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The Framework comprises two main aspects:
The Foundation –
The foundation on which the community component must rely is
represented by a wide-sector partnership at central and
implementation level.
The planning process
– The Framework lists 10 key steps of the planning process at
national and implementation level as a guide to planning at these
levels. Much emphasis is given to building district capacity for
situation analysis and planning. A description is given of the five
“specific elements” of a community child care strategy, i.e. those
that characterize “IMCI” as key features as compared to traditional
community interventions, and eight essential “planning principles”
that should always be considered when planning for the community
component.
For a short description of the Framework’s main
sections click on the links below or download the
pamphlet.
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Any plan should include clear, measurable
indicators and set quantitative targets so as to enable regular
monitoring of what has been done (‘process’) and what this has led
to (‘outcome’). To assist in this task, a special section of the
Framework describes, with
practical examples, relevant measurable indicators (from process to
outcome indicators) and related targets that should always be part
of a plan, as useful management tools to monitor implementation.
This section has been particularly welcomed by countries and
expanded to respond to their requests for more examples. It is
emphasized that, when selecting indicators, attention should be paid
to which monitoring instruments should be used to follow up progress
of implementation, identify constraints and address them
accordingly. Monitoring methodology should be adapted or developed
locally and be simple, inexpensive and integrated in monitoring
systems wherever these exist, to avoid creating new vertical
projects. As much as possible, monitoring should allow for the
collection of information on both process and outcomes and help link
activities with results. To read more about indicators and targets,
the examples provided, the logical flow of indicators and a list of
indicators at household level click
here.
Documentation of inputs (resources made available
for the intervention), outputs of activities, experience with
implementation and outcomes of the intervention is necessary to
identify strengths and weaknesses and describe lessons learnt, as
well as for advocacy. The situation analysis carried out by eleven
countries participating in two inter-country planning workshops has
clearly showed that the community interventions reviewed were often
poorly or incompletely documented, limiting the value of those
experiences. This makes it difficult to learn from such experiences
and make reliable conclusions. On the other hand, the example of the
Lady Health Worker programme
in Pakistan has shown the importance and value of a thorough
documentation, to provide effective feedback to those concerned,
reinforce programme components and continue to receive the required
political and financial support.
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Guide
to the planning process
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Planning
steps for
the IMCI
community
component at
national
level
A working
document
Revised
version,
August 2003
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English
(pdf, 356 kb) |
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This working document was
originally developed in 2002 to standardise the writing of country
progress reports as a preparatory step to inter-country workshops on
planning for the IMCI community component of the IMCI strategy. The
document was found very useful by the country teams in these
workshops and was revised in 2003 to serve as a planning guide. The
steps highlighted in the guide are based on the “Framework
for the community component of the integrated child care strategy”.
The document lists a number of questions to guide programme managers
throughout the process, providing several practical examples, and
helping them to conduct a thorough situation analysis as the basis
for the development of their plans. Together with the Framework, it
was used by 11 countries in the Region to prepare plans of actions
for the IMCI community component during the two above-mentioned
workshops, in
2002
and
2003, respectively. The
workshops were preceded by intensive work: the Child and Adolescent
Health and Development unit (CAH) of the Regional Office provided
clarifications on the process and on the use of the planning guide,
assisted in reviewing country preliminary reports, and provided
additional comments. During the workshops, group work was organized
around the main themes of the EMRO Framework which were being
addressed by the participating countries at that stage, including
the situation analysis, partnership, setting priorities,
identification of potential interventions, and setting indicators
and targets. Top
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Community and sustainability
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The community component of the Integrated
Management of Child Health (IMCI) strategy is potentially seen as one of
the key answers to the issue of sustaining over time the
achievements made by the whole strategy. However, mechanisms should
clearly be devised to ensure that the community interventions
themselves and the improvement of child care practices accomplished
through them are sustainable over time. These mechanisms should rely
on full involvement of the community in the intervention and strong
links between the community and the health systems.
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Linking the community with teaching institutions
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The establishment of
close links between the community and teaching institutions has been
identified in this Region as vital for ensuring sustainability in
the long term. In many countries in the Region, medical graduates
should serve in rural areas before working with the Ministry of
Health. In some other countries, service in rural areas is a
pre-requisite for registration with the medical council and
enrolment in postgraduate studies. This rural service has been seen
as a good opportunity for doctors to understand the reality in the
field and the importance of community work. Even before then, while
at university, medical students would often be exposed to the
community through outreach field visits during the community
medicine, family medicine and paediatrics rotations. They would also
collect data from the community for operational research, be
involved in educating the community on health topics and assist it
in addressing health issues. Thus, a good and useful link could be
set up between the community and teaching institutions.
To formalize the
approach, there would be a need to orient teaching staff of
community medicine, family medicine and paediatrics departments to
the
IMCI strategy and its community component, and include them in
community working groups at various levels. The staff would have to
participate in planning, implementation, monitoring, and evaluation
of community activities. Results of evaluations and operational
community research conducted by the medical schools could be
presented in medical conferences and meetings of professional
societies, to promote the importance of public health work and its
relationship with everyday medical practice. Some countries in the
Region are taking steps in this direction (see
pre-service education).
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