2OverviewOur training uses malaria as a foundation for integrated community case management (iCCM) and community-directed intervention (CDI), but in other countries/areas other combinations of package components may be more appropriate for starting out
3Module 5 Objectives By the end of this module, learners will: Name components of a Malaria Plus Package (MPP)Describe key household and community practices that impact child growth promotion and developmentList steps and activities for disease prevention at the home/community level to reduce illnesses and deathsExplain home management of malaria-related diseases (e.g., diarrhea, chest infection, malnutrition, anemia)List activities to promote care seeking and compliance with healthy practices
4A Malaria Plus Package … … starts with preventing and treating malaria services, but then:Strengthens the health system to improve delivery of a variety of community interventionsExpands the capacity of the Ministry of Health (MOH) and the local government authorities in the target states/municipalities, to deliver an integrated package to the communityProvides appropriately tailored support to the states/municipalities to help them improve their planning, implementation, coordination and supervision capacities for the integrated package
5Malaria Plus Includes … Increasing access to, and utilization of, preventive measuresExpanding access to, and utilization of, effective diagnostic and treatment servicesStrengthening community mobilization and communication for behavior changeImproving state-/municipality-specific monitoring and evaluation (M&E) for evidence-based managementStrengthening partnerships for resource mobilization and implementationEnhancing capacity of the states/municipalities for oversight and project coordination
6Three MPP Delivery Channels/Links Family-oriented, community: Home management of childhood illness; health-promoting activities like exclusive breastfeeding, long-lasting insecticide-treated net (LLIN) use, intermittent preventive treatment in pregnancy (IPTp)Population-oriented outreach and schedulable services: Delivery of health services (e.g., through a Child Health Week in collaboration with partners)Individual-oriented clinical services: Facility-based care available on a 24-hour basis to deliver routine services and manage severe illness
7Our Focus in CDIWe are focusing on the family/community channel for CDIKey household and community practices are a set of practices that—when combined—have the greatest impact on child survival, growth and developmentThese key practices can prevent a variety of health problems, not just malariaFamilies play a very significant role in the growth and development of their children as well as in the well-being of mothers
8Role of Families and Communities Caregivers need knowledge and skills in key household and community practices that have the greatest impact on the well-being of mothers and childrenThe purpose of this module is to outline contents for training community-directed distributors (CDDs)/community-oriented resource persons (CORPs) to promote the key household and community practices
9Why Malaria Plus Packages? The majority of children die at home in spite of the availability of health servicesMany children die from other malaria-related diseases (e.g., diarrhea, chest infection, malnutrition, anemia)Initial care (whether using orthodox or traditional medicine) takes place in the familyFormally trained health workers are usually either inaccessible or unavailableFeasible interventions that can significantly reduce illness and death exist, and can be practiced at home/in the community
10Examples of Good Practices Appropriate breastfeeding can reduce childhood illness by 10%Good hygiene practices can reduce childhood illness by 10%Improved complementary feeding can prevent death from malnutrition, diarrhea, measles, etc.
11Household PracticesThe key household practices can be grouped into four broad clusters:Growth promotion and developmentDisease preventionHome managementCare seeking and complianceCan you name these practices and the services the community can provide to foster these practices?
12Growth Promotion and Development Exclusive breastfeeding: Feeding a baby with only breast milk, not even water, from birth until six months of ageComplementary feeding: Feeding children with freshly prepared energy- and nutrient-rich complementary foods, beginning at six months of age, while continuing to breastfeed up to two years or longer
13Growth Promotion and Development (continued) Micronutrients and diet supplementation: Ensuring that children receive adequate amounts of micronutrients (vitamin A, iron, iodine and zinc in particular), either in their diet or through supplementationGrowth monitoring: A process of weighing a child at intervals, charting the weight on a child health card and showing the mother whether the child is doing well or not
14Growth Promotion and Development (continued) Promoting mental and psychosocial development: Providing children with a stimulating environment to achieve optimal development later in lifeBirth registration: The official recording of the birth of a child with the National Population Commission
15Disease PreventionProper feces disposal and handwashing: Disposing of feces, including children’s feces, safely; and washing hands with soap after defecation, before preparing meals and before feeding childrenProtecting children and pregnant women in malaria-endemic areas, by ensuring that they sleep under insecticide-treated netsPreventing HIV and caring for people living with HIV/AIDS (PLWHA): Providing appropriate care for HIV/AIDS-affected people, especially orphans, and taking action to prevent further HIV infections
16Disease Prevention (continued) Preventing child abuse and neglect, and taking appropriate action:Taking action to prevent child abuseRecognizing child abuse when it has occurred and taking appropriate action
17Home ManagementPreventing and managing child injuries by taking appropriate action:Keeping the home environment tidy and free of objects that may cause accidents among childrenPreventing and providing appropriate treatment for child injuries
18Home Management (continued) Giving appropriate home treatment for infection:Beginning appropriate home management of diarrhea immediately to prevent dehydrationGiving salt sugar solution or drinking water in addition to breast milk if the child is still exclusively breastfedContinuing to feed and offering more food and fluid when the child is sick, including breast milkTaking the child to a health facility immediately if the child has any of the following signs:Is not able to drinkDevelops a feverIs getting worsePasses blood in stool
19Home Management (continued) Taking all children with a cough to a health facility where the cough will be properly assessed and treated Also, taking all children to a health facility for assessment if they develop any of these signs:Breathing is fastBreathing becomes difficultChild is not able to drinkChild is getting worse
20Care Seeking and Compliance Immunization: Ensuring that every child completes the full course of routine immunization five times before the child’s first birthdayAlso, ensuring that, from the age of six months, a child receives vitamin A supplementation and deworming tablets every six months until the child reaches five years of age
21Care Seeking and Compliance (continued) Recognizing when a child needs treatment outside the home, and seeking care from appropriate providers:Taking the child with severe illness to the health facility immediately to save the child’s lifeFollowing the health worker’s advice on treatment, follow-up and referral
22Care Seeking and Compliance (continued) Birth preparedness and complication readiness: Getting ready for a baby’s birth and possible problems/dangers that may arise during labor, and taking care of emergencies when they ariseIf a woman is well prepared for normal childbirth and possible complications, she is more likely to receive the skilled and timely care she needs to protect her overall health and the health of her baby
23Care Seeking Family planning using appropriate methods Families that plan and space their children ensure that the pregnant woman:Regains her strength between pregnanciesAvoids frequent exposure to health risksGives birth to children who are strong and healthy
24Avoiding DelaysThree ways of wasting time (delays) may lead to complications and death of a woman and her child:Delay in seeking careDelay in reaching careDelay in receiving care
25Care Seeking and Compliance (continued) Essential community newborn care:Identifying danger signs in newborns and advising to take baby immediately to nearest health facilityEnsuring that mother and baby go back to the health facility within the first week and at six weeks of delivery— and if she delivered at home, ensuring that mother and baby go to the health facility within 24 hoursActive participation of men in child care and reproductive health: Ensuring that men actively participate in the provision of child care and are involved in reproductive health
26MPP-Driven Commodities Examples of commodities that will drive the MPP implementation strategy are:Folic acidFerrous sulfateAnti-helminthicsOral rehydration saltsAntibiotics that are already in the work plan/procurement plan of the participating states/municipalitiesLLINs for mop-up phaseVaccinesNot all commodities will be available through the community channel
27In Your CountryWhat is the package of services and health promotion activities that are provided at the community level through community efforts?How were the components of this package decided?Are there other services that could be added?We have discussed many services (20); so, how do we decide:Which ones to start delivering first?Which ones to train CDDs on first?
28Planning for Malaria Plus Key practicesResources neededSource of assistanceGrowth promotion and developmentDisease preventionHome managementCare seeking and complianceAs a group exercise, fill out this chart—you may substitute a different set of services relevant to your country
29Integration Challenges How can we integrate these additional areas into the training and work of the CDDs/CORPs?What are the cost implications for CDD training and CDD kits?How can we provide integrated supportive supervision for CDDs to implement MPP?What other concerns do you have?
30Summary and Conclusion Key household and community practices have a potential impact on child survival, growth and developmentThe key household and community practices are deployed as part of an integrated maternal, neonatal and child health strategyImproving knowledge about key household and community practices will:Promote survival, growth and development of newborns, children under five years of age and their mothersStrengthen the community management of malaria and related illnessesReduce maternal and child deathsEach MPP must be decided by the country and district concerned