Governorates which have started implementing IMCI

Districts which have started implementing IMCI

Health facilities implementing IMCI | Graphs

Health providers trained in IMCI

IMCI case management training courses conducted

IMCI clinical training

• Targeted coverage of providers of health facility

•  Course duration

•  Materials

Target coverage of providers of health facility

• For low-caseload outpatient health facilities: training of all health providers managing children less than 5 years old

• For high-caseload outpatient settings (including hospitals’ OPD): training of a number of providers adequate to manage the average caseload of sick children underfive in that facility.

Course duration

• Physicians: 9-day courses

• Nurses: 3 days

Materials

Different training materials used for physicians and nurses, to reflect their different responsibilities:

• Physicians: adapted training materials for standard IMCI course  based on the Tunisian adapted version of the IMCI guidelines.

• Nurses: newly developed materials for Tunisia

Systematic approach to IMCI implementation at district level: key steps and tools

1. Selection of governorates/districts for IMCI implementation

2. Preliminary visit of national IMCI team to the governorates  selected

3. Situation analysis of the districts selected

4. Visit of national IMCI team to discuss the findings of the situation analysis

5. Orientation workshop in the selected governorate

6. District planning workshop

7. Preparation of health facilities prior to implementation

8. Creating a pool of facilitators at local level

9. Training in case management (skills acquisition)

10. Training in facilitation and follow up skills

11. Follow up after training (skills reinforcement)

12. Supervision

13. Documentation

1.  Selection of governorates/districts for IMCI implementation

Different criteria have been used to select areas for the Early Implementation Phase and the Expansion Phase, respectively, as follows:

• Early Implementation: criteria based on the rationale to provide initial evidence on IMCI in areas with adequate support to implementation:

1. Leadership and motivation of staff at different levels

2. Districts representing different geographical areas (Urban and rural)

3. Previous successful experience in public health programmes

4. Easy accessibility to the national team

5. Good health facility physical structure

• Expansion: criteria prioritising high underfive mortality areas:

1. Underfive mortality rate

2. Starting first with the most committed and manageable districts, to show a model for the other districts in the governorate

3. More focus on the early implementation governorate to reach 100% coverage and move to a new governorate per year. Top

2.  Preliminary visit of national IMCI team to the governorates  selected

1. Brief orientation of decision-makers -Undersecretary of health, and other concerned authorities- to the IMCI strategy and its implementation

2. Joint selection of the districts based on the criteria described in 1.

3. Designation of an IMCI focal point. Top

3. Situation analysis of the districts selected:

• Status of equipment and supplies at each health facility

• Health providers’ performance
  (tool used is the follow up forms). Top

4. District orientation/ planning workshop

1. Objectives: to orient district teams on the IMCI strategy and previous experience in the country, to develop district plans of action for IMCI implementation, describing tasks, responsibilities, time frame, indicators and targets for the three IMCI components.

2. Participants: representatives from no more than 2 – 3 governorates per workshop, including Regional Director of health, PHC directors, IMCI focal points at the governorate level, staff from the pharmaceuticals and health information service HIS (fixed members for all workshops) at governorate level, district health director, MCH assistant district level. A mixture of new and old governorates is usually followed to learn from the already existing experience.

3. Methodology: Plenary sessions, group work at the national level

4. Duration: 3 days

5. Outcome: plans of action for the three IMCI components for each selected district. Top

5. Preparation of health facilities prior to implementation

1. Reviewing staff’s responsibilities

2. Re-arranging flow of patients

3. Making drugs available

4. Making necessary supplies and equipment available

5. Monitoring by the central team to facilitate the process and ensure that facilities are ready for implementation. Top

6. Creating a pool of facilitators at local level

(see points 9 and 10 below). Top

7. Training in case management (skills acquisition)

1. Preparation of the selected training site for the governorate

2. Nomination of participants

3. Conduct of training (9-day course for the IMCI case management training at district level for physician and 3-day course for nurses)

4. Entering information in the central database on IMCI training. Top

8. Training in facilitation and follow up skills

9. Follow-up after training (skills reinforcement)

1. Carried out 4 – 6 weeks after training

2. Documented with reports by health facility visited, then compiled as district summaries

3. Data entered in central database on training and follow-up. Top

10. Monitoring and Supervision

1. Using the IMCI follow up visits after training forms

2. Preparation of reports based on a recording form and giving feedback. Top

11. Documentation

It is one of the main features throughout the process. It is based on performance of doctors and nurses, caretaker knowledge about home care and satisfaction with health services before and after IMCI implementation, quarterly IMCI reports, IMCI activity reports, a database on training courses  (number of courses and staff trained) and coverage, and follow up visits. Top

States which have started implementing IMCI

Localities which have started implementing IMCI

Health facilities implementing IMCI | Graphs

Health providers trained in IMCI

IMCI case management training courses conducted 

IMCI implementation in states

IMCI clinical training

• Targeted coverage of providers at health facility
• Course duration
• Materials

Targeted coverage of providers at health facility

Physicians and especially medical assistants at PHC facilities are the main target for IMCI training. Nurses and nutritionists have also been trained in IMCI in selected cases.

Course duration

11-day courses for both physicians and medical assistants

Materials

Training materials are based on the Sudanese-adapted version of the IMCI guidelines available in English and Arabic.

Systematic approach to IMCI implementation at district level: key steps and tools

1. One-day IMCI orientation workshop
2. Establishment of an IMCI committee at state level
3. Assessment and preparation of a training centre
4. Training of trainers
5. Selection of locality for IMCI implementation
6. Collection of baseline data
7. Assessment of health facility basic needs and supplies
8. IMCI district planning workshop
9. Training in case management (skills acquisition)
10. Training in facilitation and follow up skills
11. Follow up after training (skills reinforcement)
12. Supervision
13. Selection of a community for IMCI implementation

1.   One-day IMCI orientation workshop for staff from State Ministry of Health, local government, and non-governmental organizations operating in the state. Top

2. Establishment of an IMCI committee at state level with assignment of an IMCI coordinator, including the state minister of health, state ministry of health director-general, EPI coordinator, nutrition coordinator, director of pharmacy, and representative of state non-governmental organizations. Top

3. Assessment and preparation of a training centre for IMCI training activities. Top

4. Training of trainers to build state capacity for IMCI training. Top

5. Selection of locality for IMCI implementation based on the following considerations:

1. Number, conditions and functionality  of health centres in the area;
2. Implementation of other initiatives in the area (e.g., community-based basic development needs or BDN);
3. Presence of non-governmental organizations working in the area with a focus on health;
4. High proportion of children under-5;
5. High prevalence of the main problems targeted by IMCI. Top

6. Collection of baseline data , with findings discussed in an IMCI orientation workshop. Top

7. Assessment of health facility basic needs and supplies (e.g. daily register, sick young infant and child recording forms, monthly reporting forms, IMCI chart booklets and mother cards, timers to count the respiratory rate, thermometers and scales).  Top

8. IMCI district planning workshop

9. Training in case management (skills acquisition) for doctors and medical assistants. Top

10. Training in facilitation and follow up skills

11. Follow up after training (skills reinforcement), conducted 6-12 weeks after the IMCI training course. Top

12. Supervision, carried out at Federal, state and lower level (routine supervision). Federal supervision includes review of implementation of the annual plan, visit to the IMCI training site and drug store, and visit to at least 3 health facilities implementing IMCI in the state (using the form for follow-up visits after IMCI training, which includes review of health provider and health facility performance). All health facilities are supposed to be visited on a quarterly basis. Supervisors undergo a 3-day training on IMCI supervision, including practising the use of the IMCI supervisory checklist under the supervision of the course facilitators. Reports are collated on a quarterly basis and sent to the central office in Khartoum. Top

13. Selection of a community for IMCI implementation to introduce the IMCI community component; training of trainers of volunteers; assignment of a community component coordinator; KAP survey; training of volunteers.  Top