1. Key health interventions

1.1 Tropical diseases | 1.2 Disease surveillance and control |  1.3 Malaria | 1.4 Tuberculosis | 1.5 HIV/AIDS and sexually transmitted diseases
1.6 Noncommunicable diseases | 1.7 Mental health and substance abuse | 1.8 Reproductive health and research |  1.9 Making pregnancy safer |  1.10 Immunization and vaccine development | 1.11 Emergency preparedness and humanitarian action | 1.12 Child and adolescent health (including IMCI)

1.12 Child and adolescent health (including IMCI)

Issues and challenges

1.3 million children under 5 years of age die every year in the Region, mostly due to preventable causes. With the current pace of mortality reduction and the low coverage of cost-effective interventions in some countries, particularly those with high child mortality, it is most unlikely that countries with high child mortality will achieve Millennium Development Goal 4. Despite the stated priority of child heath, the resources allocated to child health at regional and national level have been decreasing. Other major challenges concern the health system, in most priority countries, human resources capacity and turnover at all levels, and the absence of one national plan to which all partners can contribute. Although neonatal deaths represent around 40% of under-5 deaths, they have not received due attention. To address this issue an effective collaboration between maternal and child health programmes is required. A detailed adolescent health situation analysis is required to identify a well structured approach.

Action taken in 2007 and results achieved

Celebrating 10 years of implementation of the integrated management of child health (IMCI) strategy in the Region, the Regional Director announced IMCI as the primary child health care strategy encompassing a package of cost-effective interventions. Seventeen countries are at different phases of IMCI implementation. Three countries (Djibouti, Egypt (Figure 1.1) and Islamic Republic of Iran) are close to achieving universal coverage. Follow-up visits and reviews conducted in two of those countries showed an improvement in the quality of primary health care services delivered to children at this coverage level. The Regional Director, together with the Federal Minister of Health, Sudan, visited IMCI implementation sites in Khartoum to observe community volunteers in action, while the visit of HM Queen Rania El Abdallah to IMCI implementing facilities in Jordan has created a highly supportive environment.

As a major approach to sustainability, technical support was provided for scaling up of IMCI pre-service education in Egypt, Morocco and Yemen, including organization of national IMCI pre-service education workshops which brought together representatives of all medical and paramedical teaching institutions, and organization orientation/planning workshops for individual medical schools to develop plans of action.

Three medical schools and 10 nursing teaching institutions introduced IMCI into their paediatric and community medicine teaching programme, bringing the total number of medical schools and allied health institutions that implement the IMCI pre-service education in the Region to 29 and 210, respectively. The capacity of national and peripheral staff was further strengthened through training in supervisory, planning and evaluation skills. A regional guide to planning for IMCI implementation at district level was developed to build the planning capacity of programme managers at all levels.

Figure 1.1 Quick steady progress in number of health facilities implementing IMCI, Egypt

Follow-up visits to Djibouti, Jordan and Yemen were conducted to monitor the IMCI implementation status, strengthen skills and solve problems. The visit in Yemen revealed low health service utilization which was due, in some areas, to difficult geographic access. As a result, integrated child health mobile teams were established to address this issue in two districts, with encouraging results (Figure 1.2). An IMCI review visit in Morocco revealed the need to look into the existing potential financial resources and the crucial need to strengthen the related elements of the health system, if a good quality of IMCI implementation is to take place. Inter-directorate collaboration was one major recommendation to mobilize resources and to improve quality of implementation.

Figure 1.2 Impact of child health mobile team in two districts, Yemen

Figure 1.3 Performance of health providers in Morocco, IMCI health facility survey

The Regional Office supported capacity-building of staff in Iraq and Palestine in different IMCI skills. Evaluation of IMCI implementation was supported through IMCI review workshops in Egypt and Djibouti and a health facility survey in Morocco (Figure 1.3).

The Regional Committee adopted resolution EM/RC54/R.2 on neonatal health. To date, 12 countries have introduced the neonatal component into their IMCI guidelines and community component. Breastfeeding promotion was also at the core of work. The Regional Office involved influential community categories, namely religious leaders and university staff, in two regional workshops to advocate for breastfeeding, in addition to training health providers in counselling on infant and young child feeding using the regional material, in Egypt and Sudan.

Work to undertake a detailed situation analysis on adolescent health was started, aiming at establishment of a well defined, structured approach for adolescent health in the Region. In addition, a review of interventions currently in place in Morocco was conducted.

Future directions

The Regional Office will continue to provide technical support to countries to achieve Millennium Development Goal 4 in the following areas: advocacy for child health and mobilization of resources; promotion of universal coverage of cost-effective interventions; implementation of resolution EM/RC54/R.2 on neonatal health; introduction of the neonatal component as an integral part of IMCI in all countries; development of national child health policy documents; scaling up of IMCI pre-service education and the community component as major sustainability approaches; promotion of breastfeeding practices; national capacity-building; responding to country needs through further developmental work; strengthening reporting on and monitoring of the progress of child health through defining of a set of regional indicators; and monitoring the progress and evaluating the quality of IMCI. The Regional Office will also support the development of a regional package on adolescent health and monitor the implementation of adolescent health interventions in countries.

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