Transcript Going to scale: Experience with Community IMCI Meeting of RBM and IMCI Task Forces 24th–26th September 2002 Harare, Zimbabwe Presentation by IMCI AFRO IMCI Unit AFRO.

Going to scale:
Experience with Community IMCI
Meeting of RBM and IMCI Task Forces
24th–26th September 2002
Harare, Zimbabwe
Presentation by IMCI
AFRO
IMCI Unit AFRO
Community IMCI
… is an integrated child care approach that
aims at improving key family and
community practices that are likely to
have the greatest impact on child survival,
growth and development
IMCI Unit AFRO
WHY SHOULD WE FOCUS
ON THE HOME?
• Healthy life style starts at home
• Home is where treatment of sick children start
using locally purchased medicine
•
A big segment of the population in developing
countries do not have access to health facilities
• Even where access to health facilities is
reasonably good, most children die at home
without seeking any health care outside the home
IMCI Unit AFRO
IMCI Key Family and
Community Practices
– documented/greatest impact on
mortality
– feasible to implement in countries
– Cost-effective
– address major problems on child health,
nutrition and development
– Focus on behavior change
IMCI Unit AFRO
Key Family Practices
Growth Promotion &Development
•Exclusive breastfeeding for 6m
•Appropriate complementary feeding from 6m whilst
continuing BF up to 24m
•Adequate micronutrients through diet or supplementation
•Promote mental and psychosocial development
Home Management
•Continue to feed and offer more food & fluids when child
sick
•Give child appropriate home treatment for infections
•Take appropriate actions to prevent and manage child
injuries and accidents
IMCI Unit AFRO
Key Family Practices..contd.
Disease Prevention
•Proper disposal of faeces, hand washing etc
•Child sleeps under ITN
•Prevention and care of HIV/AIDS
•Prevent child abuse/neglect & taking appropriate action
Care Seeking & Compliance
Take child to complete full course of immunization
before 1st birthday
Recognize when child needs treatment outside home and
take to HW
Follow HW advice about treatment, FU and referral
ANC attendance and TT vaccination during pregnancy
Active participation of men in childcare and reproductive
health activities
IMCI Unit AFRO
Countries with c-IMCI
Orientation Meeting
•Common
understanding
•Share information
•Identify stake
holders
•Consensus on way
forward
IMCI Unit AFRO
COUNTRIES WITH PLAN FOR C-IMCI
•Planning at
national and
district levels
•Partners
collaboration in
planning
IMCI Unit AFRO
To understand
the current
situation at
district and
national levels
Revise policy
and guidelines
C-IMCI
SITUATION
ANALYSIS
(11 countries)
IMCI Unit AFRO
Identifying the various
partners and planning
together
Sharing of
experience
Breastfeeding Indicators (%)
120
100
80
60
40
20
0
DRC
Uganda
Tanzania
Exclusive breastfeeding <4m- 6 Months
Source
Uganda DHS 2000
Mixed feeding 6-9m
Tanzania MCE HH Survey 1999
Breastfeeding at 1y
DRC Situational Analysis 2002
IMCI Unit AFRO
Use of mosquito nets
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Ever-treated net
DRC
Tanzania
Uganda
Source
Uganda DHS 2000
Tanzania MCE HH Survey 1999
DRC Situational Analysis 2002
IMCI Unit AFRO
Management of sick children at home
60%
50%
40%
30%
20%
10%
0%
Morogoro
Sick child given food &
more fluids (n=206-258)
Febrile child given
antimalarial (n=155-199)
IMCI Unit AFRO
Rufiji
Ulanga
Kilombero (R)
Comparison of IMCI: non IMCI
logistic regression with adjustment for clustering
Sick child given food & more fluids: p=0.25
Febrile child given antimalarial: p=0.15
Regional level support
•Development of Briefing Package for planning of C-IMCI
Developed for use by facilitators/ consultants who
would assist countries in the planning for c-IMCI
•Pre tested in Benin in February 2002
•Field test conducted , 15 countries (10
Anglophone and 5 francophone) involved
•Revision to be done in early October
• Manual on the recommendation for home care
•CHW’s training manual Other materials to be developed
IMCI Unit AFRO
Situation analysis
Community and community
interventions
What does the community have?
-Practices
-Community health services
-Resources
-Previous/existing interventions
-Others sectors
-Links with the health system
What does the community know?
-Information
-Knowledge
What are the community needs?
Opportunities
Constraints
C-IMCI Briefing
Package
Selection of
priority practices:
-Effective
-Feasible
-Pertinent
-Acceptable
-Cost effective
IMCI/Child Health Strategy Document
Strategic Plan for IMCI/Child Health
IMCI Unit AFRO
Community IMCI : Implementation Status
Countries with
child health
related
community
interventions
Countries with C-IMCI
in more than 3 Districts
IMCI Unit AFRO
KEY FACTORS FOR SCALING
UP C-IMCI : LESSONS LEARNT
•Advocacy and Resource Mobilization
• Showing Impact
•Partnership
•Documentation and sharing of experience
•Building on existing structures
(and not substituting community resources)
IMCI Unit AFRO