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COMMUNITY BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (CB-IMCI) PROGRAM

AND CB-NCP PROGRAMME in Nepal

Presented By:Laxman BhattaB.PH 5th semester

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Introduction

• In 1997 the IMCI program was initiated in Mahottari districts

as a pilot.

• In 1999 CBAC was merged in IMCI program and now is

called CB-IMCI

• Fiscal year 2o66/67 (2009/2010) CB-IMCI covers all 75

districts.

• CB-IMCI program is an integrated package of child survival

interventions and addresses major childhood killer diseases

(Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition )

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Cont……..• CB-IMCI is for 2 months to 5years children in a holistic way

• CB – IMCI also includes management of infection, Jaundice,

Hypothermia and counseling on breastfeeding for young infants

less than 2 months of age

• FCHVs are the main vehicle of services delivery and also play

key role to increase community participation

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Vision

• Contribute to survival, healthy growth and development of under five years children of Nepal.

• Sustain the achievement of MDG 4 beyond 2015.

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Goal

• To reduce morbidity and mortality among children under‐five due to pneumonia, diarrhoea, malnutrition, measles and malaria.

 

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Target • To reduce under‐five mortality from the current rate of

54/1,000 live births to 38/1,000 live

• To reduce Births and infant mortality from the current rate of 46/1,000 live births to 32/1,000 live births by 2015.

• To reduce neonatal mortality from the current rate of 33/1,000 live births to 16/1,000 live births by 2015.

• To reduce morbidity among infants less than 2 months of age.

Source annual report 2011

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Objectives

• Reduce frequency and severity of illness and related to

Pneumonia, Diarrhoea, Malaria, Measles and Malnutrition

• Contribute to improved growth and development

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Strategy The following strategy have been adopted by CB-IMCI program 1. Improving knowledge and case management skill of

health service providers.

2. Improving overall Health Systems

3. Improving family and community practices

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Major Components

1. Management of sick children below 2 months of age.

2. Management of sick children 2 months to 5 years of age.

3. Management of Diarrheal Diseases

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SIGNS CLASSIFY AS IDENTIFY TREATMENT

PNEUMONIA

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Key Achievement By Figure

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SIGNS CLASSIFY AS IDENTIFY TREATMENT

DIARRHOEA

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Treatment of Diarrhoeal disease

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SIGNS CLASSIFY AS IDENTIFY TREATMENT

MALARIA

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SIGNS CLASSIFY AS IDENTIFY TREATMENT

MEASLES

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SIGNS CLASSIFY AS IDENTIFY TREATMENT

MALNUTRITION

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Achievement on Malnutrition

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Major ActivitiesMajor activities carried out in FY 2070/71 include the following:• Conduction of CB‐IMCI Refresher Training 10 districts ‐ Sankhuwasava,

Saptari, Morang, Myagdi,Jumla, Humla, Dolpa, Banke, Doti, Bajhang• Training of CB‐IMCI all health workers.• Referral IMNCI Training • CB‐IMCI/NCP Orientation Training to HWs of Private Sectors• Capacity Building Training to CB‐IMCI Focal Persons (EDR and CDR

Regions)• Child Health: CB‐IMCI/NCP• Celebration of World Pneumonia Day (12 November)• Conduction of operational Research on increasing access of IMCI/NCP in

underserved areas• Conduction of efficacy study of Cotrimoxazole• Initiation of Intensive Monitoring and Supervision in low performance districts• Advocacy and marketing of CHX, Zinc, Cotrimoxazole and ORS• Supervision and Monitoring

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Other common childhood illnesses• IMCI Program also focuses on identifying malnutrition, measles,

malaria and other common illnesses among children.

• IMCI Section would actively collaborate with EPI and Nutrition Sections for the reduction of malnutrition, measles and other common childhood diseases through generating evidences relating to changing pattern of childhood disease epidemiology and strengthening the integrated approach to childhood disease prevention.

• Further, the issue of childhood TB and HIV is growing and this issue is also being addressed in the new package currently being developed.

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Community Based Newborn Care Package (CB‐NCP)

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Background• NDHS-2011 has shown that 33 neonatal death per 1000 live birth

which accounts 61% of under 5 deaths.

• The major causes of neonatal deaths in Nepal are(IBPH)- Infection- Birth Asphyxia- Preterm birth- Hypothermia

• NDHS-2011 also shows that only 35% of birth take place in health facility,so the neonatal mortality should be addressed for achieving MDG 4.

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• MoHP has made newborn health a priority and initiated integrated newborn health care package called “Community Based Newborn Care Program (CB-NCP)” based on the National Neonatal Health Strategy 2004.

• The program was implemented as pilot program in 10 district in FY 2065/66.

• Further expanded covering 39 districts by the end of FY 2069/70. It was further expanded to two districts in FY 2070/71.

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CB-NCP coverage

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Goal

• The goal of CB-NCP is to reduce neonatal mortality (NMR) through the sustained high coverage of effective community based interventions.

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Objectives

The specific objectives of CBNCP include:

• To prevent and manage newborn infection

• To prevent and manage hypothermia and LBW babies

• To manage post‐delivery asphyxia

• To develop an effective system of referral of sick newborns

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Data Recording and Reporting System in CB‐NCP Districts

• The CBNCP uses seven different types of recording and reporting tools at community and health facility level.

• Out of them, five are for recording and two are for reporting purpose.

• The recording tools include CBNCP 1, 2 and 3 for FCHVs, CB NCP 4 for VHW/MCHWS and CBNCP 5 for HFs.

• CBNCP 6 and 7 are data compilation tools that are used by HFs for reporting all services provided by FCHVs, VHW/MCHWs and HFs.

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Analysis of AchievementIndicators 2067/68 2068/69 2069/70

N0. of newborn register by FCHV 7859 8065 7893

% of LBW identified by FCHVs among registered

0.87 0.70 0.58

% of Birth asphyxia initiated stimulate by FCHV at home among total cases

0.47 0.11 0.13

% of Birth asphyxia treated using Delee suction by FCHV at home among total cases

0.06 0.07 0.06

% of Birth asphyxia treated with Bag and mask by FCHV at home

0.01 0.03 0.06

% of newborn applied chlorhexidine at home immediately after cord cutting (Home)

0 0 53.11

% of PSBI cases of 0-28 days 29.78 42.71 42.71

% of 0-28 days newborn received cotrim P

55.75 76.33 72.35

No of 0-28 days newborn who received full dose of Gentamycin injection

1143 1174 1180

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New Approach: Vision 90 by 20

90% Coverage

by2020

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Role OF Health Personnel in Programme Management

• FHV/MCHV• Health post/Sub-health post• DPHO/DHO• RHD• CHD• LMD

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Impacts of Program

• Institutional delivery has increased • Newborn Sepsis identified and treated at community level • Universal treatment procedure over the district • Government providing incentives to FCHVs for new born

care• Community people are satisfied due to no cost for the

treatment • Decreased neonatal and child morbidity and mortality • Improvement in other safe-motherhood and Child Health

indicators• Recognization of FCHVs in the community/ social

mobilization

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CONCLUSION

• Over the last decade, Nepal has achieved significant progress in reducing the under five mortality rate.

• Nepal is one of the country that have reduced under-five mortality by 50% since 1990 by implementing the community based child health program.

• It addresses the major childhood illness.

• FCHVs have important roles on CBIMCI at grassroots level.

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References

• Annual report department of Health services FY 2070/71(2014/2015)

• CBIMCI user manual published by CHD• Hand book of CMIMNCI 2071 by CHD,DoHS Nepal

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THANK-YOU