1. 15 Nov 2011Regional CH Meeting, Kathmandu1 Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011 Progress in Implementation of Child Health Programme Country: Sri Lanka Dr. Neil Thalagala (MBBS,MSc,MD) Programme Manager Early Child Developement & Special Needs Family Health Bureau, Ministry of Health

2. 15 Nov 2011Regional CH Meeting, Kathmandu2 Sri Lankan Child Health Program Tertiary Care Hospitals (curative) Secondary care hospitals (curative) PHC Preventive Primary care hospitals (Curative) National Child Health program (Design, M&E @ Central ) Community based care (Implementation) LRH (1) TH(16), PH (12), BH (44) Total 72 DH (161) PU (95) RH(182) CD&MH(59) CD(441) Total 938 MOH teams (329) DISTRICT COORDINATORS MOMCH (25) 329 divisions

3. Sri Lankan Child Health System 25 Administrative District 329 Health Districts (MOH AREAS ) FURTHER DIVIDED IN TO 6690 PHM AREAS

4. PHM AREA FOR 3000 PEOPLE EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS IN THE COUNTRY 1000-3000 births year 5000 to 15000 Under 5 children MOH (1-2) PHNS (2) SPHI (1) SPHM (2) PHMS(15-25) PHIS (10-15)

5. PHM AREA FOR 3000 PEOPLE EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS IN THE COUNTRY

6. Secondary/ /Tertiary care Hospitals 15 Nov 2011Regional CH Meeting, Kathmandu6

7. 15 Nov 2011Regional CH Meeting, Kathmandu7 Nuwara Eliya, Hatton 376878 Badulla 161269 Rathnapura 102384 Kandy 92869 Galle 17257 Total 806128 806128 18,797,252 4.29% Under estate health program PHDT ESTATE SECTOR POPULATION

8. 15 Nov 2011Regional CH Meeting, Kathmandu8 SPR

9. Epidemiology / burden of childhood diseases: 15 Nov 2011Regional CH Meeting, Kathmandu9 Under 5 mortality 1992-2007

10. Epidemiology / burden of childhood diseases: 15 Nov 2011Regional CH Meeting, Kathmandu10 Under 5 mortality =10.4

11. 15 Nov 2011Regional CH Meeting, Kathmandu11 Epidemiology / burden of childhood diseases:

12. LBW 15 Nov 2011Regional CH Meeting, Kathmandu12

13. 15 Nov 2011Regional CH Meeting, Kathmandu13 Epidemiology / burden of childhood diseases: Causes of IMR2009% IUGR, Prematurity and LBW60921.7 Congenital malformations50718.1 Birth asphyxia / Intrauterine hypoxia44315.8 Other Perinatal causes41714.9 Septicaemia / Meningitis2278.1 Pneumonia1384.9 Other respiratory disease371.3 Malignancies130.5 Diarrhoea and Gastroenteritis20.1 Other / Un specified41214.7 Total2805100.0

14. IMCI Implementation IMCI WAS NOT ADAPTED AS A GENERIC PACKAGE LIMITED APPLICATION DEVELOPMENTOF STANDARD GUIDELINES FOR MANAGING COMON ILLNESSES TRAINNED ONLY Estate Medical Assistants

15. 15

16. Newborn health ENCC Course adapted: Year 2007 Other training courses: –Neonatal Advanced Life Support Course (One day) –Breastfeeding Promotion and Support in a Baby Friendly Hospital A 20 hour course for maternity staff –WHO/UNICEF 40 hour Breastfeeding Counseling Course

17. Newborn Health Healthcare Providers Total No.No. Trained% Medical Officers including Pediatricians (60) and Obstetricians (3) 81052564.8 Nurses252654521.5 Midwives268452519.6 Volunteers--

18. 15 Nov 2011Regional CH Meeting, Kathmandu18 In-Patient (Hospital) care of sick newborns and children NOT ADAPTED

19. Special need program National Strategic plan for special need children developed Community based parent mediated model for children with special needs being piloted PHC training program was developed PHC workers in Colombo and Puttlum district trained A model EDC is being established 15 Nov 2011Regional CH Meeting, Kathmandu19

20. CFD interventions for all by parents 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24……………60 Age in months Birth cohort 375000 Developmental screening By parents using ECDS By PHC workers using a developmental scale designed for Sri Lanka Delays & Deviations < 18 months Non Specific Early Interventions by parents supervised by PHC workers Special need interventions by parents / PHC workers / therapists jointly Special need screening for ASD / CP etc… > 18 months

21. Screening by mothers/PHC MOH Assessment & Follow up Parent education Parent counseling Early intervention center Home Clinic Pre school Training of parents care givers on intervention Function as a day care center Staff training Parent mediated intervention Case management model

22. 15 Nov 2011Regional CH Meeting, Kathmandu22 CHW approach for care of sick newborns and children District implementing CHW approach Total No. of Distt Implementing Districts % Home based newborn care 0 Sick child package0 Healthy child package (ECD) 251768 Any review of the experience Currently being done

23. Child Health Indicators Neonatal Mortality Rate Infant Mortality Rate Perinatal Mortality Rate Under five Mortality Rate % Infant registered % infants visited at home by area PHM % infants attending CWC Low birth weight index % weighing % moderate underweight % severe underweight % overweight Immunization coverage Infant Preschoolar 1-2 yrs & 3-5 yrs

24. 15 Nov 2011Regional CH Meeting, Kathmandu24 Future Plans Strengthening and scale-up plans for Next 2 years IMCI: Capacity development OPD staff/N&E Develop national strategic plan on Child Health Develop NSP on IYCF Completion of adapting & systematizing of SPR on MCH & FP Healthy Child (ECD) package: Being scaled up to N&E Capacity development of health care workers on ENCC and BFHI and LM Evaluation of impact of ENCC training Quality assurance system for newborn care introduced

25. 15 Nov 2011Regional CH Meeting, Kathmandu25 Future Plans Strengthening and scale-up plans for Next 2 years Scaling up of NSP on special needs Develop and implement a Surveillance system on child mortality and establishment of a child death review system

26. 15 Nov 2011Regional CH Meeting, Kathmandu26