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Integrated Management of Neonatal & Childhood Illnesses (IMNCI)

State Institute of Health and Family Welfare, Jaipur

IMNCI?

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

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p Developments Related To Child Health

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

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y Why IMNCI

· Reduce infant and child mortality rates · Improving child health & survival · IMR reduced from 114 (1980) to 47 (2010 SRS bulletin) · Decline not uniform across states · 8 states including Rajasthan are below national average · Malnutrition and low birth weight (LBW) are contributors to the about 50% deaths

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IMNCI: Status

India Number of districts where IMNCI i h is implemented 495 Rajasthan 33

Total Numbers of 537454 People t i d on IMNCI P l trained

Source: MoHFW (MIS 31/03/2012)

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32043

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IMNCI Beneficiaries

· Care of Newborns and Young Infants (infants under 2 months) · Care of Infants (2 months to 5 years)

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Care of Newborns and Young Infants (infants under 2 months) I f t (i f t d th )

Keeping the child warm arm Initiation of breastfeeding Counseling f exclusive b C li for l i breastfeeding tf di Cord, skin and eye care Recognition of illness in newborn and management and/or referral · I Immunization i ti · Home visits in the postnatal period

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· · · · ·

Care of Infants (2 months to 5 years)

· Management of diarrhoea, ARI malaria, measles, acute ear infection, malnutrition and anemia · Recognition of illness and risk · Prevention and management of Iron and Vitamin A deficiency d fi i · Counseling on feeding for all children below 2 years ears · Counseling on feeding for malnourished · I Immunization i ti

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IMNCI Components and Intervention areas Inter ention

Improve health worker skills Improve health systems Case management District & Block standards & planning and guidelines management Training of facility- Availability of based public health IMNCI drugs care providers

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Improve family & community practices Appropriate Care seeking Nutrition

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IMNCI Components and Intervention areas I t ti

Improve health worker skills IMNCI roles for private providers Improve health Improve family systems & community practices Quality Home case improvement management & and supervision adherence to at health recommended facilities ­ public treatment & private

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IMNCI Components and Intervention areas

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

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Components of IMNCI

Training Effective implementation · Improvements to the health system · Improvement of Family and Community Practices Collaboration/coordination with other Departments epa t e ts

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C p C Components of IMNCI

Training g

IMNCI is a skill based training in both facility and community settings Broadly, two categories of training are included · for medical officers · for front-line functionaries including front line ANM's and AWW's

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Components of IMNCI p

Effective implementation Improvements to the health system

· Ensuring availability of the essential drugs · Improve referral · Referral mechanism · Functioning referral centers · Ensuring availability of health workers / p providers at all levels · Ensuring supervision and monitoring through follow up visits

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Components of IMNCI

Effective implementation Improvement of Family and Community Practices Counseling of families and creating awareness which includes: · Promoting healthy behaviors · IEC campaigns · Counseling of care givers and families · During home visits identify sickness and focused BCC

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Components of IMNCI

Collaboration/coordination with other Departments · I Involvement of ANM and AWW l t f d AWWs · Involvement of grass-root functionaries of other sectors · Active involvement of PRI, SHGs and women s women's groups

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F-IMNCI

From November 2009 IMNCI h F N b has been re -baptized as F-IMNCI, (F Facility) with added component of: · Asphyxia Management and · Care of Sick new born at facility level, besides all other components included under IMNCI

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g Institutional Arrangements

· State Level · District Level

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g State level Institutional Arrangements

· · · · · · · Appoint Nodal Officer Set S t up a co-ordination G di ti Group Arrange logistics Create C t pool of State level trainers l f St t l lt i Selection of priority districts Review progress Identify the State Nodal institute for training · Improvement in family and community practices

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g District level Institutional Arrangements

· · · · Appoint District Coordinator Set up an IMNCI Coordination Group Train District Trainers. Develop a detailed plan for implementation · Ensure timely supplies & logistics, supervision and follow-up · IEC activities

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Training in IMNCI

Focus on Skill Development Hands-on training · Visits to hospitals · Fi ld visits and visits to the h Field i i d i i h homes of f sick children

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g C Training in IMNCI

Training at two levels · In-service training for the existing staff · Pre-Service Training

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Type of Personnel to be Training trained Clinical skills training

Durat Package Place of ion to be Training used Medical Officer 8 Physician Medical and Pediatrician days Package college y g g /District Hospital Health workers 8 Health District ANMs, LHVs, days Workers Hospital y p Mukhya sevika Package CDPO's and AWWs

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Durati Package D ti P k to be on used d Supervis Medical 2days Superviso ory Skill Offi Skills Officers, ry Skill Skills Training Pediatricians, package CDPO's LHV CDPO' LHVs and Mukhiya M khi Sevikas)

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Type of T f Training

Personnel to P lt be trained

Place of Pl f Training Medical college ll /District Hospital H it l

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g Training of Trainers

· All pediatricians in the district · Selected medical officers from CHCs and block PHCs · Selected staff nurses and LHVs and C O s and u ya Se as o CDPO's a d Mukhiya Sevikas from ICDS

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Number to be trained

· Average size District -1800 health staff will need to be trained · N b of th staff of other departments Number f the t ff f th d t t should be included in consultation with concerned district officers · Staff belonging to PHC areas may be taken up fully before moving to another PHC area

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Training Institutions

· State Level · District Level

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State Level Training Institutions

· Identify a Regional Training Centre · The Departments of Pediatrics and Preventive & Social Medicine in each college

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g District Level Training Institutions

· District hospital for training of medical officers · CHCs/operational FRUs etc for training of health workers

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Follow up Training (FUT) Follow-up

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

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Pre Service Training Pre-Service

· Training of undergraduate students and interns · ANM AWW, and Staff Nurses ANM, AWW Nurses' training schools need to include IMNCI in their training schedules

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Funding Arrangements

National Level training: by the GoI State Level training: State project funding NRHM/RCH-II-PIPs District Level training: State project funding -NRHM/RCH-II-PIPs a. At District Training Cell (in the District Hospital) b. b At other Training C t th T i i Centres within th ithi the District (Maximum two in identified CHCs/PHCs) CHC /PHC )

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g g Funding Arrangements

· Translation, printing and supply of training material · Field-level Monitoring Support, Support Follow up and Coordination

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j y ( ) Navjat Shishu Suraksha Karykram(NSSK)

Launched on September 15, 2009 Focuses on: · Prevention of Hypothermia · P Prevention of Infection ti f I f ti · Earl initiation of Breast feeding Early · Basic Newborn Resuscitation

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Navjat Shishu Suraksha Karykram (NSSK)

Objectives: · One trained person at institutional facility, where deliveries take place · NSSK will train healthcare providers at the district hospitals CHCs & hospitals, PHCs

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Limitations of IMNCI

· Outpatient Facility Based · Community activities not given adequate focus · Training centre of attention · Vertical initiatives in Non IMNCI districts sorely lacking

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Thank You

For F more d t il l details log on t to www.sihfwrajasthan.com or contact : Director-SIHFW Director SIHFW on [email protected]

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