Presentation on theme: "EXPERIENCES IN COMMUNITY IMCI IN SEAR"— Presentation transcript:
1EXPERIENCES IN COMMUNITY IMCI IN SEAR Dr Neena Raina Child and Adolescent Health and Development World Health Organization South East Asia Regional Officer
2Community Health Volunteers IMCI - EVERYWHERE!!IMCIDistrictIMCIHealth FacilityIMCIBasic Health WorkersCommunity Health VolunteersIMCIIMCIFamily/Community
3Are we reaching the unreached through IMCI? Facility based IMCI has limited outreach for sick childrenImproving access to IMCI increases use rateArmy of volunteers available. Need to train in specific tasks to promote child health and developmentCBV will improve care seeking behaviourBangladesh ExampleUpzila Health complex: 200, ,000Doctor, nurseFWVDoctor± MA Union Health & FW : 21,000CentreFWV, HA Community clinics:FWA :TBA,Female union Family :Parishad Member,± local initiative prog.Volunteers.± BRAC volunteers[208,000]11-day11-day6 days5 days?
4DIFFERENCES BETWEEN F – IMCI AND C - IMCI Government/Organized SectorRemuneration/ SalaryNumber manageablePre-service trainingJob description definedIn-service training – 11 dayTraining based on job descriptionDisease focus, Limited Health PromotionCommunity/ FamiliesRecognition/ RewardsNumber large.Limited or No Pre-service TrainingJob expectations varied, determined by community5 day trainingOngoing training neededProfile based (one size will not fit all)Focus on health promotion. Simple treatment of common illness.
5THE NEED FOR TRAINING BHWs The workers have knowledge about diseases and child health but this is superficial.In communication skills, familiarity with the message is present but problem analysis and solution skills are poor.They know many facts but are often confused.Only a few priority problems should be short-listed and addressed.Focus on qualitynot only on quantity
6Training of Basic Health Workers (CHWs) SEAR is first region to develop CHW training package.CHW 5-day training package developed in joint partnership with CARE and GOI.Field tested in 6 states of India. Training package refined after each course. Experience shared during dissemination meeting with other Member Countries.Demonstration model course and orientation in Bangladesh,Nepal,India and Indonesia and adaptation doneMalaria and young infant added for BHW
7Status of BHWs trained Supervisory checklist - Myanmar BHW TOT IndiaNepalMyanmar(IMMCI)Bangladesh -- 24(Demo course)Regional Follow-up after training guidelines developed. Adaptation done in IndiaSupervisory checklist - MyanmarWeak in counting RRchecking chest indrawingVit A deficiency, andchecking BCG scar.
8Anganwadi Anganwadi is the Focal Point for Delivery of ICDS Services. Located in a Village/Slum.Anganwadi is run by an AWW, supported by a Helper.AWW is the 1st Point of Contact for Families ExperiencingNutrition and Health Problems.
9ICDS Packages of Services IMCIICDS Packages of ServicesHealth NutritionImmunization Supplementary FeedingHealth Check-ups Growth Monitoring & PromotionReferral Services Nutrition and Health Education (NHED)Treatment of Minor IllnessesEarly Childhood Care & Preschool ConvergenceEducationOf other Supportive Services, Such as SafeEarly Care and Stimulation for Younger Drinking Water, Environmental Sanitation,Children Under Three Years Women’s Empowerment Programmes, Non-formal Education and Adult Literacy.Early Joyful Learning Opportunities toChildren in the Three to Six YearsAge Group.
10Integrated Child Development Scheme (ICDS) in India Opportunities for community based IMCI
11IMCIThe ProjectThe Pilot Project on IMCI is an action research project.Pilot Project is being implemented in 3 States - Haryana,Rajasthan & Uttar PradeshAction Plan of the project includesTraining of Trainers and AWWsImplementation of IMCI StrategyFollow-up-After TrainingImpact AssessmentAdaptation of IMCI Strategy in ICDS ProgramIntroduce IMCI Strategy in the Job Training Curriculum ofICDS Functionaries.
12CB-IMCI - 1999/2000 Community Level IMCI Program Experiences CB-IMCI Improve pneumonia/diarrheacase management andnutrition and EPI counselingup to community levelIMCIIntegrated Management of5 major childhood killers(pneumonia, diarrhea,measles, malaria,malnutrition) in HFCB-IMCI
14WHO ARE FCHVsLocal Married Women Selected by the Community (by mothers’ group) willing to serve voluntarily in health related activities for and in the community
15TREAT “PNEUMONIA” USING INTERVENTION MODELSHOME CARE ADVICEAND FOLLOWUPTREATMENTCHWs DIAGNOSE ANDTREAT “PNEUMONIA” USINGONLYCOTRIMOXAZOLEREFER “SEVEREPNEUMONIA ANDVERY SEVERE DISEASE”REFERRALREFER ALL PNEUMONIACASES
16COMMUNITY- LEVEL TRAINING ACTIVITIES (1994/95 - 2001/2002) VHW= Village Health WorkersMCHW = Maternal and Child Health WorkersFCHV = Female Community Health Volunteer
22COMMUNITY-LEVEL ORIENTATION ACTIVITIES (1994/95 - 2001/2002) DLL= District Level LeaderLEL = Local Elected Leader
23ACHIEVEMENTS 420,000 pneumonia cases treated in program districts Over 17,000 deaths averted*Over Rs. 167 million saved **The Community-Based IMCI now reaches 35% of the population under 5 years of age.* Meta-analysis of intervention trials on case-management of pneumonia in community settings, Black R. and Sazawal S. assumes 20% mortality reduction for < 1 year olds and 25% mortality reduction for 1-4 years of age** According to A Study Conducted by JSI Caregiver spend Rs. 397/Pneumonia Case
24BUILDING PARTNERSHIPS AT THE COMMUNITY LEVEL Health VolunteersPrivatePractitionersWater and SanitationWorkersTraditional BirthAttendantsAgriculturalWorkersBasic Health WorkerWomen’s GroupsYouth GroupsSocial WelfareOpinion LeadersMother’s GroupsTeachers
26Tapping the vast potential CHALLENGES AHEADKeeping the issue alive and active.Profile based – need based response (Tailor made)Link with Health System. Builds credibility.Partnerships – Public-private mix.Converting knowledge into action (the right mix of Science and Art).Decentralization and capacity development.Resources. Issues of monetary incentives?Tapping the vast potential
28LOCAL PARTNERSHIPS FOR SUCCESS OF IMCI Independently workers or volunteers / traditional providers not effective even after training.Utilization rates are poor.Volunteers / traditional providers may have technical limitations. Together they can be very successful.FCHV referral of sick child successful when traditional healers (Dhamis, Jhakris) convince the family to use referral facility.Trained Midwife is acceptable in providing skilled birth attendance when she teams up with Traditional Birth Attendant.Health volunteer and village practitioners can team up in providing curative care.AWW and RMP can team up to promote exclusive breastfeeding and complementary feeding practices.
29COMPLIMENTARITY OF F-IMCI and C - IMCI F – IMCI falls short in access of IMCI to families. BHWs and CHVs link F – IMCI to families.F – IMCI provides integrated management of selected diseases in children but requires a lot of support from C – IMCI to promote health.C – IMCI can succeed only if well supported by F – IMCI through training, ongoing supplies, logistic support and management.C – IMCI is important for success of F – IMCI through increased demand for appropriate and timely care, improved compliance and participation in immunization and other preventive programmes.C – IMCI can complement F – IMCI by volunteers providing selected IMCI components on health care in areas where F – IMCI falls short because of missing health workers.
30INCREMENTAL BUILD UP OF C - IMCI Develop capacity of local communities through guided education so that they can plan, support and monitor C – IMCI.Plan an incremental, block by block development of capacity through on going training.There cannot be a universal recipe for all CHVs because of their varied background and differing potential and contributions. Each one can provide a piece and for that must be skilled.Logistics and supplies to be ensured with community assuming responsibility at least partly in covering the costs.
31C – IMCI TO BE SUCCESSFUL MUST BE THE RIGHT MIX OF ART AND SCIENCE OF KNOWLEDGE Knowledge which is evidence based and acceptable must be converted to action.Existence of knowledge is of no use unless it is accepted and adopted.Creativity is required in C – IMCI to provide knowledge and promote its widespread use at the community and family level.All knowledge is not evidence based but practices have existed for centuries and longer. If they have not caused harm these need not be discontinued This is the art part of C – IMCI.The programme should find the right mix.