Overview of IMCI strategy and implementation

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Overview of IMCI strategy and implementation
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What are major issues affecting child health?
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Significant Progress and Huge Inequities in
Child Mortality
Under 5 mortality rate (per 1000), by income
level,
WHO Member States, 1978 and 1998
180
High income
160
149
Low/middle income
140
120
100
100
80
60
40
19
20
8
0
1978
1998
Source WHR, 1998
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Major Causes of Death, ChildrenUnder 5, WHO
Member States, 1998
Total deaths
10.8 million
Perinatal (20)
Respiratory diseases (17)
Diarrhoeal diseases (17)
Measles (8)
49 of
Malaria (7)
child
Injuries (6)
deaths
Congenital (4))
HIV/AIDS (3))
All other (18)
Malnutrition is estimated to
contribute to around 50 of
all childhood deaths.
EIP/WHO
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Common Problems That Affect the Quality of Care
Provided to Sick Children at Health Facilities

• Health workers skills
• incomplete examinations and counselling
• poor communication between health workers and
  parents
• irrational use of drugs
• Health system issues
• location of health services and responsibility
  (centralisation)
• availability of appropriate drugs and vaccines
• supervision / division of labour / organization
  of work
• Community and family practices
• poor knowledge of when to return to a health
  facility
• seeking assistance from unqualified providers
• poor adherence to health worker advice and
  treatment
• delayed careseeking

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Vertical health programmes
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Major issues affecting the health of children

• inequities (differences between rich and poor,
  urban and rural, tertiary and primary care)
• poor quality of care at all levels
• low efficiency (vertical delivery mechanisms)

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Integrated Management of Childhood Illness
(IMCI)What is it?
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Integrated Management of Childhood Illness
(IMCI)Objectives

• To reduce significantly global mortality and
  morbidity associated with the major causes of
  disease in children under five
• To contribute to healthy growth and development
  of children

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Target age groups forIMPAC pregnancy and
early neonatal period (up to 7 days of life)
IMCI 7 days up to 5 years
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IMCI as a key strategy for Improving Child Health
promotes

• integrated case management of sick children
• Nutrition
• Immunization
• Other disease prevention
• Prevention of injuries
• Psychosocial support and stimulation

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IMCI components and intervention areas

• District planning and
• management
• Availability of IMCI
• drugs
• Organization of work
• at health facilities
• Quality improvement
• and supervision at
• health facilities
• Referral pathways
• and services
• HIS
• IMCI and health
• sector reforms

Case management guidelines and standards

• Careseeking, Nutrition
• Home case management
• Adherence to recommended treatment
• Community involvement in health planning and
  monitoring

Training of facility-based public health providers

IMCI roles for private providers

Maintenance of competence among trained health
workers

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What is New with IMCI?
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The IMCI Strategy Promotes Integration at Many
Levels
Health Facilities - provide support and essential
resources for the prevention and treatment of
major childhood illnesses
Families and Communities - promote appropriate
home care and safe and supportive environments
for healthy growth and development
Health Care Providers - attend one training
course, rather than an array of disease -specific
courses, and provide integrated care
Children - receive holistic care
Ministry of Health - different MoH
departments and technical programmes work
together with professional societies,
universities and others to plan and implement
the strategy
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Case Management Process
Golden paediatric standard
Complete examination all signs and systems
Preliminary Diagnosis
Laboratory examination
Final Diagnosis
Treatment strategy
Treatment procedures
Differential Diagnosis
Advise to caretakers Follow- up
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IMCI vs. Vertical health programmes
National programmes collaborate in
Integrated clinical guidelines
and training materails
integrated training courses
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Benefits of the IMCI strategy

• leads to increased efficiency of health services
  and saves resources
• focuses care on major health problems in children
• contributes to prevention as well as treatment
• leads to improved quality of care and utilisation
  of services
• improves equity
• is a flexible strategy that can be adapted to
  major child health issues in a given context
• may lead to a significant impact on childrens
  health

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What IMCI can contribute to Health Sector Reform
efforts

• Cost-effective child health strategy included in
  the basic package of essential health services
• emphasizes capacity building at district level -
  facilitates decentralization
• potential cost savings through
• rational use of drugs
• reduces missed opportunities
• pooling of resources

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IMCI is not Just Another Vertical Programme"
Case management guidelines and training
for individual diseases
Integrated case management guidelines,
training and follow-up
Health worker skills
IMCI brings it all together
Interventions to improve family
and community practices
Health education activities for individual
diseases
Family and community

Drug supply and management
District level management of health services
Health system
Health system development