Household Household && Community Community IMCIIMCI

The Child Survival Collaborations and Resource Group

A Global Framework A Global Framework built with Local Know-built with Local Know-

HowHow

Courtesy of PCI

Courtesy of LifenetsI

Courtesy of Microsoft

Courtesy of OFDC

Courtesy of UNICEF

DefinedDefined

Investments $$Investments $$

MaterialsMaterials

DefinedDefined

Investments $$Investments $$

MaterialsMaterials

?

Undefined

Little investment $$

Few Materials

The 3 Components of IMCIThe 3 Components of IMCI

The HH/C IMCI Timeline:The HH/C IMCI Timeline:

1992

WHO/UNICEF LAUNCHES IMCI

1992-1997

Early efforts focus on Health worker skills and system improvements

Santo Domingo Meeting recog. Importance of HH/C-IMCI

Sept. ‘97

Oct. ‘97

UNICEF Meetings with NGO particip produces mandate

for HH/C IMCI

IAWG estab with UNICEF leadership

to develop HH/C-IMCI guidelines

Feb. ‘98

1998-99

CORE IMCI WG dedicates focus on

HH/C IMCI agenda

CORE Mtg. at PAHO

acknowledging role of NGOs in

advancing HH/C IMCI

Feb. ‘99

Durban Mtg consensus on 16 key practices and role

of HH/C IMCI in promoting them

Jun. ‘00

Reaching Communities for Child Health:

Advancing PVO/NGO Technical Capacity and Leadership for

Household and Community Integrated

Management of Childhood Illness(HH/C IMCI) 

Baltimore, Maryland USAJanuary 17-19, 2001

BASICS II CSTS

Who the participants were…Who the participants were…

Non-Governmental Organizations Project HOPECRSWorld Vision Project Concern International Medical Care Development Hellen KellerAndean Rural Health Care PLAN Counterpart International International Rescue Committee CARE Minnesota International Health Volunteers ADRA Salvation Army Save the Children Christian Children’s Fund Aga Khan Foundation Health Alliance International Pearl S. Buck International

Public Health SpecialistsBASICS

CSTS

Environmental Health Project

University Research Center Johns Hopkins School of Public Health

AED

John Snow

MOST

World Education

DISH

Donor Organizations USAID WORLD BANK

UN OrganizationsUNICEFWHOPAHO

From all around the world…From all around the world…

Nicaragua

Uganda

KenyaArgentin

a

Peru

HondurasUnited States

Canada

Rwanda

Uzbekistan

Philippines

Nepal

India

Indonesia

Vietnam

3 Important Resources were used…3 Important Resources were used…

The 4 Intervention Options for HH/C IMCI

By

Peter Winch

18 Presentations

on community strategies

that have had an impact on child health

The expertise of 120

participants

In defining a framework the following questions In defining a framework the following questions were important to consider…were important to consider…

3) What are the roles of MOH, PVOs, NGOs and donor community in HH/C IMCI?

1) How will HH/C IMCI be different than what we are doing now?

2) What will be the relationship between the HH/C IMCI and the other two components?

The Outcome…The Outcome…

The driving force of the workshop, and one of its most promising outcomes, was the evolution of a consensus that articulates a clear vision and dynamic framework for community IMCI. It provides governments, NGOs and communities alike with a clear structure for assessing programs, for future programming, and for advocating for resources necessary to fully operationalize HH/C IMCI.

Element #1:Element #1: Improving partnerships between the facilities and the communities they serve

Courtesy of FAO

Element #1:Element #1: Improving partnerships between the facilities and the communities they serve

Clinic to community•Outreach skills

•Interpersonal counseling

•Quality of health services

Community to clinic•Awareness of health services

•Appropriate and timely use

•Community management

•Health information systems

Cou

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Des

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Element #1 Examples

• Joint village level outreach by community and facility-based providers

• Collaborative oversight, management and supervision of health services by community committees

• Joint collaboration on community-based health information systems

Element #1:Element #1: Improving partnerships between the facilities and the communities they serve

Potential Roles:Potential Roles:

Ministry of Health Improved service provider and partner

NGO Skills building (clinic and community); facilitators; designers of community-based HIS

Community Service user and partner; provider of community health information

Bi/Multi-lateral Agencies Advocate for and fund partnership development activities; Research successful strategies

Validating Questions for Element #1: of IMCI fHave mechanisms been created to Have mechanisms been created to formalize community involvementformalize community involvement in facility-level management decision-making? in facility-level management decision-making?

Have programs assessed and attempted to improveHave programs assessed and attempted to improve service quality service quality and demandand demand based on client feedback? based on client feedback?

Does Does substantive information sharingsubstantive information sharing between the community and between the community and facility occur that affects how and what kind of services are provided?facility occur that affects how and what kind of services are provided?

Element #1:Element #1: Improving partnerships between the facilities and the communities they serve

How do we know if we are How do we know if we are implementing Element 1?implementing Element 1?

Element #2:Element #2: Increasing appropriate and accessable health care and information from

community-based providers

Courtesy of PLAN

Element #2:Element #2: Increasing appropriate and accessable health care and information from

community-based providers

Community-Based Providers

Community Health Workers

Private providers

Traditional Healers

Traditional Birth Attendants

Shopkeepers/Drug sellers

Pharmacists

Health Care

Direct Treatment

Pre-natal care

Immunization

Health Surveillance

Referral

Health information

Behavioral Change Communication (BCC)

Counseling

Awareness

Advocacy

Element #2 Examples

• Training of pharmacy personnel to reduce overuse of antibiotics or to correctly prescribe anti-malarials

• Implementation of mini-pharmacy kits managed by community agents

• Training of CHWs in case management / counseling using simplified IMCI algorithm

Element #2:Element #2: Increasing appropriate and accessable health care and information from

community-based providers

Potential Roles:Potential Roles:

Ministry of Health Supervision, support and training

NGO Trainers, facilitators, service providers

Community Determines service providers, supervises, compensates, complies with counsel

Bi/Multi-lateral Agencies Advocate for and fund element 2 activities as a part of HH/C IMCI

Validating Questions for Element #2: of IMCI fAre you or your partners working with community providers to help Are you or your partners working with community providers to help them expand and improve the following services in the community? them expand and improve the following services in the community?

• appropriate front-line care appropriate front-line care

•referralreferral

•surveillancesurveillance

•health informationhealth information

Element #2:Element #2: Increasing appropriate and accessable health care and information from

community-based providers

How do we know if we are How do we know if we are implementing Element 2?implementing Element 2?

Element #3Element #3:: Integrating promotion of key family practices for child health and nutrition

Element #3Element #3:: Integrating promotion of key family practices for child health and nutrition

A) For physical growth and mental development

B) For disease prevention

C) For appropriate home care

D) For seeking care

Element #3 Examples

• Promoting key health messages through various strategies, such as: communication and behavior change efforts in malaria prevention (ITNs)

• Rehabilitating malnourished children and preventing future malnutrition through the PD/Hearth approach

• Promoting access and use of ORS for diarrhea• Participatory assessments to promote community

input into health behaviors to be promoted

Element #3Element #3:: Integrating promotion of key family practices for child health and nutrition

Potential Roles:Potential Roles:

Ministry of Health Organize national messages, Educates and counsels in clinic

NGO Facilitates identification of priority behaviors, helps adapt and deliver messages via appropriate mechanisms

Community Determines priority behaviors, helps identify appropriate ways of communicating message

Bi/Multi-lateral Agencies Advocate for and fund element 3 activities as a part of HH/C IMCI

Validating Questions for Element #3: of IMCI fElement 3: Are you or your partners helping families to employ key Element 3: Are you or your partners helping families to employ key family practices through effective social and behavioral change family practices through effective social and behavioral change strategies?strategies?

Element #3Element #3:: Integrating promotion of key family practices for child health and nutrition

How do we know if we are How do we know if we are implementing Element 3?implementing Element 3?

Multi-Sectoral Platform

The focus of the multi-sectoral platform is The focus of the multi-sectoral platform is similar to addressing primary health (Alma similar to addressing primary health (Alma Alta): Alta):

– Water and SanitationWater and Sanitation

– EducationEducation

– Income generationIncome generation

– AgricultureAgriculture

Multi-Sectoral Platform

Examples tend to fall in one of three Examples tend to fall in one of three categoriescategories

CONDUIT FOR TRANSFERRING IMPORTANT HEALTH MESSAGES TO THE COMMUNITY AND FAMILY

#1

Multi-Sectoral Platform

Examples of this would be...Examples of this would be...

Incorporating handwashing messages into water and sanitation programs

Building preventive messages on HIV/AIDS into a credit program

Training agricultural extensionists to promote proper weaning foods

Using schools to train students as youth community health promoters

Multi-Sectoral Platform

#2

ALLIGNING DIFFERENT SECTORS TO ADDRESS BARRIERS TO CHANGE FOR KEY HEALTH PRACTICES

Multi-Sectoral Platform

Examples of this would be...Examples of this would be...

Increasing water and sanitation programs to address preventable causes of diarrhea

Mobilizing income generation efforts to break down the economic barrier to ITN purchase

Multi-Sectoral Platform

And...And... #3

MULTI-STAKEHOLDER PLANNING

Validating Questions for MSP: of IMCI fAre you or your partners working with or through other (non-health) Are you or your partners working with or through other (non-health) sector entities in ways that improve child health?sector entities in ways that improve child health?

How do we know if we are How do we know if we are optimizing the MSP?optimizing the MSP?

Multi-Sectoral Platform

Frequently Asked QuestionsFrequently Asked Questions

How does HH/C IMCI link How does HH/C IMCI link with facility-based IMCI?with facility-based IMCI?

How can you apply HH/C How can you apply HH/C IMCI without a health IMCI without a health

facility?facility?

Frequently Asked QuestionsFrequently Asked Questions

Do you really need all the Do you really need all the elements and the MSP?elements and the MSP?

How do they link How do they link together?together?