Transcript الشريحة 1 - An-Najah National University

Palestine
MOH
Integrated Management of Childhood
Illness:
The road to healthy childhood
Palestinian Experience in IMCI
Dr. Younis Awad Allah
IMCI National Coordinator
MPH
1
2
Palestine
Total population in OPT: 3,762,005
West Bank: 2,372,216
Gaza Strip: 1,389,789
, Proportion of pop aged under 5 years (19.2% in GS
and 16.6% in WB)
Reported CBR per 1000 pop (33.7 in GS Vs 23.9 in
WB)
Reported CDR per 1000 pop (3.1 in GS Vs 2.5 in WB)
IMR 20.8 per 1000live births( 20.8 in GS Vs 3.9 in
WB).
Child U5years mortality rate 20.07 per 1000 live
births (24.6 in GS Vs16.3 in WM
3
Child Health care
The Palestinian authority has recognized child
survival interventions as a high priority since long
time .
Many child health care interventions were introduced
during the last period, commonly run through
vertical national programme . CDD and ARI
programs were adopted since 1994.
EPI programme passing with an excellent coverage
Breastfeeding and supplementary feeding
programme need more activation .
Screening of newborns for hypothyroidism and PKU
still active programme.
WBC and anthropometric measures programme
need more activation.
4
What Is Integrated Management of
Childhood Illness IMCI
The united Nation “Convention on the rights of
child” urge countries to take appropriate
measures to fully implement the rights of child
;among which are:
1- to diminish infant and child mortality;
2- to ensure the provision of necessary medical
assistance and health care to all children with
emphasis on development of primary health;
3- to combat diseases and malnutrition;
4- to ensure that parents and children have
access to education and are supported in the
use of knowledge of child health and nutrition.
5
World challenge
WHO estimate that about 12 million children in
developing countries die every year before
reaching their fifth birthday.
Seven in 10 of these deaths are due to one or
combination of group of common diseases.
These are ARIs (mostly pneumonia),
dehydration (due to diarrhea) ,measles, malaria
and malnutrition.
In addition, one, or a combination of these five
condition causes 3 in 4 episodes of childhood
illness.
6
Bryce J, et al. “WHO estimates of the causes of death in children.” Lancet 2005.7
So;
WHO, CHD, with UNICEF
responded by developing the
strategy known as IMCI
8
IMCI Strategy
IMCI is neither another vertical program,
nor a project, it is a strategy of managing
common illnesses among children under 5years of age.
9
Recently WHO (EMRO) Announcement
(Nov.2007)
IMCI is adopted by the Regional Office as
the primary child health care strategy,
offering a wide range of interventions
under its overall umbrella and countries
invited to see IMCI within this vision, and
not as a vertical training program, and to
commit increased resources for it to
achieve the child mortality-related
Millennium Development Goal no. 4.
10
IMCI Objectives
1- To reduce significantly mortality and
morbidity associated with the major
causes of disease in children.
2- To contribute to healthy growth and
development of children.
11
IMCI Addresses Most Causes of
Death
Pneumonia
Diarrhea
Measles
Malaria
Malnutrition
Sepsis
Meningitis
Dehydration
Anemia
Ear infection
HIV/AIDS
Wheezing
Sore throat
12
Integrated Management of
Childhood Illnesses (IMCI)
integrated approach
aims to reduce death, illness and disability,
and to promote improved growth and
development
includes both preventive and curative
elements
implemented by families, communities and
health facilities
13
Components of IMCI
The IMCI strategy seeks to reduce the child
mortality through a broad and crosscutting approach with components as:
Improves health worker skills
Improves health systems
Improves family and community
practices
14
Improving Health Worker Skills,
Community Care, and Health Systems
Clinical
Assessment
and treatment by health workers
Knowledge,
Beliefs
and skills
caretakers
Capacity, structure
and functions of
health system
15
16
17
18
IMCI as a Key Strategy for
Improving Child Health
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
Integrated Management of Childhood Illness
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
19
IMCI as a Key Strategy for
Improving Child Health
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
Integrated Management
of Childhood Illness
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
20
IMCI as a Key Strategy for
Improving Child Health
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
Integrated Management
of Childhood Illness
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
21
IMCI as a Key Strategy for
Improving Child Health
Strengthening
health workers
skills
Strengthening
health system
support
Strengthening
community
involvement &
participation
SICK
CHILD
Integrated Management
of Childhood Illness
Strengthening
health workers
skills
WELL
CHILD
Strengthening
Strengthening
health system
support
community
involvement &
participation
22
Introduction of IMCI was
significantly associated with:
reductions in the misuse of 
antibiotics
A simplified model of IMCI impact
Correct treatment of child 
illness with antibiotics
more frequent 
administration of the first
dose at the facility
improved efforts by health 
workers to educate
caregivers on home
treatment
increased knowledge 
among mothers about how
to administer drugs
correctly
IMCI Intro/Planning
Improved drug
availability, supervision,
other health system
improvements
Training of health
workers/follow up visits
ITNs, other family and
community interventions
Improved
quality of care in
health facilities
Improved careseeking,
increased utilization
Improved household
compliance/care
Improved
health/nutrition
23
The principles of integrated care
The IMCI guidelines are based on the following
principles:
# All sick children must be examined for “general
danger signs”.
# All sick children must be routinely assessed for
major symptoms
# Only a limited number of carefully-selected
clinical signs are used, based on evidence of
their sensitivity and specificity7 to detect disease.
24
25
The road to healthy
Palestinian childhood
Palestinian Experiences in IMCI
26
Implementation of IMCI involves
three phases:
the introductory phase to ensure that key
persons in MoH and other health services
providers understand IMCI strategy .
the early implementation phase to plan
and prepare for IMCI implementation .
the expansion phase includes efforts to
increase access and to broaden the range
of IMCI interventions.
27
Achievements:
Introduction phase:
H.E MOH Minister approved to adopt IMCI
strategy within the health system 2001.
Introduction of IMCI approach under PHC
umbrella.
Attendance of Rabat-morocco meeting 1998.
Attendance of inter-country meeting for IMCI
national coordinators Damascus, Syria July
1999 (3 participants) from Gaza & WB
28
Nomination of IMCI National coordinator and IMCI
focal persons for GAZA and West Bank.
One day orientation meeting conducted (August
2000) both in GAZA and West Bank. (WHO), followed
by:
Two days preliminary and adaptation workshop
(August 2000) in GAZA and West Banks. (WHO)
Orientation meeting (UNICEF and Al Quds
university).
abroad training: IMCI task force members trained in
Egypt (2 participants from GS & WB). * Training key
personnel in Syria (4 participants) from GS & WB
(2001) including IMCI national coordinator and Local
persons.
29
2 orientation meetings in Gaza (2001)
IMCI working group formulation (IMCI
task force):1- Adapting group
2- Planning and implementation group
3- Community and family practice
group
30
Early Implementation Phase:
Developing of national strategy and plan.
Initiate districts were selected
Adaptation of the IMCI guidelines one for
physicians and one for nurse and training
materials to the local context , producing
Palestinian (national adapted IMCI guidelines
and training material packages , mother card,
wall charts, recording , reporting, and follow
up requirements.
31
Printing of Palestinian IMCI materials
4 consensus workshops were conducted.
TOT training course (15 in GAZA) (30 in WB)
IMCI training courses were held as 337
physicians were trained (189 in GAZA, 148 in
WB), and 138 nurses also already trained
Attending most of inter-country meetings,
related to all IMCI COMMPONENT.
32
Attending of both IMCI facilitation and
follow training course to reinforce IMCI
skills for trainers
Adaptation of a special psychosocial
guideline and package were finished
but need revision and piloting.
(generic) .
Completing the building and upgrading
of 3 training centers for IMCI &
Neonatal strategy's activities
distributed to cover all provinces.
33
IMCI components under
activation:
National child health policy initiative (NCHPI).
IMCI community component (CIMCI).
IMCI psychosocial component (generic in
Palestine).
breast feeding and supplementary feeding counsel
for infants and young children component.
Adapting IMCI curriculum for pre-service training
at medical and nursing collages .
IMCI Follow up after training and ongoing
supervising.
Scaling up the IMCI Training activities
34
IMCI partnership
UNICEF
WHO / EMRO
Other partners:
* safe the children
*
35
Constrains
1- Political instability
2- conflicts in management system of MOH .
3- The strike of the MOH STAFF.
4- FINANCAL CONSTRAINS ( direct payment via
UNICEF).
5- Mobility restriction ( the need for vehicle).
6- Limited capacity of MOH to recruit /assign technical
staffs for IMCI org. structure.
7- Disparity between WB &GS in organizational
structure results in non identical training approach.
8- Evacuation of trained staffs from PHCcs by
transferring them to hospitals beside the turnover of
some .
36
Web Site
Palestine have a special web sit at WHO –
EMRO
http://www.emro.who.int/cah/imci_impleme
ntation_pal.asp?country=Palestine
37
IMCI: Lessons learned
Pneumonia and diarrhoea remain diseases most
often associated with child deaths
Under-nutrition is an important direct cause
associated with mortality from common childhood
illnesses
IMCI provides a valuable and systematic conceptual
for improving child health services
Where a well-defined IMCI management structure
was in place and relations with other programs
defined, program management and implementation
were efficient
38
IMCI: Lessons learned…cont
IMCI is largely funded by donor resources and few
governments have allocated a substantial regular
budget line to it
IMCI in pre-service training of medical and paramedical health professionals is well embraced in
many countries, and considered a necessary way
forward for sustainable implementation
Follow-up after training has been found very useful,
identify problems in the health system, and
contribute to the process of system improvements at
peripheral level
Wherever investments were made to improve the
health system, this has had positive results on the
system and enhanced the perceived success of IMCI
implementation
39
IMCI: Lessons learned…cont
Poor health worker motivation and high turn-over
negatively affect IMCI implementation
Adapting the pre-set national plan to be more flexible
by adopting a scientific specific annual plan, this
will help to absorb unforeseen incidents and achieve
actual implementation .
C-IMCI should be activated as soon as possible to
sensitize the communities towards child health, and
sensitize participating health staff about why and
how to deal with communities.
Decentralization of management tasks towards
district is a prerequisite to help local capacity
building, to introduce and enhance expansion and to
maximize the potential for sustainability
40
Lot’s of unanswered questions
41