COMMITMENT FOR THE INTEGRATED MANAGEMENT OF CHILD HEALTH IMCI IN TUNISIA Intercountry meeting on IMC

1
COMMITMENT FOR THE INTEGRATED MANAGEMENT OF CHILD
HEALTH (IMCI) IN TUNISIAIntercountry meeting
on IMCI sustainability and scaling up September
2003, TunisiaDr Mounira GARBOUJ
2
Surface Area 154530 Km2 General
Population 9 779 000 habitants Birth Rate
16.80 Number of births 163 000
Number of children under five 812 000
Natural growth rate 1.14 Fertility index
2.09 Life expectancy 73 ans
Crude death rate 5.6o
3
INTRODUCTION (1) ? Child Health received a
particular attention from the Tunisian
government.   ?MCH/ FP activities were among
the first preventive activities established in
the country.   ?Programmes addressing different
aspects of child health were implemented
progressively (Immunization CDD ARI Growth
monitoring).
4
INTRODUCTION 2))The impact of this strategic
direction was ? The achievement of the
majority of the objectives of the World Summit
for children in the last decade, ? The constant
reduction of communicable diseases prevalence and
even the disappearance of some of them,
5
INTRODUCTION (3) ? The demographic changes
characterized by the reduction of births,
fertility index and the natural growth rate, ?
The increased support given to all aspects of
child health related to both child survival and
the quality of life as well as the well being of
children.
6
INTRODUCTION (4) So, new challenges need to be
addressed . The IMCI strategy fullfills the
need to consolidate the achievements, by the
improvement of the quality of health services
delievered to children.   Tunisia has commited
since three years to implement the IMCI strategy
as an approach that aims at improving the quality
of health services, allowing a holisitic case
management of children, focusing on both the
curative and preventive aspects and addressing
the preventive aspect of mother health.
7
WHY IMCI OBTAINED THIS HIGH LEVEL OF COMMITMENT?

• It fulfills the commitment to further reduce the
  infant mortality (by 30 during the next decade)

8
2. Communicable diseases remain among the leading
causes of under five deaths
MICSII, 2000
9
3. Strengths of IMCI strategy ?Adapted to
the national context. ?Acts as a catalyst for
child health related programs. ? Enhances -
The coordination between programs, - The
integration of services, - Organization of
services. - Team work,
10
HOW THE COMMITMENT TO IMCI WAS ESTABLISHED?

• - Started Participation in IMCI Intercountry
  meeting, Morocco, 98
• - Reinforced IMCI national orientation meeting,
  March 00, in collaboration with WHO
• - Consolidated dissemination of results of first
  IMCI follow up visit that provided the evidence
  of improvement of quality of health care
  delivered to children, improvement of health
  providers performance in child case management
  and the caretaker satisfaction.

11
 
RESULTS ? Improvement of health providers
performance in child case management (fig. Shows
comparision between the results before and after
IMCI implementation)
12

• FORMS OF COMMITMENT
• IMCI benefited from full support of MOPH.
• Its introduction coincided with the adoption of a
  quality
• assurance policy of health services, within
  which IMCI
• has been identified as a strategy that aims at
  improving
• the quality of health services delivered to child
  and
• mother.
• This support has been demonstrated by
• Designation of a national IMCI focal point and a
  national focal point for community ocmponent..
• Formulation of an IMCI technical committee
  composed of staff from PHC dpt. MOPH, physicians
  and paramedics from the regional teams, academe,
  and paediatricians.

13
FORMS OF COMMITMENT

• Official announcement by HE the Minister of
  health considering IMCI as a quality strategy for
  child health.
• Official formulation of a national IMCI working
  group (Ministerial).
• Decision to expand the IMCI implementation in the
  country.
• Resource allocation drugs, supplies, training
  material, audiovisual equipment, registers, HIS
  support
• WHO/UNICEF Technical and financial support for
  IMCI early implementation phase.

14
FORMS OF COMMITMENT

• Incorporation of IMCI in
• National child health policy,
• National development plan (5 year plan)
• National program of action for children for the
  next decade,
• National plan for MDG,
• Programs of cooperation with WHO UNICEF)

15

• CONCLUSION LESSONS LEARNT
• COMMITMENT TO IMCI has been obtained essentially
  due to
• - High value of its objectives
• - It came in line with the political commitment
  to children.
• - IMCI fexibility to address national challenges
  aiming at improving the quality of life of
  children.
• Advocacy for IMCI should be an ongoing process.
• Commitment of international partners (WHO/UNICEF)
  played an important role in the success of the
  implementation.
• Results of IMCI implementation should be widely
  disseminated to show evidence that IMCI works.

16

• CONCLUSION LESSONS LEARNT
• To sustain the achievements, commitment should be
  obtained and maintained at all levels
  (international, central, regional, district, HF
  and community levels)
•  Motivation of health centers teams is
  indispensable (certificates, regular monitoring
  and supervision, skill reinforcement improvement
  of the working environment, problem solving,
  giving more value to paramedics role).

17
THANK YOU