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Integrated Management of Childhood Illness

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AFRICA SOTA Nairobi June 10 - 15, 2002 Integrated Management of Childhood Illness Progress to Date Successful introduction phase IMCI in 80 countries worldwide ... – PowerPoint PPT presentation

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Title: Integrated Management of Childhood Illness


1
Integrated Management of Childhood Illness
AFRICA SOTA Nairobi June 10 - 15, 2002
2
Progress to Date
  • Successful introduction phase
  • IMCI in gt 80 countries worldwide 39/44 WHO
    AFRO countries
  • 37 countries w/ updated child health
    policies 17 modified essential drugs lists
  • IMCI now part of 35 World Bank projects
  • Broad support from major supporters WHO,
    UNICEF, World Bank, USAID, DFID

3
Progress to Date
  • Operational partnership b/w IMCI and
    Roll Back Malaria (RBM)
  • Joint strategies for community action and
    scaling up developed Regional Task Forces
    merged in 2000.
  • HH and Community component
  • HH/C IMCI in the IMCI plans of 16
    countries in the region

4
Progress to Date
From DFID/USAID Review of IMCI in the Africa
Region
  • IMCI has resulted in widespread improvement
    of child health policies
  • Some evidence that IMCI training can lead to
  • improved quality of clinical care
  • improved organization of work
  • more rational drug use/cost savings

5
For example,
6
Progress to Date
BUT
  • Districts overloaded, under-resourced,
    limited capacity
  • Many first contacts for care are with
    practitioners outside government facilities,
    yet Comp III focused on public sector
  • Referral of severely ill children, drug
    availability, staffing, supervision, other
    systems issues remain serious constraints

7
Sample DMCI results
Source RPM DMCI studies
8
Progress to Date
From the MCE Uganda
  • HW performance can change, and the way children
    are treated can substantially improve
  • Cannot achieve this without attention to broader
    health system issues
  • Drugs, vaccines
  • Supplies, basic equipment
  • Improved support for the health worker
  • Contribution of Community Component in achieving
    impact

Source Pariyo G, Burnham G, et al. Preliminary
reports from the MCE-Uganda, 2001.
9
Community IMCI may change the way forward for
IMCI by moving the focus from the health facility
to the community..
- DFID Review
10
Why Community Approaches?
  • To reach unreached families and communities

11
100
90
Percentage of Children with Unmet Need
80
70
58
60
52
50
of children didn't receive
CS interventions
40
40
32
28
26
25
30
20
10
0
DPT3
ORT
Iodized Salt
Vitamin A Sup
ARI Treatment
Exc Breast Feeding
Nutrition (Underweight)
Immunization data for 12-23 months children and
exclusive breastfeeding for children under 4
months only.
Source DHS, ACC/SCN, Unicef


12
El Alto, Bolivia ARI Diarrhea Deaths
99 -- Did not get appropriate home care
39 -- Used community providers
Source BASICS Project, 1997
13
Where Health Care Received
TH/Other
Private Clinic
4
NGO
41
2
Other
Public
17
15
Shop/Drug
store
38
Source Pariyo G, Burnham G, et al. Preliminary
results from HH survey in 10 districts,
MCE-Uganda, 2001.
14
  • To mobilize additional resources and
    partners (including communities families
    themselves)

Percentage of Household Income Spent on Treatment
of Fever - Malawi, 1992
Percent of household income
Source Ettling et al, 1992
15
Can Community Approaches Increase Impact?
16
Treating Pneumonia - Nepal
Source Penny Dawson, presentation
Community-based IMCI in Nepal, Jan 2001
17
Other Examples - Community Approaches at Scale
  • Madagascar - Immunization, Nutrition, Safe Water,
    Community IMCI
  • Bamako Initiative

18
Community IMCI is
  • A national process,
  • Focused on the district level,
  • Implemented through partnerships with
    communities,
  • Building on existing organization, programs,
  • experiences, and assets,
  • To promote a set of key behaviors that
    improve
  • the health and nutrition of young children.

19
Key Behaviors Related to Major Causes of Infant
and Child Mortality
Promotion of Health/ Prevention of Illness
Illness Recognition, Home Care Care Seeking
  • Recognizing illness
  • Appropriate home care
  • Dangers signs
  • indications for care seeking
  • Seeking appropriate
  • care
  • Accepting referral
  • Continued care
  • Breastfeeding
  • Appropriate feeding
  • Micronutrient intake
  • Immunization
  • Handwashing
  • Hygiene
  • Bednets

20
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21
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22
Strategic Areas of Interest
  • Expansion and achievement of program scale within
    present program countries
  • New activities in key areas e.g.
  • community drug assessments
  • private/non-formal sector approaches
  • linkages with HIV/AIDS, neonatal health
  • Expanded investment to PVOs/NGOs
  • role in National program strategy

23
Strategic Areas of Interest
  • Identify 3-4 RFMP countries for accelerated
    Community Approaches to Child Health
  • Document and disseminate successful programs
    working at scale
  • Support research to assess effectiveness/
    cost-effectiveness/ impact
  • Facilitate coordination at National level
  • WHO Analytic Review of IMCI

24
Madagascar and Ghana Country Examples
  • Key Points
  • Program highlights and lessons learned esp. for
    going to scale
  • Role of the Mission as part of National
    programming strategy
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