The courage to make every life count Murwa Bhatti Program Manager, Maternal & Child Health Program,...
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Transcript of The courage to make every life count Murwa Bhatti Program Manager, Maternal & Child Health Program,...
The courage to make every life count
Murwa BhattiProgram Manager, Maternal & Child Health
Program, IRDOct 14, 2015 @ HANIF meeting, Nathiagali
electronic Integrated Management of Childhood Illnesses (eIMCI)
Geographical Scope: Muzaffargarh District
Priority Area: Nutrition
Start Date: April 15, 2015
End Date: December 15, 2015
Global Under 5 mortality
Country % of U5 Mortality Burden U5 Mortality Rate per 1000 live births
India 22.3 61 Nigeria 11.3 128 Congo 6.1 99 Pakistan 5.6 72 China 4.1 15 Ethiopia 3.6 77
Sources: United Nations Interagency Group on Child Mortality Estimation (Report 2012) Liu L. et al. Lancet. 2012
Background: Under 5 Children Health
Source: DHS, Nigeria 2013
Two-thirds of child deaths are from preventable or treatable infectious diseases
Malaria
Pneumonia
Diarrhea
Sepsis/meningitis
Measles
Malnutrition
Integrated Management of Childhood Illness (IMCI)
Aims:
WHO & UNICEF started developing strategy in 1992
Strengthening primary health
Identification of true cases
Rationalizing use of drugs
Reducing hospitalization
Reduce: Death, Illness & Disability
Promote: Improved Growth & Development
IMCI implementation in Pakistan
Currently deployed in more than 80% of 135 districts across Pakistan
– Within district coverage limited to few health facilities
– Lack of adherence by community workers
Adopted by Pakistan in 1998
In 2000 - Launched in 2 Punjab districts
Challenges in Implementation
1 2 3 4
Low training coverage
Challenges in Implementation
21 3 4
Inadequate training
Challenges in Implementation
21 3 4
Complex modules and algorithms
Challenges in Implementation
31 2 4
Lack of adherence to protocol
Sick children not properly
assessed and treated
Parents poorly advised
Weak referral mechanism
between community and
healthcare facility
Inability to reduce
morbidity and mortality
Poor Implementation
leads to…
Overall Goal
Reduce child mortality in an outreach setting to prevent and improve the management of common, and potentially life threatening illnesses in children using a mobile health platform
Focus population: low-socio economic class by selecting a district with the very poor indicators through a effectively proven service
delivery structure of LHW program
Build upon the existing infrastructure of the LHW network to proactively identify and link children and parents to appropriate care
Support the existing healthcare system through LHW capacity building and strengthening the referral network
Through the eIMCI program progress will be directly measured through:
Increase in referrals to target community BHUs and hospitals
Increase in community based care
All < 5 year olds
Inclusion of Dengue, UTI &
TB
Direct enrollment in
interactive reminders program
Direct cellular communication
with CHWs
eIMCI Local Adaptations
Improved monitoring in real time, at scale
01020304
05
Clinical Decision Support System – with screening algorithms to gather patient data and reduce human error
Decreased dependency on quality of training, health workers and supervision
Better implementation of IMCI protocol
Increased screening speed and reduced waiting time
Benefits of electronic-IMCI
eIMCI Application
Implementation Challenges
Availability of LHWs for 11 consecutive days for training is difficult since they spend 9
days a month on polio campaigns
Geographic connectivity and flood warnings
High cost of a 11 day training
Coordination with Punjab Information Technology
Board (PITB)
CORRECT Attributes
C : Credible WHO recommended guidelines
O: Observable Real Time data reporting and results
R: Relevant Refines an LHWs ability to identify and manage an illness
R: Relative Advantage Innovation in technology
E: Easy to install and understandable Easy-to-use smartphone application
C: Compatible Facilitates daily duties of end users (LHWs)
T: Testable Pilot followed by implementation
Key Stakeholders
LHW teams
EPI
Indus Hospital
Local Community
Provincial and District
Health Departments
Other National Programs
eIMCI Scale up plan
International Expansion
END