Approach to Implementation Phila Mntwana Approach to Implementation

KZN POPULATION PYRAMID

Progress in reducing NNMR & U5MR Lancet 2005; 365, 1891 - 900

In KZN ... 1 in 20 children die before their 5th birthday Of these… 38% die outside the health service 55% die in association with HIV 33% have underlying severe malnutrition

Age distribution of under 5 deaths

Aim of Phila Mntwana To Reduce morbidity and mortality from preventable conditions: HIV, Pneumonia, diarrhoea and malnutrition

Objectives of Phila Mntwana To provide comprehensive prevention and health promotion package for children at community level. To provide the community leadership and War Room members with a simple diagnosis of the status of the children in the community, so that corrective measures may be taken when necessary. To monitor the Nutritional and Health Status of all Children under 5 years at community level on a monthly basis. To ensure early identification of children with malnutrition, diarrhoea, TB and other health conditions as early as possible and to refer for health care. To identify children who require referral for government To improve access to preventative health services: Growth Monitoring; Oral rehydration, Breastfeeding and Immunization.

Child Mortality: Growth Monitoring: Mid Upper Arm Circumference (MUAC) Tape– early detection of underweight children or weighing where applicable Effective recognition of sick / malnourished children in the community (OSS). SASSA/ DOH/ DSD Cooperation on Malnutrition – referral of children with malnutrition for social relief intervention

Child Mortality: Oral Rehydration To prevent dehydration from diarrhoea, sugar/salt water solution is best for rehydration CCGs have been trained to educate all mothers and caregivers CCGs also have ORS for rehydration prior to referral

Breastfeeding New Infant and Young Child Feeding (IYCF) in the Context of HIV Policy launched October 2010 – Full implementation 1 July 2011 BREAST IS STILL BEST Support for appropriate infant and child feeding and nutritional counselling One-home-one garden

Wellness Immunization EPI Screening and /or referral and other Health Services for children under 5 years   Wellness Vitamin A supplementation to children 12 – 59 months administered 6 monthly HIV counseling and referral TB screening and/or referral DSD (social worker) referral for further assessments and intervention

Location The location of the “PHILA MNTWANA CENTRE” will be dependent on the decision by the local leadership as part of the OSS operations in the ward. The location will include but not limited to the following structures: War Rooms Early Childhood Development Centers (ECDs) Elderly Luncheon Clubs Any other point in the ward depending on the catchment population under 5 years and the accessibility based on geographical size of the ward N.B. Each “PHILA MNTWANA CENTRE” should be linked to a local PHC facility or mobile team

Site Preparation a. Site assessments for preparedness Site assessment visits should be conducted to assess feasibility prior to implementation, using War Room Assessment Tool. b. Leadership and Community Mobilization Intensive community education and mobilization is key to the success of the sites. They must be sensitized in terms of the nature of the services to be provided, the importance of monthly monitoring of the growth of the child and importance of keeping the children healthy at all times. c. Referral Systems Assess referral systems that are in place within the wards so that these systems are enhanced to ensure children with nutritional and health problems are detected and referred early. Existing CCG referral forms should be used for referral purposes from community to PHC facility.

Staffing and Supervision CCGs will be responsible for staffing the “PHILA MNTWANA CENTRES” CCGs will rotate daily to ensure that at all times serves are provided. The CCG Facilitator will be responsible for staff rotation rooster CDW as per existing role of coordination Supervision and Support The CCG supervisors and CHF’s will supervise and monitor the activities conducted by the CCGs In the wards with Family Health Teams (FHTs), the Team will support the CCGs with all the activities in the “PHILA MNTWANA CENTRES”

Resources •Table •Chairs •MUAC Tapes Baby weighing Scales (where available) •Vitamin A supplements •Site register (exercise book) •Health Education book •Log Book (exercise book) •Growth Monitoring wall chart •Sugar and Salt solution/ORS sachets •1 Litre container (eg juice bottle) •Posters •IEC material •Condoms (male and female) •Condocans

OSS Objectives for Phila Mntwana Launch Phila Mntwana in all functional War Rooms or at a suitable site that can be opened 5 days a week Utilise the OSS Structures to mobilise the community to access preventative maternal and child health services at the Phila Mntwana sites Utilise the War Room Task Team to provide transversal, integrated and comprehensive services to mothers and children Ensure the War Rooms that provide Phila Mntwana services are fully equipped with the necessary furniture, materials and IEC material

OSS Objectives for Phila Mntwana (cont) Ensure with the PHC Facility and DSD that a CCG is rotated at a Phila Mntwana site Profile household in the case where a malnourished child is identified Train Integrated CCG on the CCG Foundation Course Monitor, evaluate, provide feedback and track service delivery

Phila Mntwana Poverty Package If child malnourished, Profile Household at the Phila Mntwana site Refer to DSD for assessment and referral to SASSA ‘s for 6 month social relief Refer to Department of Agriculture for food security, gardening, income generation Refer to Department of Education if child in ECD or school-going Refer to PHC facility for health services Refer to DSD for social services SASSA/DSD for social relief – malnourished children

Provincial Training of Integrated CCGs

Ten-Day Integrated CCG Foundation Course Training Modules Module 1 Role of the CCG Module 2 Healthy Living Module 3 Maternal, Child & Women’s Health Module 4 Infectious Diseases Module 5 Chronic Conditions Module 6 Community Care & Support The ten day Integrated CCG foundation is made up of 7 modules, the role of the CCG in Sukuma Sakhe, Healthy Living, Maternal Child Women’s Health and Nutrition, Infectious Diseases, Chronic Conditions and Community Care and Support. The content for all materials were provided by the DoH and the DSD. CCGs are already trained in child health services. Note: Materials supplied by Department of Health and Department of Social Development

Training of CCGs on the Integrated CCG Foundation Course All CCGs in Ugu and uThungulu already trained in maternal and child health services Sisonke, Umkhanyakude, eThekwini, UMgungundlovu, Amajuba and iLembe starting soon Uthukela, Zululand, Umzinyathi still to be prioritised The purpose of the integrated CCG Foundation Course is to: Provide CCGs with foundation knowledge on health and psycho-social topics to support an integrated scope of practice Provide CCGs with appropriate and relevant tools to assist them in the transfer of knowledge and to enable them to screen and refer citizens to appropriate services Provide CCGs with skills development to perform their integrated scope of practice

Components of the Integrated CCG Foundation Course MATERIALS AVAILABLE IN ENGLISH AND ISIZULU OSS Backpack Learner Guide Household Guide Screening Tools Household Profiling Tool Stationery The training materials are made up of the OSS Backpack, Learner Guide, Household Guide, Screening Tools, Household Profiling Tool Stationery and demonstration tools

Immediate Next Steps DTT through the structures, promote Phila Mntwana using this PowerPoint Presentation DTT to work with LTT and WTT to develop an Implementation Plan (Implementation Plan Template will be distributed for guidance) District Implementation Plans to be presented to next PTT WTT, LTT and DTT reports to include Phila Mntwana services