Project telegram

Country/regionPilots in Tanzania, Peru and Indonesia, global implementation underway

Project objective- Scale up effective training of health workers

in Integrated Management of Childhood Illness (IMCI)

- Facilitate national adaptation of IMCI guide-lines

Target groupsIMCI adaptation professionals, IMCI teachers and first-level health workers

PartnersWHO Department of Maternal, Newborn, Child, and Adolescent Health (MNCAH)Swiss Tropical and Public Health Institute (Swiss TPH)

Technical supportSirius Technologies AG (software development until July 2011)Swiss TPH as of August 2011

Project duration2005-2010: Development and early application of ICATT2011-2012: Scaling up of ICATT and develop-ment of maternal and newborn health tool

Project websitewww.icatt-training.org

Novartis Foundation for Sustainable DevelopmentProject description

In 2009, more than eight million children died before reaching their fifth birthday, most of them in developing countries. The majority of these deaths could have been prevented through a relatively small number of simple low-cost interventions such as pre-, ante- and post-natal care, vaccinations, and antibiotics. The technical guidelines for these interventions exist, but effective application by trained health workers at various levels in the health system is still lacking.

To support and scale up training of health personnel working with sick children, the Novartis Foundation for Sustainable Development (NFSD), together with the World Health Organization (WHO), devel-oped an e-learning tool for Integrated Management of Childhood Illness (IMCI). IMCI is a WHO/UNICEF strategy that aims to sig-nificantly and rapidly reduce infant and childhood mortality. The new software is thus called ICATT (IMCI Computerized Adaptation and Training Tool) and is available free of charge. Tanzania, Peru and Indonesia have been the first to adapt ICATT and use the e-learning tool for training in IMCI. Results from these countries show that ICATT can reduce training time and costs and allows for faster and more flexible upscaling of IMCI training.

ICATT: Innovative e-learning tool for training in childhood illnesses

Integrated WHO strategy to improve children’s healthDeaths in children under five have declined steadily worldwide from 93 per 1,000 live births in 1990 to 72 in 2008. Nevertheless, even today eight million children per year die before reaching their fifth birthday. A child born in a developing country is over 13 times more likely to die within the first five years of life than a child born in an industrialized country. In sub-Saharan Africa, one in seven children dies before his/her fifth birthday. Most common causes are respiratory infections (mostly pneumonia), diarrhea, measles, malaria and malnutrition.

Seventy percent of these deaths could be prevented or treated through relatively simple interventions including pre-, ante- and postnatal care, childhood vaccinations, antibiotics for common infectious lung diseases such as pneumonia, zinc and electrolyte solution for diarrhea, and nutritional interventions. Several isolated interventions have proven effective, such as prompt malaria treat-ment or vaccinations to reduce measles. Many children, however,

have overlapping symptoms of diseases and a single diagnosis can be difficult. What is therefore needed is an integrated approach addressing the overall health of children. Integrated Management of Childhood Illness (IMCI), developed by WHO and UNICEF, is one of the cornerstones of the drive to reach the child health-related Millennium Development Goals. It has three components: - Improve case management skills of healthcare staff, - Improve overall health systems, and- Improve family and community health practices.

To date, more than 100 countries have adopted IMCI as a strategy to improve child and infant health. The introduction of IMCI at country level requires a great deal of coordination among exist-ing health programs and services. Main challenges include the adoption of national IMCI guidelines on a regular basis as well as training and retraining of a sufficient number of staff in IMCI.

Innovative technology to scale up IMCI trainingIn order to scale up the IMCI workforce, the Novartis Foundation has supported the WHO Department for Maternal, Newborn, Child, and Adolescent Health in the development of an innova-tive e-learning tool. ICATT (IMCI Computerized Adaptation and Training Tool) enables a large number of health workers to be trained in IMCI in a cost-effective way without a loss in quality.

At the same time, ICATT is an open, flexible software and allows for technical updates, different languages and country-specific circumstances. The generic ICATT version is a starting point for creating national and local IMCI training courses according to the relevant categories of health staff and desired languages (see figure 2). This is done by the responsible department for adapt-ing the IMCI guidelines at the national Ministry of Health and medical or paramedical schools, often supported by WHO. The number of training units can be varied. Videos, pictures, sounds and any document can be integrated into ICATT and, if needed, linked to the training course. The process of adapting the techni-cal IMCI guidelines is facilitated and new guidelines can easily be incorporated.

Figure 1: Under-five mortality rate per 1,000 live births, 1990 and 2008

!

80 120 160 200400

Sub-Saharan Africa

Southern Asia

South-Eastern Asia

Latin America

Developed regions

Developing regions

184

121

73

52

12

100

144

74

38

23

6

72

1990

2008

2015 Target

Source: UN Millennium Development Goals Report 2010

Vaccination of infant in Cinzana, Mali

IMCI assessment in health facility in Ifakara, Tanzania

Waiting room of health facility near Ifakara, Tanzania

2 | Novartis Foundation for Sustainable Development Project description

Figure 2: Adaptation of ICATT software

Generic ICATT software is provided by WHO / NFSD

Generic ICATT software isadapted locally by the Ministry of Health or medical schools

Healthworkers are trained through ICATT in IMCI refresher courses (in-service use)

Students are trained through ICATT in IMCI courses (pre-service use)

Once ICATT is adapted to national requirements it can be “closed” and the training player can be distributed to IMCI training institu-tions. The software can then be used for both pre-service (students) and in-service use (refresher courses for health workers). Any medi-cal and paramedical personnel including nurses, midwives, doctors and medical assistants can be trained through ICATT.

The software creates a profile of the user and monitors the trainees’ progress throughout the training. To run the software, a trainee has to have access to a computer but no specific computer skills are needed. The program can either be installed on a com-

puter or run directly from a CD-ROM or memory stick. The most recent version of ICATT released in August 2011 is also equipped to run on intranets and internet sites as well as the World Wide Web, creating global access to the training.

The first English version of ICATT was released in May 2008 together with a moderated website (www.icatt-training.org) to assist and provide software updates for ICATT users. Russian, French, Spanish, Portuguese, Swahili, Indonesian and Khmer versions have been released and others are under development. The copyright of ICATT belongs to WHO and the Novartis Foundation but the program can be used free of charge by anyone for health-related training without commercial purpose.

Successful implementation to dateIn 2008, the ICATT software was piloted and tested in Tanzania, Peru and Indonesia. Results showed that adaptation of national guide-lines was facilitated specifically because ICATT allows the creation of several different training packages to serve different categories of trainees. Costs were reduced as ICATT does not require printing of hard copy training material. As for the training itself, three different approaches have been tested: - classroom training with individual computers,- classroom training with projector, and- distance learning.

Each type of training showed some strengths but also bears some challenges. Classroom teaching with individual computers for exam-ple allows for working at individual pace while interaction with a facilitator is ensured. Though the need for a large number of comput-ers is obviated when teaching with a projector, ICATT training is more demanding for both students and facilitators and monitoring training progress is difficult. Distance learning cuts down costs even more as no travelling and physical attendance is needed. Disadvantages, however, include the need for regular access to a computer and potential lack of motivation or interaction with the facilitator.

All in all, ICATT courses proved to be more cost-effective because no print outs are necessary and the course can be done in a shorter

Source: NFSD

ICATT course in Peru

ICATT course at Tanzanian Training Center, Ifakara

Novartis Foundation | 3 for Sustainable DevelopmentProject description

Structure of ICATT training player:

Read (technical information)

See (illustration material such as pictures and videos)

Exercise (exercises with immediate feedback)

Test (feedback is not immediate but can be used by facilitator)

Project description

Collaboration with World Health Organization (WHO), Swiss Tropical and Public Health Institute (Swiss TPH), and Tanzanian Training Centre for International Health (TTCIH)

ICATT is being further developed for training in Integrated Management of Pregnancy and Childbirth (IMPAC)

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. A global partnership for development

Contribution to the Millennium Development Goals

Innovative e-learning tool for training in Integrated Management of Childhood Illnesses (IMCI)

ICATT contains training modules on common childhood illnesses (incl. malaria)

4 | Novartis Foundation for Sustainable Development

period of time compared to traditional IMCI training. This also allows more time for clinical practice. The feedback from students was also very positive, reflecting the user-friendliness and flexibility of the tool compared to other e-learning programs.

Global roll-out of ICATT To date, a number of other countries have also started introducing ICATT for adaptation and training. WHO estimates that in total, 12 countries have completed adaptation through ICATT (Cambodia, Fiji, Indonesia, Kiribati, Malaysia, Mozambique, Peru, Philippines, Solomon Islands, South Africa, Tanzania, and Vietnam) and seven of them have started to implement training. To further scale up, the WHO conducted a Global Orientation and Capacity-Building Workshop at the end of 2010 and has organized several regional workshops in the course of 2011. The Novartis Foundation is sup-porting the regional workshop in Western Africa held in Mali.

Sirius Technologies has further developed ICATT to enable the train-ing player to be run on an internet browser. On the one hand, this will allow training institutions to teach ICATT through their intranets or internet sites. On the other hand, as of 2011 the ICATT training player is also hosted on the World Wide Web, giving access to IMCI training to students around the world.

The potential of ICATT as an alternative training approach has also been recognized by other health programs which are not related to IMCI. The software is currently used to develop training courses such as on the Convention on Rights of the Child for WHO staff and on Chronic HIV care as part of the Integrated Management of Adolescent and Adult Illness course.

New partnership for maternal and newborn healthApart from child diseases, one of the biggest challenges today is maternal and newborn mortality. Every day, up to 1,500 women and up to 10,000 newborn babies die due to complications in preg-nancy and childbirth. A woman in a developing country is 300 times

more likely to die during childbirth or due to pregnancy-related complications than a woman in a developed country. To tackle these challenges, training in maternal and newborn care must be scaled up globally.

Thus, the Novartis Foundation and the WHO decided to continue their collaboration in order to develop an e-learning tool for training in Integrated Management of Pregnancy and Childbirth (IMPAC). The tool is based on the ICATT software and will comprise training modules in pregnancy care, childbirth, newborn care, postnatal maternal care and postnatal newborn care.

The tool will be developed together with a new partner, the Swiss Tropical and Public Health Institute (Swiss TPH). The first course module on Essential Newborn Care is under development and ready for testing by the end of 2011. To ensure sustainability and make use of synergies within Swiss TPH, the technical work of the software maintenance has been transferred from Sirius Technologies to the Swiss TPH.

Useful links: www.icatt-training.orgwww.novartisfoundation.org/projects

Premature newborns, Ifakara, Tanzania