1. Approach to Implementation
Phila Mntwana
Approach to Implementation

2. KZN POPULATION PYRAMID

3. Progress in reducing NNMR & U5MR
Lancet 2005; 365,

4. 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

5. Age distribution of under 5 deaths

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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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”

15. 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

16. 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

17. 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

18. 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

19. Provincial Training of Integrated CCGs

20. 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

21. 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

22. 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

23. 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