no alternative nor answers to the typical concerns of their age that are increased by the trauma of the accident, IAINQ provides direct attention services such as prevention, rehabilitation and general education in health. e Being able to suggest relevant alternatives of personal and community support to the victims enable them to adapt, starting with the acceptance of their new corporal image that they have to consider as valuable as other kids.

6) Description of innovation: Burns in children are basically a matter than entails future disabilities; consequently training for prevention and first aid is a must in order that any member of the family and/or the community can be capable of providing a correct answer from the very moment of the accident and when the injury is caused. In our model we remark the importance of emotional support in crisis not only to the victim but those around him/her. The most important disabilities in the case of pediatric burns are emotional ones (96P)

The model has already being replicated in Querétaro, in some way in the hospitals of Xochimilco and Tacubaya; to this date, both public hospitals have integrated multi disciplinary groups as per the model proposed by IAINQ since 1985 and even some other emergent organizations in the last three years are trying it.

7) Operational model: Our activities focus on: • Provide an integral attention to restore health in individuals that have suffered burns during their childhood, • Perform actions for education for prevention of these type of accidents, and • Study (research) conditions surrounding the problem of child population suffering burns. Multi disciplinary groups constantly visit the community in order to offer courses on prevention and first aid and detect children that present sequels of burns. The presence of the media is seek in the interviews in order to promote the services of the hospital. Initially we subscribed a cooperation agreement with the medical services of the FD. After the research and diagnosis were consolidated and as a result of the work for harmonizing actions in 1988 the government of the state of Querétaro donated a piece of land of one hectare in order that the Institute has its own facilities, being the latter its most representative unit. The hospital was inaugurated in 1995. The construction was possible due to the cooperation of private persons, companies and federal and government entities, as well as the permanent financing campaign the Institute, whose headquarters are in the city of Mexico. It should be remarked that during this stage the founder of the project had a grant from Ashoka. To start the expansion of services, initially in the Bajío and then on national scope, a second organization was founded with the name of Instituto para la Atención Integral del Niño Quemado, Unidad Querétaro, (Institute for integral attention of the burned child, Querétaro Unit) as a civil association.

8) Human resources: The permanent operative group is formed by 26 persons (it should be 104). We have volunteers (an average of 40) that cover the functions of the personnel for which we do not have resources. We also have an average group of 25 social service students by semester.

9) Key operational partnerships: In 2003 we established an alliance with Herseys for a similar program which allowed us a 13% decrease in the incidence of accidents. They included in their promotion of one product ( in self service stores in different cities of the republic) elements for prevention of burns (calendars, games, etc) that we designed. The alliance with the health sector of the Government is indispensable because of regulatory aspects of sanitary type, as well as those imposed to medicine students. Since 2000, we have subscribed an agreement that in turn validates all the agreements made with different academic institutions with the purpose that the studies made with us by students of medicine and nursery have curricular value.

Our principal contributors have been: Rotary Clubs, Embassy of Netherland, Embassy of United Kingdom, United Fund, Government of the State of Querétaro, ITESM, National Lottery, Public Assistance Office Luz Saviñón, National Pawn Shop, Patrimony of Public Welfare Office, SEDESOL, UNAM, Universidad del Valle de México, UAQ, Variety Club, American Refrigeration Mexican Stock Market, Bank of Mexico, CENCADE Danone, Dupont, TELMEX FOUNDATION, Kimberly Clark, Herdez, Hewlett Packard, Mallinckrodt Medical, Nestlé, Smurfit, Carton and Paper of Mexico, Sony of México, UPS

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: • A symbolic recuperation quota is used as per a socio economic study. (We have observed a slower recuperation of children when their family have a distortion derived of a charity vision. Absence, not keeping appointments and abandonment of treatment is more common in those that do not pay the recuperation quota. These quotas are not even 2% of the financial needs of the organization. As from the beginning of the medical architectonic project of the Querétaro hospital a self sustainability strategy included areas of peripheral health namely: pediatric ambulatory surgery, Xr, Laboratory, Pharmacy (all of those for an open population nor necessarily with burns). Unfortunately we have not been able to secure investors to become associates for handling of these areas

          • Earned incomes as a percentage of operating costs: 2%

          • Other funding sources: • Donations specifically addressed to a program item or a given number of patients in addition to government subsides (17%) and the operation of peripheral services

          • Strategy for long-term sustainability: • The sustainability for the prevention program basically depends on the possibility of creating a seed fund from which products derive permanent actions.

11) Current and Future Impact

          • Total number of clients: 100,000

          • Clients in the past year: 25,000

          • Percentage of low-income clients: x

          • Impact: • Last year we had in the accidents prevention program 3,400 direct beneficiaries. The replication in the community of what was learned is estimated in 10,000. • The annual average of beneficiaries during the last four years in the prevention program is 20,000 personas. We can duplicate this target if we have the resources as we have more conscience regarding the risk of burns and the possibility of avoiding them.

          • Overall "market": • Child population of the area which we intend to target is approximately 13 million persons. We would train promoters of prevention in Latin American countries if they are in the position of attending some of our courses.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: • We are in the expansion phase. Sustainability basically depends in the case of the hospital from finding possible associates for the project to operate in the areas already described and in the prevention case through the creation of a seed fund from which permanent actions will derive.

13) Policy change: Public policies should avoid as much as possible that this type of projects turn into “clientelares”. Even though we internally have a clear vision of sustainability we do believe there is the need of revising with the help of new participants, the operation projects of areas that might be of joint administration in order to generate a new synergy that allows convening other persons with social responsibility. From this revision it should be generated the updating of programs for: performing ambulatory surgery or short pediatric permanence, use of doctor’s offices by volunteers of health sector that become financial contributors, use of the kitchen space for similar projects as feeding children with malnutrition problems, nutrition advise to population in general, offer of low cost medicines and alternative products, operation of the diagnosis areas located in external consultation, etc

14) Origin of the initiative: 23 years ago the Institute for the Integral Attention of the Burnt child was founded in the City of Mexico as an institution of private assistance with the mission of providing a high quality integral attention to children affected by burns in order to rescue boys and girls that are victims of burns; 3 objectives were stated to contribute to the solution: Lilia Cisneros Luján. Bachelor of Law, college graduate from the Autonomous University of Mexico. Se studied locution. Se has participated in seminars to stimulate the Development of the Human Element, Managerial Effectiveness and in the Social Formation areas in Mexico, the United States, England and Greece.

Contact Information:
Manuel  Salgado Martínez
Ashoka Fellow
Director of the Queretaro hospital
Instituto para la Atención Integral del Niño Quemado Unidad Querétaro A.C.
(NGO)
Julio María Cervantes 105, Colinas del Cimatario, Querétaro Querétaro
Mexico
Tel: 01 44 2 22357 07
Fax: 01 44 2 2235708
Email: direccion@iainq.org.mx
Website: www.iainq.org.mx