WHO EMRO - CHILD AND ADOLESCENT HEALTH

The Integrated Management of Child Illness (IMCI) strategy was introduced in the Eastern Mediterranean Region in 1996. Initially, the main focus of the strategy was on improving clinical care provided at health facilities to outpatient sick children. Over the years, more attention has gradually been given to fully integrated child care, addressing health, growth and development of any young child, whether sick or healthy, whether taken to health facilities or cared for in the home. The strategy has then broadened its scope in this Region and changed into the Integrated Management of Child Health, while still retaining its original acronym “IMCI”. More emphasis is also being placed on promoting good child care practices at home and in the community.

The family and the community where children live play a major role in child health and development. There is a longstanding need to involve the family and community actively and plan and implement child care interventions in both the health system and the community in parallel. While many interventions and projects exist at community level which concern child health, there has been some delay in countries in integrating such interventions into a comprehensive child care strategy that includes a well developed community approach effectively linked with the health system (i.e., the “IMCI community component”). Furthermore, interventions often fail to reach those who need them most, including the Poor, who are among the most vulnerable people.

Initially, the Regional Office has developed tools and supported activities to build capacity in planning for the IMCI community component in the Region.

More recently, the Regional Office has started to increase access to quality child care through community health workers, to respond to a need expressed by a number of countries in the Region. The first step has been to place the community health worker-based child care approach within a supportive policy environment, by reviewing with interested countries and partners plans for the required health system and community support elements, which are considered essential for any community intervention of this type. Issues include among others policies on which services and medicines community health workers would be allowed to deliver, availability of medicines and supplies (job aids, recording forms, registers, etc.), and feedback and motivation schemes by the health system and community.

The Child and Adolescent Health programme of the Regional Office has developed regional training materials on “Caring for the sick child in the community”. The course content addresses the main causes of deaths in children under five years of age, such as pneumonia, diarrhoea, malaria—where relevant—and malnutrition, describing action-oriented guidelines on identification of key health problems in this age group, their treatment, and advice on home care, immunization and feeding practices. Taking into account whether or not community health workers can dispense medicines and whether there is a malaria risk in countries, three versions of the training materials have been developed: a malaria version for countries with malaria risk in which community health workers can treat sick children, a non-malaria version for countries with no malaria risk in which community health workers can treat sick children, and an adapted non-malaria version for countries such as Egypt in which community health workers are not authorized to dispense medicines.

Each version of the training materials includes a facilitator guide, a set of facilitator aids and a participant module with a list of a few bulleted points per topic to act as key reminders. The core of the course is the sick child recording form. The materials and training methodology have been designed to target community health workers with low literacy levels and little or no health background, as recommended by countries in the Region. Extensive use is made during training of interactive methods, games, videos and exercises with group and individual feedback requiring very minimal reading or writing skills and making participant learning an enjoyable experience. The training materials and methodology were first reviewed by a team of experienced Integrated Management of Childhood Health (IMCI) master trainers and then field-tested in Egypt in July 2010. They are currently being revised. Find out more about the activities undertaken in this area by the Regional Office.