Implementation of IMCI in Yemen
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 strategy formally endorsed by the Ministry of Public Health and Population and National IMCI Task Force established with national IMCI coordinator appointed. |
1998 |
National IMCI Orientation Meeting and Preliminary Planning Workshop conducted |
1998 |
National IMCI Planning and Adaptation Workshop conducted |
October 2000 |
Adaptation of IMCI clinical guidelines and training materials completed |
November 2000 |
First 11 – day IMCI case management course at central level for doctors conducted |
January 2002 |
IMCI early implementation phase started at district level |
June 2002 |
First IMCI follow up visits after training conducted |
August 2002 |
Early implementation phase in 3 districts completed |
December 2002 |
Review of Early Implementation Phase in 3 districts completed |
December 2002 |
Beginning of expansion to new districts and governorates |
January 2003 |
Integrated child health mobile teams established |
2007 |
March 2010 |
IMCI clinical training
Both physicians and paramedical staff are targeted for training in IMCI
Systematic approach to IMCI implementation at district level: key steps and tools
1. Selection of governorates/districts for IMCI implementation
Malaria risk (high and low) was used to select the areas for the early implementation phase. Then, criteria for the selection of districts included the following:
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Presence of a health centre and a hospital for referral cases;
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Facilities in the district staffed with medical assistant or nurse, trained in the management of acute respiratory infections (ARI) and diarrhoeal diseases (CDD);
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Facilities in the district supplied with refrigerators for immunization (cold chain);
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Availability of facilities for training in the district (physical place, video facility to show IMCI training video). Top
2. Orientation workshop in the selected districts
A one-day orientation meeting for key officials and partners was held in all districts, followed by the situation analysis. Top
3. Situation analysis of the districts selected
The IMCI planning and implementation working group reviews information on related policies, practices and facilities at district level (demographic and health statistics, human resources, supply—including drugs—and equipment, training facilities and staff) as part of the situation analysis of the district prior to IMCI implementation. Top
4. Approach to the community component
- Establishment of a national IMCI community working group
- Collection and review of health education and communication materials related to child health and available at the Ministry of Public Health and Population
- IMCI community baseline survey and two-week morbidity survey conducted in the two IMCI early implementation districts, to obtain information on child health status and family practices
- Review of the key family practices on child care
- Initial development of a plan of work
- Development of a training manual for trainers on the community component and a flipchart for health communication at local level. Top
5. Training in case management (skills acquisition)
Training followed the standard approach recommended by WHO for health provider skill acquisition. Top
6. Follow up after training (skills reinforcement)
Only one follow-up visit—as defined by WHO—was conducted in Yemen to reinforce clinical skills of health providers trained in IMCI and review the supporting environment in which they operate within four weeks of training. Two visits were carried out by the national team to other governorates many months after training. Top
7. Supervision
A supervisory checklist has been developed for supervision of staff trained in IMCI. This supervision is not integrated with routine supervision covering other topics than IMCI. Top
Implementation of IMCI in Tunisia
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 strategy formally endorsed by the Ministry of Public Health as the “Integrated Management of Maternal and Child Health” and National IMCI Coordinator appointed |
March 2000 |
National IMCI Orientation Meeting and Preliminary Planning Workshop conducted |
March 2000 |
National IMCI Planning and Adaptation Workshop |
October 2000 |
Adaptation of IMCI clinical guidelines completed |
December 2001 |
Pre-intervention assessment conducted |
February 2002 |
First 9-day IMCI case management course at central level for doctors conducted |
March 2002 |
IMCI training material in French for 4- day course for nurses at local level |
May 2002 |
IMCI early implementation phase started at district level |
September 2002 |
First IMCI follow-up visits after training conducted |
December 2002 |
Early implementation phase in 3 districts completed |
December 2002 |
Review of Early Implementation Phase and planning for the Expansion Phase conducted |
April 2003 |
Beginning of expansion to new districts and governorates |
June 2003 |
Healthy Child module developed |
2003 |
First meeting on the development of a National Child Health Policy held |
April 2004 |
Situation analysis for a National Child Health Policy prepared |
May 2004 |
National Child Health Policy document published |
2006 |
IMCI clinical training
Target coverage of providers of health facility
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For low-caseload outpatient health facilities: training of all health providers managing children less than 5 years old
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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
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Physicians: 9-day courses
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Nurses: 3 days
Materials
Different training materials used for physicians and nurses, to reflect their different responsibilities:
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Physicians: adapted training materials for standard IMCI course based on the Tunisian adapted version of the IMCI guidelines.
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Nurses: newly developed materials for Tunisia
Systematic approach to IMCI implementation at district level: key steps and tools
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Preliminary visit of national IMCI team to the governorates selected
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Visit of national IMCI team to discuss the findings of the situation analysis
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:
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Early Implementation: criteria based on the rationale to provide initial evidence on IMCI in areas with adequate support to implementation:
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Leadership and motivation of staff at different levels
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Districts representing different geographical areas (Urban and rural)
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Previous successful experience in public health programmes
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Easy accessibility to the national team
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Good health facility physical structure
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Expansion: criteria prioritising high underfive mortality areas:
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Underfive mortality rate
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Starting first with the most committed and manageable districts, to show a model for the other districts in the governorate
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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
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Brief orientation of decision-makers -Undersecretary of health, and other concerned authorities- to the IMCI strategy and its implementation
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Joint selection of the districts based on the criteria described in 1.
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Designation of an IMCI focal point. Top
3. Situation analysis of the districts selected:
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Status of equipment and supplies at each health facility
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Health providers’ performance
(tool used is the follow up forms). Top
4. District orientation/ planning workshop
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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.
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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.
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Methodology: Plenary sessions, group work at the national level
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Duration: 3 days
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Outcome: plans of action for the three IMCI components for each selected district. Top
5. Preparation of health facilities prior to implementation
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Reviewing staff’s responsibilities
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Re-arranging flow of patients
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Making drugs available
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Making necessary supplies and equipment available
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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)
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Preparation of the selected training site for the governorate
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Nomination of participants
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Conduct of training (9-day course for the IMCI case management training at district level for physician and 3-day course for nurses)
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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)
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Carried out 4 – 6 weeks after training
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Documented with reports by health facility visited, then compiled as district summaries
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Data entered in central database on training and follow-up. Top
10. Monitoring and Supervision
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Using the IMCI follow up visits after training forms
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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
Implementation of IMCI in Sudan
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 strategy endorsed by the Federal Ministry of Health and preliminary planning workshop conducted |
November 1996 |
National IMCI Steering Committee established by Ministerial Decree |
May 1997 |
IMCI Planning and Adaptation Workshop |
May 1997 |
Adaptation of IMCI clinical guidelines completed |
November 1997 |
First 11-day IMCI case management course at central level for doctors conducted # |
December 1997 |
IMCI training materials translated into Arabic (for medical assistants) |
December 1998 |
IMCI early implementation phase started at district level |
February 1999 |
First IMCI follow-up visits after training conducted |
June 1999 |
Early implementation phase in districts completed |
December 1999 |
Review of Early Implementation Phase and planning for the Expansion Phase conducted |
December 1999 |
Beginning of expansion to new districts and governorates |
2000 |
Introduction of IMCI into pre-service medical education |
April 2000 |
Development of medical student IMCI manual |
2002 |
IMCI health facility survey conducted |
March – April 2003 |
Meeting to introduce IMCI pre-service training in medical assistant schools |
2003 |
First draft of the situation analysis for a National Child Health Policy prepared |
March 2004 |
IMCI implementation in states
IMCI clinical training
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
- One-day IMCI orientation workshop
- Establishment of an IMCI committee at state level
- Assessment and preparation of a training centre
- Training of trainers
- Selection of locality for IMCI implementation
- Collection of baseline data
- Assessment of health facility basic needs and supplies
- IMCI district planning workshop
- Training in case management (skills acquisition)
- Training in facilitation and follow up skills
- Follow up after training (skills reinforcement)
- Supervision
- 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:
- Number, conditions and functionality of health centres in the area;
- Implementation of other initiatives in the area (e.g., community-based basic development needs or BDN);
- Presence of non-governmental organizations working in the area with a focus on health;
- High proportion of children under-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