Palestine MOH

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PalestinePalestineMOHMOH

Integrated Management of Childhood Integrated Management of Childhood IllnessIllness::

The road to healthy childhoodThe road to healthy childhoodPalestinian Experience in IMCIPalestinian Experience in IMCI

Dr. Younis Awad AllahDr. Younis Awad AllahIMCI National CoordinatorIMCI National Coordinator

MPHMPH

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PalestinePalestine

Total population in OPT: 3,762,005Total population in OPT: 3,762,005 West Bank: 2,372,216West Bank: 2,372,216 Gaza Strip: 1,389,789Gaza Strip: 1,389,789

, Proportion of pop aged under 5 years (19.2% in GS , Proportion of pop aged under 5 years (19.2% in GS and 16.6% in WB) and 16.6% in WB) Reported CBR per 1000 pop (33.7 in GS Vs 23.9 in Reported CBR per 1000 pop (33.7 in GS Vs 23.9 in WB) WB) Reported CDR per 1000 pop (3.1 in GS Vs 2.5 in WB) Reported CDR per 1000 pop (3.1 in GS Vs 2.5 in WB) IMR 20.8 per 1000live births( 20.8 in GS Vs 3.9 in IMR 20.8 per 1000live births( 20.8 in GS Vs 3.9 in WB).WB).Child U5years mortality rate 20.07 per 1000 live Child U5years mortality rate 20.07 per 1000 live births (24.6 in GS Vs16.3 in WMbirths (24.6 in GS Vs16.3 in WM

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Child Health careChild Health care

The Palestinian authority has recognized child The Palestinian authority has recognized child survival interventions as a high priority since long survival interventions as a high priority since long time .time .Many child health care interventions were Many child health care interventions were introduced during the last period, commonly run introduced during the last period, commonly run through vertical national programme . CDD and ARI through vertical national programme . CDD and ARI programs were adopted since 1994.programs were adopted since 1994.EPI programme passing with an excellent coverageEPI programme passing with an excellent coverageBreastfeeding and supplementary feeding Breastfeeding and supplementary feeding programme need more activation .programme need more activation .Screening of newborns for hypothyroidism and PKU Screening of newborns for hypothyroidism and PKU still active programme.still active programme.WBC and anthropometric measures programme WBC and anthropometric measures programme need more activation.need more activation.

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What Is Integrated Management of What Is Integrated Management of Childhood Illness IMCIChildhood Illness IMCI

The united Nation “Convention on the rights of The united Nation “Convention on the rights of child” urge countries to take appropriate child” urge countries to take appropriate measures to fully implement the rights of measures to fully implement the rights of child ;among which are:child ;among which are:1- to diminish infant and child mortality;1- to diminish infant and child mortality;2- to ensure the provision of necessary medical 2- to ensure the provision of necessary medical assistance and health care to all children with assistance and health care to all children with emphasis on development of primary health;emphasis on development of primary health;3- to combat diseases and malnutrition;3- to combat diseases and malnutrition;4- to ensure that parents and children have 4- to ensure that parents and children have access to education and are supported in the access to education and are supported in the use of knowledge of child health and nutrition. use of knowledge of child health and nutrition.

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World challengeWorld challenge

WHO estimate that about 12 million children in WHO estimate that about 12 million children in developing countries die every year before developing countries die every year before reaching their fifth birthday.reaching their fifth birthday.Seven in 10 of these deaths are due to one or Seven in 10 of these deaths are due to one or combination of group of common diseases. combination of group of common diseases. These are ARIs (mostly pneumonia), These are ARIs (mostly pneumonia), dehydration (due to diarrhea) ,measles, malaria dehydration (due to diarrhea) ,measles, malaria and malnutrition.and malnutrition.In addition, one, or a combination of these five In addition, one, or a combination of these five condition causes 3 in 4 episodes of childhood condition causes 3 in 4 episodes of childhood illness.illness.

77Bryce J, et al. “WHO estimates of the causes of death in children.” Lancet 2005.

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So;So;

WHO, CHD, with UNICEF responded by developing the strategy known as IMCI

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IMCI StrategyIMCI Strategy

IMCI is neither another vertical program, IMCI is neither another vertical program, nor a project, it is anor a project, it is a strategy of managing strategy of managing common illnesses among children under -common illnesses among children under -5years of age.5years of age.

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Recently WHO (EMRO) Announcement Recently WHO (EMRO) Announcement

(Nov.2007)(Nov.2007) IMCI is adopted by the Regional Office as IMCI is adopted by the Regional Office as the primary child health care strategy, the primary child health care strategy, offering a wide range of interventions offering a wide range of interventions under its overall umbrella and countries under its overall umbrella and countries invited to see IMCI within this vision, and invited to see IMCI within this vision, and not as a vertical training program, and to not as a vertical training program, and to commit increased resources for it to commit increased resources for it to achieve the child mortality-related achieve the child mortality-related Millennium Development Goal no. 4.Millennium Development Goal no. 4.

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IMCI ObjectivesIMCI Objectives

1- To reduce significantly mortality and 1- To reduce significantly mortality and morbidity associated with the major morbidity associated with the major causes of disease in children.causes of disease in children.

2- To contribute to healthy growth and 2- To contribute to healthy growth and development of children. development of children.

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IMCI Addresses Most Causes of IMCI Addresses Most Causes of DeathDeath

PneumoniaPneumonia

DiarrheaDiarrhea

MeaslesMeasles

MalariaMalaria

MalnutritionMalnutrition

SepsisSepsis

MeningitisMeningitis

DehydrationDehydration

AnemiaAnemia

Ear infectionEar infection

HIV/AIDSHIV/AIDS

WheezingWheezing

Sore throatSore throat

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Integrated Management of Integrated Management of Childhood Illnesses (IMCI)Childhood Illnesses (IMCI)

integrated approachintegrated approach

aims to reduce death, illness and aims to reduce death, illness and disability, and to promote improved growth disability, and to promote improved growth and developmentand development

includes both preventive and curative includes both preventive and curative elements elements

implemented by families, communities and implemented by families, communities and health facilitieshealth facilities

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Components of IMCIComponents of IMCI

The IMCI strategy seeks to reduce the child The IMCI strategy seeks to reduce the child mortality through a broad and cross-mortality through a broad and cross-cutting approach with components as:cutting approach with components as:

Improves health worker skillsImproves health worker skills

Improves health systemsImproves health systems

Improves family and community Improves family and community practicespractices

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Improving Health Worker Skills, Improving Health Worker Skills,

Community Care, and Health SystemsCommunity Care, and Health Systems

Capacity, structureand functions ofhealth system

Knowledge,Beliefs and skills caretakers

ClinicalAssessmentand treatment by health workers

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IMCI as a Key Strategy for IMCI as a Key Strategy for Improving Child HealthImproving Child Health

Strengtheninghealth system

support

Strengtheningcommunity

involvement &participation

Strengtheninghealth workers

skills

Integrated Management of Childhood Illness


support




skills

2020



support




skills

Integrated Managementof Childhood Illness


support




skills

2121



support




skills



support




skills

2222



support




skills



support




skills

SICK CHILD

WELL CHILD

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Introduction of IMCI was Introduction of IMCI was significantly associated withsignificantly associated with::

reductions in the misuse of reductions in the misuse of antibioticsantibiotics

Correct treatment of child Correct treatment of child illness with antibioticsillness with antibiotics

increased knowledge increased knowledge among mothers about how among mothers about how

to administer drugs correctlyto administer drugs correctly

improved efforts by health improved efforts by health workers to educate workers to educate

caregivers on home caregivers on home treatmenttreatment

more frequent administration more frequent administration of the first dose at the facilityof the first dose at the facility

A simplified model of IMCI impact

IMCI Intro/Planning

Training of healthworkers/follow up visits

Improved householdcompliance/care

Improved careseeking,increased utilization

Improvedhealth/nutrition

Improved drugavailability, supervision,

other health systemimprovements

ITNs, other family andcommunity interventions

Improved quality of care inhealth facilities

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The principles of integrated The principles of integrated carecare

The IMCI guidelines are based on the following principles:

# All sick children must be examined for “general danger signs”.

# All sick children must be routinely assessed for major symptoms

# Only a limited number of carefully-selectedclinical signs are used, based on evidence oftheir sensitivity and specificity7 to detect disease.

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The road to healthy The road to healthy Palestinian childhoodPalestinian childhood

Palestinian Experiences in IMCIPalestinian Experiences in IMCI

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Implementation of IMCI involves Implementation of IMCI involves three phasesthree phases::

the introductory phasethe introductory phase to ensure that key to ensure that key persons in MoH and other health services persons in MoH and other health services providers understand IMCI strategy .providers understand IMCI strategy .

the early implementationthe early implementation phase to plan phase to plan and prepare for IMCI implementation .and prepare for IMCI implementation .

the expansion phasethe expansion phase includes efforts to includes efforts to increase access and to broaden the range increase access and to broaden the range of IMCI interventions. of IMCI interventions.

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Achievements:Achievements:Introduction phase:Introduction phase:

H.E MOH Minister approved to adopt IMCI H.E MOH Minister approved to adopt IMCI strategy within the health system 2001. strategy within the health system 2001.

Introduction of IMCI approach under PHC Introduction of IMCI approach under PHC umbrella. umbrella.

Attendance of Rabat-morocco meeting 1998.Attendance of Rabat-morocco meeting 1998.

Attendance of inter-country meeting for IMCI Attendance of inter-country meeting for IMCI national coordinators Damascus, Syria July national coordinators Damascus, Syria July 1999 (3 participants) from Gaza & WB1999 (3 participants) from Gaza & WB

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Nomination of IMCI National coordinator and IMCI Nomination of IMCI National coordinator and IMCI focal persons for GAZA and West Bank. focal persons for GAZA and West Bank. One day orientation meeting conducted (August One day orientation meeting conducted (August 2000) both in GAZA and West Bank. (WHO), followed 2000) both in GAZA and West Bank. (WHO), followed by: by: Two days preliminary and adaptation workshop Two days preliminary and adaptation workshop (August 2000) in GAZA and West Banks. (WHO)(August 2000) in GAZA and West Banks. (WHO)Orientation meeting (UNICEF and Al Quds Orientation meeting (UNICEF and Al Quds university). university). abroad training: IMCI task force members trained in abroad training: IMCI task force members trained in Egypt (2 participants from GS & WB). * Training key Egypt (2 participants from GS & WB). * Training key personnel in Syria (4 participants) from GS & WB personnel in Syria (4 participants) from GS & WB (2001) including IMCI national coordinator and Local (2001) including IMCI national coordinator and Local persons. persons.

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2 orientation meetings in Gaza (2001)2 orientation meetings in Gaza (2001)IMCI working group formulation (IMCI IMCI working group formulation (IMCI task force):-task force):- 1- Adapting group1- Adapting group2- Planning and implementation group 2- Planning and implementation group 3- Community and family practice 3- Community and family practice groupgroup

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Early Implementation PhaseEarly Implementation Phase::

Developing of national strategy and plan. Developing of national strategy and plan.

Initiate districts were selected Initiate districts were selected

Adaptation of the IMCI guidelines one for Adaptation of the IMCI guidelines one for physicians and one for nurse and training physicians and one for nurse and training materials to the local context , producing materials to the local context , producing Palestinian (national adapted IMCI guidelines Palestinian (national adapted IMCI guidelines and training material packages , mother card, and training material packages , mother card, wall charts, recording , reporting, and follow wall charts, recording , reporting, and follow up requirements. up requirements.

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Printing of Palestinian IMCI materialsPrinting of Palestinian IMCI materials

4 consensus workshops were conducted. 4 consensus workshops were conducted.

TOT training course (15 in GAZA) (30 in WB)TOT training course (15 in GAZA) (30 in WB)

IMCI training courses were held as 337 IMCI training courses were held as 337 physicians were trained (189 in GAZA, 148 in physicians were trained (189 in GAZA, 148 in WB), and 138 nurses also already trainedWB), and 138 nurses also already trained

Attending most of inter-country meetings, Attending most of inter-country meetings, related to all IMCI COMMPONENT.related to all IMCI COMMPONENT.

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Attending of both IMCI facilitation and Attending of both IMCI facilitation and follow training course to reinforce IMCI follow training course to reinforce IMCI skills for trainersskills for trainersAdaptation of a special psychosocial Adaptation of a special psychosocial guideline and package were finished guideline and package were finished but need revision and piloting. but need revision and piloting. (generic) . (generic) . Completing the building and upgrading Completing the building and upgrading of 3 training centers for IMCI & of 3 training centers for IMCI & Neonatal strategy's activities Neonatal strategy's activities distributed to cover all provinces.distributed to cover all provinces.

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IMCI components under IMCI components under activationactivation::

National child health policy initiative (NCHPI).National child health policy initiative (NCHPI).IMCI community component (CIMCI).IMCI community component (CIMCI).IMCI psychosocial component (generic in IMCI psychosocial component (generic in Palestine).Palestine).breast feeding and supplementary feeding counsel breast feeding and supplementary feeding counsel for infants and young children component.for infants and young children component.Adapting IMCI curriculum for pre-service training Adapting IMCI curriculum for pre-service training at medical and nursing collages .at medical and nursing collages .IMCI Follow up after training and ongoing IMCI Follow up after training and ongoing supervising.supervising.Scaling up the IMCI Training activities Scaling up the IMCI Training activities

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IMCI partnershipIMCI partnership

UNICEFUNICEF

WHO / EMROWHO / EMRO

Other partners:Other partners:

* safe the children* safe the children

* *

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ConstrainsConstrains

1- Political instability 1- Political instability 2- conflicts in management system of MOH .2- conflicts in management system of MOH .3- The strike of the MOH STAFF.3- The strike of the MOH STAFF.4- 4- FINANCAL CONSTRAINS ( direct payment via FINANCAL CONSTRAINS ( direct payment via

UNICEF).UNICEF).5- Mobility restriction ( the need for vehicle).5- Mobility restriction ( the need for vehicle).6- Limited capacity of MOH to recruit /assign technical 6- Limited capacity of MOH to recruit /assign technical

staffs for IMCI org. structure.staffs for IMCI org. structure.7- Disparity between WB &GS in organizational 7- Disparity between WB &GS in organizational

structure results in non identical training approach.structure results in non identical training approach.8- Evacuation of trained staffs from PHCcs by 8- Evacuation of trained staffs from PHCcs by

transferring them to hospitals beside the turnover of transferring them to hospitals beside the turnover of some . some .

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Web SiteWeb Site

Palestine have a special web sit at WHO – Palestine have a special web sit at WHO – EMRO EMRO

httphttp://://wwwwww..emroemro..whowho..intint//cahcah//imci_implemeimci_implementation_palntation_pal..asp?countryasp?country==PalestinePalestine

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IMCIIMCI: : Lessons learnedLessons learned

Pneumonia and diarrhoea remain diseases most Pneumonia and diarrhoea remain diseases most often associated with child deathsoften associated with child deathsUnder-nutrition is an important direct cause Under-nutrition is an important direct cause associated with mortality from common childhood associated with mortality from common childhood illnessesillnessesIMCI provides a valuable and systematic conceptual IMCI provides a valuable and systematic conceptual for improving child health servicesfor improving child health services Where a well-defined IMCI management structure Where a well-defined IMCI management structure was in place and relations with other programs was in place and relations with other programs defined, program management and implementation defined, program management and implementation were efficient were efficient

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IMCIIMCI: : Lessons learned…contLessons learned…contIMCI is largely funded by donor resources and few IMCI is largely funded by donor resources and few governments have allocated a substantial regular governments have allocated a substantial regular budget line to it budget line to it IMCI in pre-service training of medical and para-IMCI in pre-service training of medical and para-medical health professionals is well embraced in medical health professionals is well embraced in many countries, and considered a necessary way many countries, and considered a necessary way forward for sustainable implementation forward for sustainable implementation Follow-up after training has been found very useful, Follow-up after training has been found very useful, identify problems in the health system, and identify problems in the health system, and contribute to the process of system improvements at contribute to the process of system improvements at peripheral level peripheral level Wherever investments were made to improve the Wherever investments were made to improve the health system, this has had positive results on the health system, this has had positive results on the system and enhanced the perceived success of IMCI system and enhanced the perceived success of IMCI implementationimplementation

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IMCIIMCI: : Lessons learned…contLessons learned…cont

Poor health worker motivation and high turn-over Poor health worker motivation and high turn-over negatively affect IMCI implementationnegatively affect IMCI implementationAdapting the pre-set national plan to be more Adapting the pre-set national plan to be more flexible by adopting a scientific specific annual plan, flexible by adopting a scientific specific annual plan, this will help to absorb unforeseen incidents and this will help to absorb unforeseen incidents and achieve actual implementation .achieve actual implementation .C-IMCI should be activated as soon as possible to C-IMCI should be activated as soon as possible to sensitize the communities towards child health, and sensitize the communities towards child health, and sensitize participating health staff about why and sensitize participating health staff about why and how to deal with communities.how to deal with communities.Decentralization of management tasks towards Decentralization of management tasks towards district is a prerequisite to help local capacity district is a prerequisite to help local capacity building, to introduce and enhance expansion and to building, to introduce and enhance expansion and to maximize the potential for sustainabilitymaximize the potential for sustainability

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Lot’s of unanswered questionsLot’s of unanswered questions

Documents

Palestine MOH