2010

7 April 2010 - 5^th birthday of the CAH website!

Pakistan accelerates IMCI implementation

Development of community health worker training package moves one step forward

20 December 2010 – Regional IMCI Coordinators’ Meeting, Sana’a, Yemen, 6–9 December 2010	| Français |
The meeting convened 59 participants―child health programme managers, senior decision-makers, academics―from 19 of the 22 countries in the Region, UNICEF country offices, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and WHO. It aimed at updating countries on progress in child health and developmental work in the Region. Five countries are close to achieving IMCI universal coverage, while progress in other countries is slow and likely to require many more years at the current rate of implementation. A 30% reduction in under-five mortality is estimated to have occurred in the Region between 1990 and 2009, against the 2015 MDG 4 of 66%. Three countries, notably Egypt, Lebanon and Oman, have already surpassed this goal, five countries are on track while the rest are not on track and needs to intensify efforts substantially. A regional web-based information tool for countries to update IMCI implementation data by level and the child health country profile to present in one document key child health indicators were presented. Experiences were shared on initiatives to increase access to quality child care such as the community health worker-based initiative and integrated outreach activities carried out in Yemen. The newly developed regional IMCI pre-service education package―to be posted on this web site soon―was presented in the meeting, aiming to assist teaching institutions in incorporating IMCI into their teaching programmes and evaluating them. The Sudan IMCI pre-service education experience was also shared together with the results of its evaluation. Plans to move forward the child health agenda were prepared by country teams. Initial information on the meeting is available here, including its conclusions and recommendations; the report will be available in due course and posted on this web site.
15 November 2010 – First training course for community health workers on caring for the sick child in the community, Dhamar, Yemen, 6–11 November 2010	| Français |
The first training course for community health workers (CHWs) on caring for the sick child was conducted in Yemen in Dhamar governorate from 6 to 11 November for 24 CHWs. The course, technically supported by WHO and with participation also of UNICEF staff, used the malaria version of the materials developed by the Regional Office, adapted to reflect the national guidelines. Based on their performance during the course, after the training most CHWs will be allowed to treat sick children for common conditions (malaria, pneumonia and diarrhoeal diseases) while the remaining will be allowed only to identify and refer sick children for treatment at the health facility and assess and counsel on feeding practices. After the course, a plan was reviewed with the national and governorate counterparts for implementation of the CHW strategy beyond training, including follow-up of the trained CHWs and health system elements, such as orientation of health facility staff supervising them, kits for CHWs, delivery of medicines to CHWs, registration of basic information on cases seen, regular meetings at health facilities, and supportive supervision including periodic review of case recording forms. The CHW strategy adds to other initiatives implemented in Yemen to reach out to communities to increase their access to child care such as the integrated mobile teams. Photo library of selected course activities
9 August 2010 - Sindh province leads Integrated Management of Childhood Health (IMCI) pre-service education efforts in Pakistan	| Français |
Sindh province is moving forward to incorporate IMCI into pre-service education. A national practical orientation and planning workshop was held in 2008, supported by the Child and Adolescent Health Programme of the WHO Regional Office for the Eastern Mediterranean, which involved representatives of 18 teaching institutions, including medical colleges and paramedical and nursing teaching institutions. Following the national event, Sindh province took the lead, conducting IMCI pre-service education orientations for medical colleges in 2009, followed by the development of plans by each institution in 2010. These plans have the objective to integrate IMCI into undergraduate and post-graduate teaching programmes of departments of paediatrics and community medicine of eight medical colleges. One-block IMCI courses for post-graduate students in the Diploma in Child Health, MD (Paediatric medicine) and Fellowship of the College of Physicians and Surgeons (FCPS) of these medical colleges have also started. Focal points in each institution have been designated and training courses in IMCI to build capacity in teaching are being held. Five public health schools have also been oriented on IMCI and are expected to develop plans soon to include IMCI in their lady health visitor teaching programme. With strong WHO technical support, these efforts are the result of active leadership in the province with partnership between the teaching institutions, the Maternal, Neonatal and Child Health Programme (MNCH) of the Ministry of Health and the Health Department of Sindh province, WHO (country and Sindh provincial offices) and projects such as the United States Agency for International Development (USAID)-funded Pakistan Initiative for Mothers and Newborns (PAIMAN) and the Norway–Pakistan Partnership Initiative (NPPI) which support maternal and child health activities. IMCI pre-service education is seen as one of the key approaches to ensure IMCI sustainability in the long term and prepare graduates to deliver quality child care services also in settings with limited resources.
26 July 2010 - Field-testing of the regional training materials on “Caring for the sick child in the community”, El Fayoum, Egypt, 6–8 July 2010	| Français |
The draft regional materials for community health workers on “Caring for the sick child in the community” were field-tested in El Fayoum, Egypt, from 6 to 8 July 2010. The course was facilitated by a group of experienced regional Integrated Management of Childhood Health (IMCI) trainers who had attended a three-day review of the same materials in Cairo.  This version of the materials, in Arabic, was designed for settings in which community health workers are not authorized to dispense medicines. Within this context, they are expected to identify common child health problems (serious conditions requiring referral, diarrhoea, pneumonia and malnutrition) and advise child caregivers on home care, vaccination and feeding practices.  The 30 participants included three cadres of community health workers relevant to Egypt and were divided into three groups, namely: 1) Raedat Ryfiat, who are community health workers hired by the Ministry of Health, whose terms of reference include maternal and child health within the “Family health model”—in addition to promoting family planning—and who operate in almost all areas served by rural health facilities; 2) volunteers from nongovernmental organizations, who are present especially in Upper Egypt and frontier governorates; and 3) home visiting nurses, who operate mostly in Lower Egypt.  This first training course was very well received by the participants and areas for revision were identified to finalize them. The final course schedule is likely to be of a five-day duration.
26 July 2010 - Review of the regional training materials for community health workers on “Caring for the sick child in the community”, Cairo, Egypt, 3–5 July 2010	| Français |
The regional materials, developed by the Child and Adolescent Health Programme of the WHO Regional Office for the Eastern Mediterranean, were reviewed by a team of experienced Integrated Management of Childhood Health (IMCI) master trainers in Cairo, Egypt, from 3 to 5 July 2010. Reviewers included 19 persons from six countries from ministries of health, academia, UNICEF and WHO offices at different levels. 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 a non-malaria version for countries such as Egypt in which community health workers are not authorized to dispense medicines. The materials describe action-oriented guidelines on identification of key health problems in children under five years of age, their treatment, and advice on home care, immunization and feeding practices. Each version of the training materials include 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 requested 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 materials will soon be revised based on the suggestions made during the review. This review follows two previous preparatory activities held in Cairo, in November 2009, and Sana’a, in March 2010, respectively.
23 May 2010 - Egypt, first country in the Region to reach MDG4	| Français |
Egypt is the first country in the Region to have reached Millennium Development Goal (MDG) 4 on reduction of under-5 mortality, with a 74% reduction between 1990 and 2008 versus the proposed MDG reduction of 66%, according to estimates published in the World Health Statistics 2010. Over 91% of primary health care facilities in the country have been covered by the Integrated Management of Child Health (IMCI) strategy, this representing an outstanding achievement. Given the good access to primary health care services, this may suggest a high coverage of the under-5 population to key primary child health care services. On the other hand, child survival inequalities (e.g. by place of residence, wealth quintiles) remain and represent one of the current challenges to be addressed. As Egypt may start looking beyond child survival, challenges also include low coverage of interventions in the community which can lay the foundations of the future health of children, such as exclusive breastfeeding.
23 May 2010 - Progress toward MDG 4 in the Eastern Mediterranean Region is slowing down	| Français |
Recent mortality estimates suggest further reductions in the number of children under-5 who died globally in 2008 compared with 2007 but no changes in the Eastern Mediterranean Region, according to the recently released World Health Statistics Report 2010. An estimated 1.2 million deaths occurred in children under-5 in the Eastern Mediterranean Region in 2008, as many as in 2007. The new under-5 mortality estimates suggest a stagnation or low progress in a number of MDG priority countries with high under-5 mortality rates, such as Afghanistan, Pakistan, Somalia and Sudan, which contribute to 80% of all under-5 deaths in the Region. Low progress is also seen in Djibouti. A preliminary analysis in a few countries of the Region suggests that trends in reduction—expressed as average annual rates of reduction—may have decreased in recent years. Although caution should be exercised when comparing these estimates for different, consecutive years, Morocco under-5 mortality estimates for 2008 suggest recent stagnation in progress, despite the country having achieved a 59% mortality reduction between the period 1990 to 2008. Yemen’s progress continues to be encouraging. Overall, a 26% reduction in under-5 mortality has been estimated for the Region for the period 1990–2008, well below the two-thirds set by MDG 4 for the year 2015. Detailed information on mortality rates and trends by country, based on the World Health Statistics, 2010, is presented in tables and illustrated with graphs in the section on "Data and statistics: Under-5 mortality and its causes".
12 April 2010 - Yemen reaches out to children	| Français |
Latest figures on Integrated Management of Childhood Health (IMCI) implementation in Yemen for 2009 confirm significant results of the Ministry of Public Health and Population initiatives in reaching out to children. By the end of 2009, 57% of health facilities in the country had staff trained in IMCI to provide primary child health care services, with an estimated 1 291 129 under-five children living in areas served by those facilities. A further step forward was reaching out to an additional under-five population estimated at 1 528 913 in more remote areas through primary health care (PHC) mobile teams, including staff trained in IMCI. The mobile teams were established on a trial basis in 2007. These services, also supported by the GAVI-health system strengthening initiative, WHO, UNICEF and other partners, are currently serving 76 districts through 537 mobile teams. The estimated total under-five population living in areas where IMCI health services are available is thus about two thirds (65.5%) of the total under-five population in the country. These efforts are likely to contribute to accelerating progress towards Millennium Development Goal #4 to reduce under-five deaths in the country by two-thirds between 1990 and 2015.
7 April 2010 - 5th birthday of the CAH website!	| Français |
Since its launching on 7 April 2005 on occasion of the World Health Day “Make every mother and child count”, the website has expanded to include more information on child health activities in the Region and respond to users’ needs. A French version of the news has also been added. On occasion of its “5th birthday”, we would be very happy to hear from users. Please, spend just a few minutes to complete the on-line questionnaire to help us improve the website. The questionnaire is anonymous, brief and easy to fill in. To go to the questionnaire, please click here.  The CAH website aims at sharing information on the work on the health and psychosocial development of children under-5 carried out by the Regional Office, and related activities and initatives promoted and carried out in countries in the Region. It is intended for public health and programme managers, academia, civil organizations and nongovernmental organizations, students and anyone interested in public child health issues, with special focus on the Eastern Mediterranean Region.   The CAH website provides detailed information on the coverage of child health activities at different levels in countries in the Region—especially the implementation of the Integrated Management of Child Health (IMCI) strategy—, the systematic approach followed in countries during implementation, the technical guidelines specifically adapted to each country, the tools developed and used at regional and country levels to plan, collect information, supervise and evaluate, and data on outcomes from structured follow-up visits and surveys. Specific sections describe the evolution of IMCI over the years in the Region and its relationship with primary health care, IMCI in pre-service education, health systems issues, the process and guidelines to develop national child health policies, the child health-related Millennium Development Goals, research work, and advocacy initiatives. A library of resources which have resulted from CAH work in the Region, including reports and documents, is also provided.  A set of publications on IMCI pre-service education – a major undertaking by this Regional Office – is expected to be posted on the website soon. If you wish to receive an e-mail alert, just enter your e-mail address here. “Stay tuned!”
31 March 2010 -- Pakistan accelerates IMCI implementation	| Français |
The latest data provided by the Federal Ministry of Health of Pakistan indicate that IMCI implementation accelerated in the country in 2009. Although formally endorsed by the Ministry of Health at the end of 1998, it was not until 2006 that the IMCI strategy started being implemented at a faster pace in the country. In the 4-year period from 2006 to 2009, the percentage of health facilities with staff trained in IMCI increased to 16.5% (2009) from 2% (2006), while the total number of health providers trained in IMCI reached 2542 by the end of 2009 from 385 (end of 2005), a 560% increase. While the proportion of PHC facilities implementing IMCI remains low and more efforts are required to provide access of the child health population to IMCI quality care, this trend is an encouraging development. An average of 14 IMCI training courses per year were conducted from 2005 to 2008, while the number of courses reported in 2009 went up to 51 during the year. Improved availability of funds provided by the Government and contributions by partners and initiatives to IMCI (GAVI-Health Systems Strengthening, USAID-funded Pakistan Initiative for Mothers and Newborns or PAIMAN, Save the Children US, etc.), strengthened institutional capacity in the provinces to conduct IMCI training and the strong interest and advocacy by senior paediatricians, the Pakistan Paediatric Association and teaching institutions are likely to have contributed to the increased implementation in 2009. One third of under-five deaths in the Eastern Mediterranean Region are estimated to occur in Pakistan and over one third of all under-five deaths in Pakistan are due to largely preventable causes such as diarrhoeal diseases, pneumonia and measles occurring in the post-neonatal period, which are well addressed in the IMCI strategy. Accelerated efforts are needed in the country to be able to get closer to the Millennium Development Goal #4 on reduction of under-five mortality by two thirds in 2015 compared with the 1990 levels.
30 March 2010 --- Inter-country demonstration training course on "Caring for the sick child in the community", Sana'a, Yemen, 21 - 26 March 2010	| Français |
WHO EMRO/Sarah ElKhayat This course, jointly supported by WHO and UNICEF, aimed to expose participants not only to the classical training approach used in the global materials for community health workers (CHWs) on "Caring for the sick child in the community"—which much rely on reading as a key method for the learner to acquire knowledge—but also to other interactive, innovative training methods requiring minimal or no reading. The latter methods were developed by the Regional Office to better suit CHWs with limited literacy levels and no health background such as those targeted in countries in the Region, as recommended in the previous workshop in November. In that workshop, the participating countries had confirmed interest in increasing access to child care through CHWs as a means of reducing under-five mortality and thus contributing to achieving the related Millennium Development Goal (MDG) #4 and identified the need for adaptation of the WHO/UNICEF CHW training. The course held in Sana’a was also an opportunity to further discuss policy and strategy needs for CHWs, review and update the plans developed in the previous workshop and agree on the next steps.  It was attended by 25 participants from 6 countries (Afghanistan, Egypt, Iraq, Sudan, Syrian Arab Republic and Yemen), including staff of ministries of health, academic institutions, development cooperation agencies and projects (JICA/Yemen and BASICS/Afghanistan), UNICEF country offices and WHO at all levels. The course content addressed the main causes of deaths in under-5 children, such as pneumonia, diarrhoea, malaria and malnutrition. Key policy and strategic issues were reviewed and discussed to place training within a health system support context. Participants strongly recommended that the Regional Office should continue the development of a well-designed CHW training facilitator guide and related materials.  Information on the workshop is available here.