Community IMCI - Ferghana, Uzbekistan

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Community IMCI - Ferghana, Uzbekistan
Mary E. Skarie, USAID/CAR
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Under-five Mortality Rates in Central Asia

• Uzbekistan 69 2000 UNICEF MICS
• Kazakhstan 71.4 1999 DHS
• Kyrgyzstan 72.3 2000 WB
• (96.4 in lowest economic stratum)
• Turkmenistan 90 2000 DHS
• Tajikistan 126 2000 UNICEF MICS

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Existing Uzbekistan Structures Supporting
Community-Based IMCI

• PHC Physician and nurse home visiting program
• Community education system in place from Soviet
  times
• Local neighborhood structure (Mahalla) provides
  social support network
• Issues Community-Based IMCI Can Address
• Exclusive breastfeeding to age 6 months at only
  22 (2000 UNICEF MICS)
• 61 of children under 3 have anemia (1996 DHS)
• Lack of knowledge on prevention/home
  treatment/professional treatment
• Diarrhea
• ARI

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Community Involvement
Schools, Kindergartens, Youth Centers
NGOs CBOs
Primary Health Care Facilities (Healthcare System)
Health Promotion Centers
Community Religious Leaders
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Community IMCI Activities

• Health campaigns
• anemia general nutrition (target general
  nutrition)
• ARI
• diarrhea
• IMCI danger signs (incorporated in diarrhea ARI
  campaigns)
• breastfeeding (upcoming)
• Health fairs - PHC sponsored
• hygiene
• diarrhea
• ARI
• breastfeeding
• NGO grant activities
• Nabahor improving client education by visiting
  nurses and midwives, including weekly bazaar
  event
• Hilol Mother Support Groups
• Ayol Va Salomatlik improving child health

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Examples of Community IMCI

• Training Health Promotion Center staff to conduct
  community conversations and health events
  (e.g., health fairs)
• anemia general nutrition (target women and
  children)
• ARI
• diarrhea
• hygiene
• Training SVP/SVA health workers for client
  education
• anemia general nutrition (target women and
  children)
• ARI
• diarrhea
• hygiene
• breastfeeding

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Examples of Community IMCI

• School health lessons
• diarrhea
• ARI
• hygiene
• nutrition
• transmission of germs/disease
• School song competition
• winner of best song Diarrhea
• Cassette with songbook (songs, skits, fables
  poems)
• hygiene
• diarrhea
• importance of staying healthy
• healthy habits

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Health Knowledge, Attitude, and Practice Survey

• This survey was conducted among the population in
  four locations in Uzbekistan in June 2001
• Quva Rayon
• a mature rural site (Ferghana Oblast)
• Ohunbabaev Rayon
• a new rural site (Ferghana Oblast)
• Margilon City
• a future urban site (Ferghana Oblast)
• SyrDarya Rayon
• a future rural site (SyrDarya Oblast)

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Survey ResultsIntegrated management of
childhood illnesses

• When should a child be seen by a health care
  worker or taken to a health are facility
• a) blood in stools d) high temperature
• b) inability of drink e) breastfeeding poorly
• c) cold or cough with f) continues to get sicker
• difficulty breathing
• Average number of reasons to take a child to a
  health care provider correctly identified.
• Quva Rayon 2 Ohunbabaev Rayon 1.8
  Margilon City 1.4 SyrDarya Rayon
  1.6

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Survey Results Knowledge about Breastfeeding
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Future Activities for National Scale-Up

• Extend previous health campaigns nationally
  through Institute of Health
• Expand NGO grants program for "Healthy
  Communities
• Extend school health curriculum nationally
  through Ministry of Education

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Future Activities Oblast-wide

• Conduct 2 new health campaigns per year
• Train visiting nurses and midwives on improved
  client (child mother) screening and health
  education during home visits
• Pilot Mother Support Groups at community level
• Promote collaboration among all organizations
  involved in community-based health education
  through Oblast Health Promotion Working Group