Transcript IMPROVING CHILDREN’S HEALTH AND NUTRITION IN COMMUNITIES

AFRICA SOTA
Nairobi
June 10 - 15, 2002
Integrated
Management of
Childhood Illness
Progress to Date
• Successful introduction phase
– IMCI in > 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
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
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
For example,
100
Improved quality of care in Tanzania
75
100
50
80
25
0
Better caretaker knowledge in Bolivia
IMCIin Niger
Reduced treatment costs
70
No IMCI
100
60
80
40Child
49
Average total pharmaceutical cost per
child
US cents
Childin 1999
Oralinab/am
Weight
checked for
checked
vaccination
cough,
against
status
20
12
diarrhoea,40 growth chart32 checked
fever
0
60
prescribed
correctly
7
23
20
How to give oral medicines
0
Before (1997)
HW not using IMCI
Tanzania
At leastSource:
twoMCEdanger
signs
After (1999)
HW using IMCI
Source: Kelly E, QAP 1999
Progress to Date
BUT……
• Districts overloaded, under-resourced,
limited capacity
• Many first contacts for care are with
practitioners outside government facilities,
yet Comp I&II focused on public sector
• Referral of severely ill children, drug
availability, staffing, supervision, other
‘systems’ issues remain serious constraints
Sample DMCI results
Indicator
Senegal
Uganda
Zambia
Bolivia
Ecuador
% of stock records =
physical stock
62%
34%
55%
N/A
50%
% of cases of nonpneumonia Rxed
antibiotics
69%
91%
63%
68%
40%
% of cases of simple
diarrhea Rxed
antibiotics
64%
66%
14%
54%
65%
% of mothers who
knew how to give
medicines as they left
the facility
59%
46%
46%
N/A
N/A
Source: RPM DMCI studies
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.
“Community IMCI may
change the way
forward for IMCI by
moving the focus from
the health facility to
the community…..”
- DFID Review
Why Community Approaches?
• To reach unreached families and
communities
100
90
Percentage of Children with
‘Unmet Need’
% of children didn't receive
CS interventions
80
70
58
60
52
50
40
40
30
26
28
20
10
0
Immunization data for 12-23 months children and
exclusive breastfeeding for children under 4 months only.
Source: DHS, ACC/SCN, Unicef
32
25
El Alto, Bolivia:
ARI & Diarrhea Deaths
60% -- Failed timely recognition
99% -- Did not get appropriate
home care
42% -- Died without reaching any
care provider
39% -- Used community providers
5% -- Received quality care from
any provider
Source: BASICS Project, 1997
Where Health Care Received
Private Clinic
41%
TH/Other
4%
Other
17%
Shop/Drug
store
38%
Source: Pariyo G, Burnham G, et al. Preliminary results from HH
survey in 10 districts, MCE-Uganda, 2001.
NGO
2%
Public
15%
• To mobilize additional resources and
partners (including communities & families
themselves)
Percent of household income
100
80
60
Percentage of Household
Income Spent on Treatment of
Fever - Malawi, 1992
40
20
0
All Households
Source: Ettling et al, 1992
Poorest 50%
Can Community Approaches
Increase Impact?
Treating Pneumonia - Nepal
100
80
% of Expected Pneumonia Cases Treated by CHW
% of Expected Pneumonia Cases Treated by HF
60
40
20
0
Non-Intervention Districts
Intervention Districts
Source: Penny Dawson, presentation “Community-based IMCI in
Nepal”, Jan 2001
Other Examples Community Approaches at Scale
• Madagascar - Immunization, Nutrition,
Safe Water, “Community IMCI”
• Bamako Initiative
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.
Key Behaviors Related to Major
Causes of Infant and Child Mortality
Promotion of Health/
Prevention of Illness
•
•
•
•
•
Breastfeeding
Appropriate feeding
Micronutrient intake
Immunization
Handwashing &
Hygiene
• Bednets
Illness Recognition,
Home Care & Care Seeking
• Recognizing illness
• Appropriate home care
• Dangers signs &
indications for care
seeking
• Seeking appropriate
care
• Accepting referral
• Continued care
Community Approaches to Child Health (Examples)
Bednets
Breastfeeding
Sick Child Treatment
Referral
INFO
NETS
INFO
Media
Media
Commercial
Mktg.
Social
Mktg.
INFO
TREATMENT
NGOs
Extension
NGOs
workers
Health
Facilities
Govt.
Mission
Private
& NGO Providers
Facilities
Govt.
CBOs
x xx xx x
x xxx x x xx x xx
xx x xxx x xx x
x x xx x xxx
Community
x xxx xx xx
x xxxx x xx xx x
xxx x xxx xx
xx x xx xx
Community
Private
CHWs
(formal/
CBOs
informal)
xx xx x providers
xx x xx xx
xxx x x x xxx x xx xx xxx xx
xx x xxx x xx x xx xx xx
Community
Media
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
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
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