CDI Module 5: Community-Directed Interventions to Deliver Malaria Plus Packages (MPPs)

©Jhpiego Corporation

The Johns Hopkins UniversityA Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services

Overview

Our training uses malaria as a foundation for integrated community case management (iCCM) and community-directed intervention (CDI), but in other countries/areas other combinations of package components may be more appropriate for starting out

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Module 5 Objectives

By the end of this module, learners will: Name components of a Malaria Plus Package (MPP) Describe key household and community practices that

impact child growth promotion and development List steps and activities for disease prevention at the

home/community level to reduce illnesses and deaths Explain home management of malaria-related diseases

(e.g., diarrhea, chest infection, malnutrition, anemia) List activities to promote care seeking and compliance

with healthy practices

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A Malaria Plus Package …

… starts with preventing and treating malaria services, but then: Strengthens the health system to improve delivery of

a variety of community interventions Expands the capacity of the Ministry of Health (MOH)

and the local government authorities in the target states/municipalities, to deliver an integrated package to the community

Provides appropriately tailored support to the states/municipalities to help them improve their planning, implementation, coordination and supervision capacities for the integrated package

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Malaria Plus Includes …

Increasing access to, and utilization of, preventive measures

Expanding access to, and utilization of, effective diagnostic and treatment services

Strengthening community mobilization and communication for behavior change

Improving state-/municipality-specific monitoring and evaluation (M&E) for evidence-based management

Strengthening partnerships for resource mobilization and implementation

Enhancing capacity of the states/municipalities for oversight and project coordination

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Three MPP Delivery Channels/Links

1. Family-oriented, community: Home management of childhood illness; health-promoting activities like exclusive breastfeeding, long-lasting insecticide-treated net (LLIN) use, intermittent preventive treatment in pregnancy (IPTp)

2. Population-oriented outreach and schedulable services: Delivery of health services (e.g., through a Child Health Week in collaboration with partners)

3. Individual-oriented clinical services: Facility-based care available on a 24-hour basis to deliver routine services and manage severe illness

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Our Focus in CDI

We are focusing on the family/community channel for CDI

Key household and community practices are a set of practices that—when combined—have the greatest impact on child survival, growth and development

These key practices can prevent a variety of health problems, not just malaria

Families play a very significant role in the growth and development of their children as well as in the well-being of mothers

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Role of Families and Communities

Caregivers need knowledge and skills in key household and community practices that have the greatest impact on the well-being of mothers and children

The purpose of this module is to outline contents for training community-directed distributors (CDDs)/community-oriented resource persons (CORPs) to promote the key household and community practices

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Why Malaria Plus Packages?

The majority of children die at home in spite of the availability of health services

Many children die from other malaria-related diseases (e.g., diarrhea, chest infection, malnutrition, anemia)

Initial care (whether using orthodox or traditional medicine) takes place in the family

Formally trained health workers are usually either inaccessible or unavailable

Feasible interventions that can significantly reduce illness and death exist, and can be practiced at home/in the community

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Examples of Good Practices

Appropriate breastfeeding can reduce childhood illness by 10%

Good hygiene practices can reduce childhood illness by 10%

Improved complementary feeding can prevent death from malnutrition, diarrhea, measles, etc.

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Household Practices

The key household practices can be grouped into four broad clusters:

Growth promotion and development Disease prevention Home management Care seeking and compliance

Can you name these practices and the services the community can provide to foster these practices?

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Growth Promotion and Development

Exclusive breastfeeding: Feeding a baby with only breast milk, not even water, from birth until six months of age

Complementary feeding: Feeding children with freshly prepared energy- and nutrient-rich complementary foods, beginning at six months of age, while continuing to breastfeed up to two years or longer

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Growth Promotion and Development (continued)

Micronutrients and diet supplementation: Ensuring that children receive adequate amounts of micronutrients (vitamin A, iron, iodine and zinc in particular), either in their diet or through supplementation

Growth monitoring: A process of weighing a child at intervals, charting the weight on a child health card and showing the mother whether the child is doing well or not

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Growth Promotion and Development (continued)

Promoting mental and psychosocial development: Providing children with a stimulating environment to achieve optimal development later in life

Birth registration: The official recording of the birth of a child with the National Population Commission

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Disease Prevention

Proper feces disposal and handwashing: Disposing of feces, including children’s feces, safely; and washing hands with soap after defecation, before preparing meals and before feeding children

Protecting children and pregnant women in malaria-endemic areas, by ensuring that they sleep under insecticide-treated nets

Preventing HIV and caring for people living with HIV/AIDS (PLWHA): Providing appropriate care for HIV/AIDS-affected people, especially orphans, and taking action to prevent further HIV infections

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Disease Prevention (continued)

Preventing child abuse and neglect, and taking appropriate action: Taking action to

prevent child abuse Recognizing child

abuse when it has occurred and taking appropriate action

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Home Management

Preventing and managing child injuries by taking appropriate action: Keeping the home environment tidy and free of

objects that may cause accidents among children Preventing and providing appropriate treatment for

child injuries

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Home Management (continued)

Giving appropriate home treatment for infection: Beginning appropriate home management of diarrhea

immediately to prevent dehydration Giving salt sugar solution or drinking water in addition to

breast milk if the child is still exclusively breastfed Continuing to feed and offering more food and fluid when

the child is sick, including breast milk Taking the child to a health facility immediately if the child

has any of the following signs: – Is not able to drink– Develops a fever– Is getting worse– Passes blood in stool

Home Management (continued)

Taking all children with a cough to a health facility where the cough will be properly assessed and treated

Also, taking all children to a health facility for assessment if they develop any of these signs: Breathing is fast Breathing becomes difficult Child is not able to drink Child is getting worse

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Care Seeking and Compliance

Immunization: Ensuring that every child completes the full course of routine immunization five times before the child’s first birthday Also, ensuring that, from the

age of six months, a child receives vitamin A supplementation and deworming tablets every six months until the child reaches five years of age

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Care Seeking and Compliance (continued)

Recognizing when a child needs treatment outside the home, and seeking care from appropriate providers: Taking the child with

severe illness to the health facility immediately to save the child’s life

Following the health worker’s advice on treatment, follow-up and referral

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Care Seeking and Compliance(continued)

Birth preparedness and complication readiness: Getting ready for a baby’s birth and possible problems/dangers that may arise during labor, and taking care of emergencies when they arise

If a woman is well prepared for normal childbirth and possible complications, she is more likely to receive the skilled and timely care she needs to protect her overall health and the health of her baby

Care Seeking

Family planning using appropriate methods

Families that plan and space their children ensure that the pregnant woman: Regains her strength between pregnancies Avoids frequent exposure to health risks Gives birth to children who are strong and healthy

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Avoiding Delays

Three ways of wasting time (delays) may lead to complications and death of a woman and her child: Delay in seeking care Delay in reaching care Delay in receiving care

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Care Seeking and Compliance(continued)

Essential community newborn care: Identifying danger signs in newborns and advising to

take baby immediately to nearest health facility Ensuring that mother and baby go back to the health

facility within the first week and at six weeks of delivery— and if she delivered at home, ensuring that mother and baby go to the health facility within 24 hours

Active participation of men in child care and reproductive health: Ensuring that men actively participate in the provision of child care and are involved in reproductive health

MPP-Driven Commodities

Examples of commodities that will drive the MPP implementation strategy are: Folic acid Ferrous sulfate Anti-helminthics Oral rehydration salts Antibiotics that are already in the work plan/procurement plan of the

participating states/municipalities LLINs for mop-up phase Vaccines

Not all commodities will be available through the community channel

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In Your Country

What is the package of services and health promotion activities that are provided at the community level through community efforts?

How were the components of this package decided? Are there other services that could be added? We have discussed many services (20); so, how do

we decide: Which ones to start delivering first? Which ones to train CDDs on first?

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Planning for Malaria Plus

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Key practices Resources needed

Source of assistance

Growth promotion and developmentDisease prevention

Home management

Care seeking and compliance

As a group exercise, fill out this chart—you may substitute a different set of services relevant to your country

Integration Challenges

How can we integrate these additional areas into the training and work of the CDDs/CORPs?

What are the cost implications for CDD training and CDD kits?

How can we provide integrated supportive supervision for CDDs to implement MPP?

What other concerns do you have?

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Summary and Conclusion

Key household and community practices have a potential impact on child survival, growth and development

The key household and community practices are deployed as part of an integrated maternal, neonatal and child health strategy

Improving knowledge about key household and community practices will: Promote survival, growth and development of newborns, children

under five years of age and their mothers Strengthen the community management of malaria and related

illnesses Reduce maternal and child deaths

Each MPP must be decided by the country and district concerned 30