imci unit afro going to scale: experience with community imci meeting of rbm and imci task forces 24...
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IMCI Unit AFRO
Going to scale: Experience with Community IMCI
Meeting of RBM and IMCI Task Forces
24th–26th September 2002Harare, 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
– 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 Key Family and Community Practices
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
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Key Family Practices..contd.
Care Seeking & ComplianceTake child to complete full course of
immunization before 1st birthdayRecognize when child needs treatment outside
home and take to HWFollow HW advice about treatment, FU and
referralANC attendance and TT vaccination during
pregnancyActive participation of men in childcare and
reproductive health activities
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
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Countries with c-IMCI Orientation Meeting
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•Common understanding
•Share information
•Identify stake holders
•Consensus on way forward
IMCI Unit AFROIMCI Unit AFRO
COUNTRIES WITH PLAN FOR C-IMCI
•Planning at national and district levels
•Partners collaboration in planning
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C-IMCI SITUATIONA
NALYSIS
(11 countries)
To understand the current situation at district and
national levels
Sharing of experience
Identifying the various partners and planning
together
Revise policy and guidelines
IMCI Unit AFRO
Breastfeeding Indicators (%)
0
20
40
60
80
100
120
DRC Tanzania Uganda
Exclusive breastfeeding <4m- 6 Months
Mixed feeding 6-9m
Breastfeeding at 1y
Source
Uganda DHS 2000
Tanzania MCE HH Survey 1999
DRC Situational Analysis 2002
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Use of mosquito nets
0%2%4%6%8%
10%12%14%16%18%20%
DRC Tanzania Uganda
Ever-treated net
Source
Uganda DHS 2000
Tanzania MCE HH Survey 1999
DRC Situational Analysis 2002
IMCI Unit AFRO
Management of sick children at home
0%
10%
20%
30%
40%
50%
60%
Morogoro Rufiji Ulanga Kilombero (R)
Sick child given food &more fluids (n=206-258)
Febrile child givenantimalarial (n=155-199)
Comparison of IMCI: non IMCIlogistic regression with adjustment for clusteringSick child given food & more fluids: p=0.25Febrile child given antimalarial: p=0.15
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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
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OpportunitiesConstraints
Selection of priority practices:-Effective -Feasible-Pertinent-Acceptable-Cost effective
Com
mu
nit
y an
d c
omm
un
ity
inte
rven
tion
s
What are the community needs?
What does the community know?-Information-Knowledge
What does the community have?-Practices-Community health services-Resources-Previous/existing interventions-Others sectors-Links with the health system
IMCI/Child Health Strategy DocumentIMCI/Child Health Strategy Document
Strategic Plan for IMCI/Child HealthStrategic Plan for IMCI/Child Health
Recommendations on Priority practices
StrategyDocument for the
C-IMCI
Sit
uat
ion
an
alys
is
C-IMCI Briefing Package
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Community IMCI : Implementation Status
Countries with child health
related community
interventions
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Countries with C-IMCI in more than 3 Districts
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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)