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Nurses Practicing Integrated Management of Childhood Illness (IMCI) in Fiji
Litia Ruban, Fiji 21st November, 2012
Presentation Outline
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Objectives of IMCI Introduction Implementation of IMCI Component Way Forward
Integrated Management of Childhood Illness (IMCI) Objectives
To reduce significantly global mortality and morbidity with the major causes of disease in children through an integrated approach.
To contribute to healthy growth and development of children
Introduction
• As according to UNICEF Child Mortality Report 2011, the global under-five mortality rate since 1990 has dropped 35 percent—from 88 deaths per 1,000 live births in 1990 to 57 in 2010.
The rate of decline in under-five mortality has accelerated— from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010—but remains insufficient to reach MDG 4, particularly in Sub- Saharan Africa, Oceania, Caucasus and Central Asia, and Southern Asia.
Only three years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by two thirds between 1990 and 2015
Introduction
Where is Fiji NOW on the Road “To reduce Child Mortality and Morbidity by 2/3 in the Year 2015”?
Fiji’s Level and Trends of Child Mortality for the Last 20 years Under five mortality rate(deaths per 1000 live births) Number of under five deaths (thousands) Infant mortality rate (deaths per 1000 live births) Number of infants deaths (thousands) Neonatal mortality rate (deaths per 1000 live births) Number of neonatal deaths (thousands)
Millennium Development Goal target for 2015 Average rate of reduction (percent)
1990
2010 2015
30
17 10 1990 -2010 1990 2010 1990 2010 1990 2010 1990 2010 1990 2010 2.8
1 0 25 15 0 0 12 8 0 0 Source: Levels and Trends of Child Mortality, Report 2011, Estimates Developed by the UN Inter Agency Group for Child Mortality Estimation (IGME)
Introduction Comparing Fiji’s levels and trends of CMR to other Pacific Islands Country Under five mortality rate(deaths per 1000 live births) Number of under five deaths (thousands) Infant mortality rate (deaths per 1000 live births) Number of infants deaths (thousands) Neonatal mortality rate (deaths per 1000 live births) Number of neonatal deaths (thousands)
1990 2010 Millennium Development Goal target for 2015 2015 Average rate of reduction (percent) 1990 -2010 1990 2010 1990 2010 1990 2010 1990 2010
Fiji Australia Cook Islands Marshall Islands Papua New Guinea Samoa Solomon Tonga Tuvalu Vanuatu New Zealand
• 30 9 20 51 90 17 5 9 26 61 10 3 7 17 30 2.8
2.9
4 3.4
1.9
1 2 0 0 12 0 1 0 0 12 25 8 17 40 65 15 4 8 22 47 0 2 0 0 9 0 1 0 0 10 12 5 9 19 30 23 27 45 25 57 39 11 20 27 16 33 9 15 8 19 1.5
2.6
2.2
2.7
0 1 0 0 0 0 0 0 23 36 21 44 17 23 13 27 0 0 0 0 0 0 0 0 10 18 11 22 14 13 5.1
0 0 31 12 0 0 16 7 6 4 3.0
1 0 9 5 1 0 4 3 Source: Levels and Trends of Child Mortality, Report 2011, Estimates Developed by the UN Inter Agency Group for Child Mortality Estimation 8 12 8 14 8 3 5 12 0 0 0 0 0 0 1990 2010 0 1 0 0 0 1 0 0 4 5 0 0 0 0 0 0
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Introduction In terms of Child Morbidity
Fiji Child Health Review 2010
What has Fiji done on the Road “To reduce Child Mortality and Morbidity by 2/3 in the Year 2015”?
WHO and UNICEF launched IMCI strategy in the mid – 1990s to reduce deaths from diarrhea, pneumonia, malaria, measles and malnutrition in children younger than 5 years The Ministry of Health, Fiji works in collaboration with WHO/UNICEF to strengthen the implementation of Integrated Management of Childhood Illness (IMCI).
Fiji Implementing IMCI Component 1. Improving case management skills of health workers
- standard guidelines – upgrading case management & counselling skills -training (pre-service and in-service) - follow-up after training
2. Improving the health system to deliver IMCI
- essential drug supply and management - organization of work in health facilities - management and supervision
3. Improving family and community practices
Implementing IMCI Components
Improving case management skills of health workers (mainly nurses)
IMCI Training in Fiji National and outreach training done are mainly for the registered nurses while few were doctors and sisters. More than 1000 nurses had been trained from then till to date.
2003, the IMCI component was in cooperated into the nursing curriculum during the curriculum review First pre service class to take this up was in 2004 and they graduated in 2007 April,2009 ICAAT training was conducted to both pre services/post services at Fiji School of Nursing.
Total trained per Year in the Preservice Level
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GRAD/YEARS
2007 2009
FIJI
171 84
OTHER PACIFIC ISLANDS
3 10
TOTAL
174 94 2010 2011 2012 2013
TOTAL
97 109 110 147
718
5 2 5 3
28
102 111 115 150
746
Total trained per Year in the Post Service Level
……
PROGRAM 2009 2010 2011 2012
Fiji OPac Fiji OPac Fiji OPac Fiji OPac
T O T
Adv.Dip.Npract.
10 10 10 5 PGDip.Midwifery
PGCert.Mental
Health Nur Post Basic PH 15 Bach.PHNur
TOTAL
25 60 70 45 15 70 50 19 74 5 5 2 2 4
IMCI Components
Improving the health system to deliver IMCI
IMCI SET UP IN CLINICAL AREAS ------------
IMCI Components
Improving family and community practices
Limitations
Inadequate resources Lack of Management, Coordination andSupervisory Systems Lack of analysis on child health data.
From now 2015 PHC Strengthening & revitalization Child Health- IMCI CHILD SURVIVAL Strengthening Health Information System Maternal and Neonatal HealthCare