Household & Community IMCI Household & Community IMCI The Child Survival Collaborations and Resource Group A Global Framework built with Local Know-How Courtesy of PCI Courtesy of LifenetsI Courtesy of Microsoft Courtesy of OFDC Courtesy of UNICEF

Defined Investments $$ Materials Defined Materials ? Undefined Little investment $$ Few Materials The 3 Components of IMCI

The HH/C IMCI Timeline: 1992 WHO/UNICEF LAUNCHES IMCI Early efforts focus on Health worker skills and system improvements Santo Domingo Meeting recog. Importance of HH/C-IMCI Sept. ‘97 Oct. ‘97 UNICEF Meetings with NGO particip produces mandate for HH/C IMCI IAWG estab with UNICEF leadership to develop HH/C- IMCI guidelines Feb. ‘ CORE IMCI WG dedicates focus on HH/C IMCI agenda CORE Mtg. at PAHO acknowledging role of NGOs in advancing HH/C IMCI Feb. ‘99 Durban Mtg consensus on 16 key practices and role of HH/C IMCI in promoting them Jun. ‘00

Reaching Communities for Child Health: Advancing PVO/NGO Technical Capacity and Leadership for Household and Community Integrated Management of Childhood Illness (HH/C IMCI) Baltimore, Maryland USA January 17-19, 2001 BASICS II CSTS

Who the participants were… Non-Governmental Organizations Project HOPE CRS World Vision Project Concern International Medical Care Development Hellen Keller Andean Rural Health Care PLAN Counterpart International International Rescue Committee CARE Minnesota International Health Volunteers ADRA Salvation Army Save the Children Christian Children’s Fund Aga Khan Foundation Health Alliance International Pearl S. Buck International Public Health Specialists BASICS CSTS Environmental Health Project University Research Center Johns Hopkins School of Public Health AED John Snow MOST World Education DISH Donor Organizations USAID WORLD BANK UN Organizations UNICEF WHO PAHO

From all around the world… Nicaragua Uganda Kenya Argentina Peru Honduras United States Canada Rwanda Uzbekistan Philippines Nepal India Indonesia Vietnam

3 Important Resources were used… The 4 Intervention Options for HH/C IMCI By Peter Winch 18 Presentations on community strategies that have had an impact on child health The expertise of 120 participants

In defining a framework the following questions were important to consider… 3) What are the roles of MOH, PVOs, NGOs and donor community in HH/C IMCI? 1)How will HH/C IMCI be different than what we are doing now? 2) What will be the relationship between the HH/C IMCI and the other two components?

The Outcome… The driving force of the workshop, and one of its most promising outcomes, was the evolution of a consensus that articulates a clear vision and dynamic framework for community IMCI. It provides governments, NGOs and communities alike with a clear structure for assessing programs, for future programming, and for advocating for resources necessary to fully operationalize HH/C IMCI.

Element #1: Element #1: Improving partnerships between the facilities and the communities they serve Courtesy of FAO

Element #1: Element #1: Improving partnerships between the facilities and the communities they serve Clinic to community Outreach skills Interpersonal counseling Quality of health services Community to clinic Awareness of health services Appropriate and timely use Community management Health information systems Courtesy of Desert Margins Program

Element #1 Examples Joint village level outreach by community and facility-based providers Collaborative oversight, management and supervision of health services by community committees Joint collaboration on community-based health information systems

Element #1: Element #1: Improving partnerships between the facilities and the communities they serve Potential Roles: Ministry of Health Improved service provider and partner NGO Skills building (clinic and community); facilitators; designers of community- based HIS Community Service user and partner; provider of community health information Bi/Multi-lateral Agencies Advocate for and fund partnership development activities; Research successful strategies

Validating Questions for Element #1: of IMCI f Have mechanisms been created to formalize community involvement in facility-level management decision-making? Have programs assessed and attempted to improve service quality and demand based on client feedback? Does substantive information sharing between the community and facility occur that affects how and what kind of services are provided? Element #1: Element #1: Improving partnerships between the facilities and the communities they serve How do we know if we are implementing Element 1?

Element #2: Element #2: Increasing appropriate and accessable health care and information from community- based providers Courtesy of PLAN

Element #2: Element #2: Increasing appropriate and accessable health care and information from community- based providers Community-Based Providers Community Health Workers Private providers Traditional Healers Traditional Birth Attendants Shopkeepers/Drug sellers Pharmacists Health Care Direct Treatment Pre-natal care Immunization Health Surveillance Referral Health information Behavioral Change Communication (BCC) Counseling Awareness Advocacy

Element #2 Examples Training of pharmacy personnel to reduce overuse of antibiotics or to correctly prescribe anti- malarials Implementation of mini-pharmacy kits managed by community agents Training of CHWs in case management / counseling using simplified IMCI algorithm

Element #2: Element #2: Increasing appropriate and accessable health care and information from community- based providers Potential Roles: Ministry of Health Supervision, support and training NGO Trainers, facilitators, service providers Community Determines service providers, supervises, compensates, complies with counsel Bi/Multi-lateral Agencies Advocate for and fund element 2 activities as a part of HH/C IMCI

Validating Questions for Element #2: of IMCI f Are you or your partners working with community providers to help them expand and improve the following services in the community? appropriate front-line care appropriate front-line care referralreferral surveillancesurveillance health informationhealth information Element #2: Element #2: Increasing appropriate and accessable health care and information from community- based providers How do we know if we are implementing Element 2?

Element #3: Element #3: Integrating promotion of key family practices for child health and nutrition

A) For physical growth and mental development B) For disease prevention C) For appropriate home care D) For seeking care

Element #3 Examples Promoting key health messages through various strategies, such as: communication and behavior change efforts in malaria prevention (ITNs) Rehabilitating malnourished children and preventing future malnutrition through the PD/Hearth approach Promoting access and use of ORS for diarrhea Participatory assessments to promote community input into health behaviors to be promoted

Element #3: Element #3: Integrating promotion of key family practices for child health and nutrition Potential Roles: Ministry of Health Organize national messages, Educates and counsels in clinic NGO Facilitates identification of priority behaviors, helps adapt and deliver messages via appropriate mechanisms Community Determines priority behaviors, helps identify appropriate ways of communicating message Bi/Multi-lateral Agencies Advocate for and fund element 3 activities as a part of HH/C IMCI

Validating Questions for Element #3: of IMCI f Element 3: Are you or your partners helping families to employ key family practices through effective social and behavioral change strategies? Element #3: Element #3: Integrating promotion of key family practices for child health and nutrition How do we know if we are implementing Element 3?

Multi-Sectoral Platform The focus of the multi-sectoral platform is similar to addressing primary health (Alma Alta): –Water and Sanitation –Education –Income generation –Agriculture

Multi-Sectoral Platform Examples tend to fall in one of three categories CONDUIT FOR TRANSFERRING IMPORTANT HEALTH MESSAGES TO THE COMMUNITY AND FAMILY #1#1

Multi-Sectoral Platform Examples of this would be... Incorporating handwashing messages into water and sanitation programs Building preventive messages on HIV/AIDS into a credit program Training agricultural extensionists to promote proper weaning foods Using schools to train students as youth community health promoters

Multi-Sectoral Platform #2#2 ALLIGNING DIFFERENT SECTORS TO ADDRESS BARRIERS TO CHANGE FOR KEY HEALTH PRACTICES

Multi-Sectoral Platform Examples of this would be... Increasing water and sanitation programs to address preventable causes of diarrhea Mobilizing income generation efforts to break down the economic barrier to ITN purchase

Multi-Sectoral Platform And... #3 MULTI-STAKEHOLDER PLANNING

Validating Questions for MSP: of IMCI f Are you or your partners working with or through other (non-health) sector entities in ways that improve child health? How do we know if we are optimizing the MSP? Multi-Sectoral Platform

Frequently Asked Questions How does HH/C IMCI link with facility-based IMCI? How can you apply HH/C IMCI without a health facility?

Frequently Asked Questions Do you really need all the elements and the MSP? How do they link together?