IMCI Unit AFRO

Going to scale: Experience with Community IMCI

Meeting of RBM and IMCI Task Forces

24th–26th September 2002Harare, Zimbabwe

Presentation by IMCI AFRO

IMCI Unit AFRO

Community IMCI

… is an integrated child care approach that aims at improving key family and community practices that are likely to have the greatest impact on child survival, growth and development

IMCI Unit AFRO

WHY SHOULD WE FOCUS ON THE HOME?

• Healthy life style starts at home

• Home is where treatment of sick children start using locally purchased medicine

• A big segment of the population in developing countries do not have access to health facilities

• Even where access to health facilities is reasonably good, most children die at home without seeking any health care outside the home

IMCI Unit AFRO

– documented/greatest impact on mortality

– feasible to implement in countries

– Cost-effective

– address major problems on child health, nutrition and development

– Focus on behavior change

IMCI Key Family and Community Practices

IMCI Unit AFRO

Key Family Practices

Growth Promotion &Development•Exclusive breastfeeding for 6m•Appropriate complementary feeding from 6m whilst continuing BF up to 24m•Adequate micronutrients through diet or supplementation•Promote mental and psychosocial development

Home Management•Continue to feed and offer more food & fluids when child sick•Give child appropriate home treatment for infections•Take appropriate actions to prevent and manage child injuries and accidents

IMCI Unit AFRO

Key Family Practices..contd.

Care Seeking & ComplianceTake child to complete full course of

immunization before 1st birthdayRecognize when child needs treatment outside

home and take to HWFollow HW advice about treatment, FU and

referralANC attendance and TT vaccination during

pregnancyActive participation of men in childcare and

reproductive health activities

Disease Prevention•Proper disposal of faeces, hand washing etc•Child sleeps under ITN•Prevention and care of HIV/AIDS•Prevent child abuse/neglect & taking appropriate action

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Countries with c-IMCI Orientation Meeting

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•Common understanding

•Share information

•Identify stake holders

•Consensus on way forward

IMCI Unit AFROIMCI Unit AFRO

COUNTRIES WITH PLAN FOR C-IMCI

•Planning at national and district levels

•Partners collaboration in planning

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C-IMCI SITUATIONA

NALYSIS

(11 countries)

To understand the current situation at district and

national levels

Sharing of experience

Identifying the various partners and planning

together

Revise policy and guidelines

IMCI Unit AFRO

Breastfeeding Indicators (%)

0

20

40

60

80

100

120

DRC Tanzania Uganda

Exclusive breastfeeding <4m- 6 Months

Mixed feeding 6-9m

Breastfeeding at 1y

Source

Uganda DHS 2000

Tanzania MCE HH Survey 1999

DRC Situational Analysis 2002

IMCI Unit AFRO

Use of mosquito nets

0%2%4%6%8%

10%12%14%16%18%20%

DRC Tanzania Uganda

Ever-treated net

Source

Uganda DHS 2000

Tanzania MCE HH Survey 1999

DRC Situational Analysis 2002

IMCI Unit AFRO

Management of sick children at home

0%

10%

20%

30%

40%

50%

60%

Morogoro Rufiji Ulanga Kilombero (R)

Sick child given food &more fluids (n=206-258)

Febrile child givenantimalarial (n=155-199)

Comparison of IMCI: non IMCIlogistic regression with adjustment for clusteringSick child given food & more fluids: p=0.25Febrile child given antimalarial: p=0.15

IMCI Unit AFRO

Regional level support

•Development of Briefing Package for planning of C-IMCI

Developed for use by facilitators/ consultants who would assist countries in the planning for c-IMCI

•Pre tested in Benin in February 2002

•Field test conducted , 15 countries (10 Anglophone and 5 francophone) involved

•Revision to be done in early October

• Manual on the recommendation for home care

•CHW’s training manual Other materials to be developed

IMCI Unit AFRO

OpportunitiesConstraints

Selection of priority practices:-Effective -Feasible-Pertinent-Acceptable-Cost effective

Com

mu

nit

y an

d c

omm

un

ity

inte

rven

tion

s

What are the community needs?

What does the community know?-Information-Knowledge

What does the community have?-Practices-Community health services-Resources-Previous/existing interventions-Others sectors-Links with the health system

IMCI/Child Health Strategy DocumentIMCI/Child Health Strategy Document

Strategic Plan for IMCI/Child HealthStrategic Plan for IMCI/Child Health

Recommendations on Priority practices

StrategyDocument for the

C-IMCI

Sit

uat

ion

an

alys

is

C-IMCI Briefing Package

IMCI Unit AFRO

Community IMCI : Implementation Status

Countries with child health

related community

interventions

IMCI Unit AFRO

Countries with C-IMCI in more than 3 Districts

IMCI Unit AFRO

KEY FACTORS FOR SCALING UP C-IMCI : LESSONS LEARNT

•Advocacy and Resource Mobilization

• Showing Impact

•Partnership

•Documentation and sharing of experience

•Building on existing structures (and not substituting community resources)