Integrated Management of Neonatal & Childhood Illnesses (IMNCI

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State Institute of Health and Family Welfare, Jaipur

Introduction

WHO/UNICEF have developed a new approach to tackling the major diseases of early childhood called the Integrated Management of Childhood Illnesses (IMCI)

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Developments Related to Child Health
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1978: EPI 1984: UIP 1985: Oral Rehydration Therapy1 1990: UIP and ORT universalized, ARI as a pilot in26 districts 1992: CSSM 1997: RCH-1 2005: NRHM and RCH II

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Why IMNCI

Ø Reduce infant and child mortality rates Ø Improving child health & survival Ø IMR reduced from 114 (1980) to 53 (2008)SRS bulletin Ø Decline not uniform across states Ø 8 states including Rajasthan are below national average Ø Malnutrition and low birth weight (LBW) are contributors to the about 50% deaths among infants and children under 5 years of age Ø
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IMNCI Beneficiaries

Ø Care of Newborns and Young Infants (infants under 2 months) Ø Care of Infants (2 months to 5 years)
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Care of Newborns and Young Infants (infants under 2 months)
Ø Keeping the child warm Ø Initiation of breastfeeding immediately after birth Ø Counseling for exclusive breastfeeding Ø Cord, skin and eye care Ø Recognition of illness in newborn and management and/or referral Ø Immunization Ø Home visits in the postnatal period Ø

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Care of Infants (2 months to 5 years)
Ø Management of diarrhoea, acute respiratory infections (pneumonia) malaria, measles, acute ear infection, malnutrition and anemia Ø Recognition of illness and at risk conditions and management/referral Ø Prevention and management of Iron and Vitamin A deficiency Ø Counseling on feeding for all children below 2 years Ø Counseling on feeding for malnourished children between 2 to 5 years Ø Immunization

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IMNCI Components and Intervention areas
Improve health worker skills Improve health Improve family & systems community practices

Case management District & Block Appropriate Care standards & planning and seeking guidelines management Training of facility- Availability of based public health IMNCI drugs care providers Nutrition

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Improve health worker skills

Improve health Improve family & systems community practices Quality Home case improvement and management & supervision at adherence to health facilities – recommended public & private treatment

IMNCI roles for private providers

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Improve health Improve health Improve family & worker skills systems community practices Maintenance of Referral competence pathways & among trained services health Health Information System
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Community services planning & monitoring

Components of IMNCI
Ø Training Ø Effective implementation ØImprovements to the health system ØImprovement of Family and Community Practices Ø Collaboration/coordination with other Departments

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Training Ø IMNCI is a skill based training in both facility and community settings Ø Broadly, two categories of training are included Øfor medical officers Øfor front-line functionaries including ANM’s and Anganwadi Workers (AWW’s)

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Effective implementation Ø Improvements to the health system ØEnsuring availability of the essential drugs ØImprove referral to identified referral facility ØReferral mechanism ØFunctioning referral centers ØEnsuring availability of health workers/ providers at all levels ØEnsuring supervision and monitoring through follow up visits


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Effective implementation Ø Improvement of Family and Community Practices Ø Counseling of families and creating awareness which includes: ØPromoting healthy behaviors ØIEC campaigns ØCounseling of care givers and families ØDuring home visits identify sickness and focused BCC for improving newborn and child care practices

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Collaboration/coordination with other Departments ØInvolvement of ANM and Anganwadi workers of ICDS ØInvolvement of grass-root functionaries of other sectors ØActive involvement of PRI, self help groups and women’s groups

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F-IMNCI

From November 2009 IMNCI has been re -baptized as F-IMNCI, (F -Facility based management) with added component ofØAsphyxia Management and ØCare of Sick new born at facility level, besides all other components included under IMNCI

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Institutional Arrangements
Ø State Level

Ø District Level

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State level Institutional Arrangements
Ø Appoint Nodal Officer Ø Set up a co-ordination Group Ø Review progress Ø Arrange logistics Ø Create pool of State level trainers Ø Selection of priority districts Ø Identify the State Nodal institute for training Ø Improvement in family and community practices
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District level Institutional Arrangements
Ø Appoint District Coordinator Ø Set up an IMNCI Coordination Group Ø Train District Trainers. Ø Develop a detailed plan for implementation Ø Ensure timely supplies & logistics, supervision and follow-up Ø IEC activities
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Training in IMNCI
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Focus on Skill Development

Ø Hands-on training
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ØVisits to hospitals ØField visits and visits to the homes of sick children
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Training in IMNCI

Training at two levels ØIn-service training for the existing staff

ØPre-Service Training
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Type of Personnel to be Durati Package Place of Training trained on to be Training used Clinical skills training Medical Officer 8 daysPhysician Medical and Pediatrician Package college /District Hospital Health workers ANMs, LHVs, Mukhya sevika CDPO’s and AWWs 8 daysHealth District Workers Hospital Package

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Type of Personnel to Durati Package Place of Training be trained on to be usedTraining Superviso Medical 2days Supervisor Medical ry Skills Officers, y Skills college Training Pediatricians, package /District CDPO’s LHVs Hospital and Mukhiya Sevikas)

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Training of Trainers
Ø All pediatricians in the district

Ø Selected medical officers from CHCs and block PHCs

Ø Selected staff nurses and LHVs and CDPO’s and Mukhiya Sevikas from ICDS

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Number to be Trained
Ø District of average size about 1800 health staff will need to be trained
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Ø Number of the staff of other departments should included in consultation with the concerned district officers
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Ø Staff belonging to a PHC areas may be taken up fully before moving to another PHC area

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Training Institutions
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Ø State Level

Ø District Level

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State Level Training Institutions
ØIdentify a Regional Training Centre

ØThe Departments of Pediatrics and Preventive & Social Medicine in each college

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District Level Training Institutions

Ø District hospital for training of medical officers

Ø CHCs/operational FRUs etc for training of health workers •

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Follow-up Training (FUT)

The Follow-up Training is designed to improve supportive supervision for 2 days which may either be clubbed with Clinical skills training or conducted within 6-8 weeks of the initial Clinical skills training

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Pre-Service Training

Ø Pre-service training in medical colleges include training of undergraduate students and interns Ø ANM, AWW, and Staff Nurses’ training schools need to include IMNCI in their training schedules

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Funding Arrangements
Ø National Level training: by the Government of India Ø State Level training: State project funding requirements for the following in NRHM/RCHII-PIPs Ø District Level training: State project funding requirements for the following in NRHM/RCHII-PIPs Ø At District Training Cell (in the District Hospital) Ø At other Training Centres within the District (Maximum two in identified CHCs/PHCs)

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Funding Arrangements
Ø Translation, printing and supply of training material

Ø Field-level Monitoring Support, Follow up and Coordination

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Navjat Shishu Suraksha Karykram (NSSK)

Launched on September 15, 2009. Focuses on: ØPrevention of Hypothermia

ØPrevention of Infection
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ØEarly initiation of Breast feeding and
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ØBasic Newborn Resuscitation


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Objectives: NSSK

Ø One trained person at institutional facility, where deliveries take place

Ø NSSK will train healthcare providers at the district hospitals, community health centres and primary health

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Limitations of IMNCI
Ø Outpatient Facility Based

Ø Community activities not given adequate focus

Ø Training centre of attention

Ø Vertical initiatives in Non IMNCI districts sorely lacking

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Thank you

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