Integrated Management of Childhood Illness

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Integrated Management of Childhood Illness
AFRICA SOTA Nairobi June 10 - 15, 2002
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Progress to Date

• Successful introduction phase
• IMCI in gt 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

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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

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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

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For example,
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Progress to Date
BUT

• Districts overloaded, under-resourced,
  limited capacity
• Many first contacts for care are with
  practitioners outside government facilities,
  yet Comp III focused on public sector
• Referral of severely ill children, drug
  availability, staffing, supervision, other
  systems issues remain serious constraints

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Sample DMCI results
Source RPM DMCI studies
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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.
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Community IMCI may change the way forward for
IMCI by moving the focus from the health facility
to the community..
- DFID Review
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Why Community Approaches?

• To reach unreached families and communities

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100
90
Percentage of Children with Unmet Need
80
70
58
60
52
50
of children didn't receive
CS interventions
40
40
32
28
26
25
30
20
10
0
DPT3
ORT
Iodized Salt
Vitamin A Sup
ARI Treatment
Exc Breast Feeding
Nutrition (Underweight)
Immunization data for 12-23 months children and
exclusive breastfeeding for children under 4
months only.
Source DHS, ACC/SCN, Unicef


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El Alto, Bolivia ARI Diarrhea Deaths
99 -- Did not get appropriate home care
39 -- Used community providers
Source BASICS Project, 1997
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Where Health Care Received
TH/Other
Private Clinic
4
NGO
41
2
Other
Public
17
15
Shop/Drug
store
38
Source Pariyo G, Burnham G, et al. Preliminary
results from HH survey in 10 districts,
MCE-Uganda, 2001.
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• To mobilize additional resources and
  partners (including communities families
  themselves)

Percentage of Household Income Spent on Treatment
of Fever - Malawi, 1992
Percent of household income
Source Ettling et al, 1992
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Can Community Approaches Increase Impact?
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Treating Pneumonia - Nepal
Source Penny Dawson, presentation
Community-based IMCI in Nepal, Jan 2001
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Other Examples - Community Approaches at Scale

• Madagascar - Immunization, Nutrition, Safe Water,
  Community IMCI
• Bamako Initiative

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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.

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Key Behaviors Related to Major Causes of Infant
and Child Mortality
Promotion of Health/ Prevention of Illness
Illness Recognition, Home Care Care Seeking

• Recognizing illness
• Appropriate home care
• Dangers signs
• indications for care seeking
• Seeking appropriate
• care
• Accepting referral
• Continued care

• Breastfeeding
• Appropriate feeding
• Micronutrient intake
• Immunization
• Handwashing
• Hygiene
• Bednets

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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

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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

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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