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Caring for newborns and children in the community:

a package of training materials for community health workers

Caring for newborns and children in the community:

a package of training materials for community health workers

Bernadette Daelmans

Coordinator Policy, Planning and Programmes

Department of Maternal, Newborn, Child and Adolescent Health

WHO, Geneva

Too many children are not reached with essential interventions

Too many children are not reached with essential interventions

Source: countdown to 2015, June 2010

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How can we contribute to increasing coverage?

How can we contribute to increasing coverage?

• Increase the availability of services

• Increase access to care for newborns and children available close to home

• Make interventions simpler to implement

• Improve the quality of services provided

• Strengthen the linkages between health facilities and community-level care providers (including promotion of care-seeking)

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Extending care to the community: Joint statements UNICEF-WHO

Extending care to the community: Joint statements UNICEF-WHO

Diarrhoea

PneumoniaSevere acute malnutrition Home visits

for newborn care

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Translating evidence into practiceTranslating evidence into practice

UNICEF/WHO training materials

1. Caring for the sick child in the community

2. Caring for the newborn at home

3. Caring for the child's healthy growth and development

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Caring for the sick child in the community

• Referral of children with danger signs and severe acute malnutrition

• Treatment in the community– Diarrhoea – Fever (malaria)– Pneumonia

Caring for the child's healthy growth and development

• Care-giving skills and support for child development

• Infant and young child feeding

• Prevention of illness

• Family response to child’s illness

Caring for the newborn at home

• Promotion of ANC and skilled care at birth

• Care in first week of life • Recognition and referral of

newborns with danger signs• Special care for low-birth-

weight babies

Summary of content of the materials

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• Age range: Addresses needs of children age 0-59 months

• Holistic: Cares for the newborn and child, not single disease conditions

• Structure of training: sequential introduction (or independent use) of components, on the-job skills reinforcement

• Level of literacy of community health workers: Literate – grade 5-8 level

• With health system or NGO system: Requires adaptation to national policies, training, regular supplies, supervision, link to IMCI in first- and referral care facilities

Design of the materials

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Caring for the sick child in the communityCaring for the sick child in the community

• Identify signs of illness• Diarrhoea• Fever• Chest indrawing• Fast breathing• Severe malnutrition

• Refer child with danger signs (or other problems) and begin treatment

• Treat diarrhoea at home (ORT and zinc)

• Treat fever (antimalarial) and fast breathing (antibiotic) at home

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Caring for the sick child in the communityCaring for the sick child in the community

• Sick Child Recording Form

• CHW training manual

• Facilitator guide

• Video and photo flip chart

• Chart booklet

• Inpatient instructor guide

• Outpatient guide

• Job aids

Duration: 6 days, includes 2 inpatient and 5 outpatient clinical practice sessions

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Caring for the newborn at homeCaring for the newborn at home

• Two home visits during pregnancy

• Home visit on the day of birth if home delivery; if delivery at facility then soon after returning home

• Additional visits during first week of life:

• days 3 and 7

• For low birth weight infants: additional visits on days 2 and 10

• Optimal timing of contacts to promote key family practices after the neonatal period are being defined

Duration 6 days, 2 clinical practices in HF, 2 home visits: to pregnant women, and newborns and mothers after childbirth

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Caring for the newborn at home: Job Aides

Caring for the newborn at home: Job Aides

• Counselling cards

• Mother and Baby card

• Referral note

• CHW register

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Caring for the child's healthy growth and development

Caring for the child's healthy growth and development

• Promote growth: Counsel on breastfeeding and complementary feeding

• Stimulate the child’s development: Play and communicate

• Prevent illness: Immunization, ITNs, hand-washing

• Respond to illness

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Caring for the child's healthy growth and development

Caring for the child's healthy growth and development

Individual counselling during home visits - themes

• Infant and young child feeding

• Early child development

• Prevention of illness

• Careseeking

Group sessions - themes

– Infant and young child feeding

– Early child development

– Safe and clean environment

– Prevention of injuries and accidents

– Careseeking

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Status of implementationStatus of implementation

• Caring for the sick child in the community

• Introduced in numerous countries, including Malawi, Philippines, Zambia

• Adapted versions in Egypt, Sudan, Uganda, Yemen

• Version with RDT tested in Uganda, final version on Web

• Caring for the newborn at home

– Based on work in Ghana and south Asia; tested in Cambodia, India, Kenya, Philippines

– Introduced in DR Congo, Malawi, Nigeria, Uganda, Zambia, Zimbabwe, Senegal, India

– Adaptations of illustrations for South Asia and for Africa

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Status of developmentStatus of development

Caring for the child's health growth and development

– Tested in Philippines in March 2011

– Revised version tested in India September 2011

– Illustrations being developed in 3 sets for use in:

• Europe / Latin America

• Asia

• Africa

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Programmatic pathway for improving survival and health

Programmatic pathway for improving survival and health

IMPLEMENTATION OF ACTIVITIES

Advocacy for child health

Human, material and financial resource

mobilization

Human resource capacity development

Communication with families &

communities

Health system supports strengthened

Progress tracked

IMPROVED

Availability and access to health care

Quality of care

Demand for care

Knowledge of families and communities

INCREASED POPULATION-

BASED COVERAGE

of key effective interventions

IMPROVED SURVIVAL

AND HEALTH

Other determinants

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Programmatic requirementsProgrammatic requirements

• Policies

• Adaptations

• Sustainable human resource plan

• Linkages with health services for maintaining performance

• Supervisory system

• Logistics and supply

• Referral and counter-referral

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Countries need to adopt relevant policies Countries need to adopt relevant policies

Source: Countdown to 2015, June 2010

Numerator Denominator

Documentation of routine data(MOH or IP at district level)

Verbal interviews

(cell phones or at gathering

place)

Inspection visits

(audits & interviews at CHW site)

Supply-side indicators

1. CHW available (deployed)# CHWs working at time of assessment

Total population under 5 years ++1 -- --

2A. CHW trained in CCM # CHWs trained in CCM # CHWs working at time of assessment (or # of CHWs surveyed)

+ ++ ++

2B. CHWs providing CCM services

# CHWs who have seen a sick child in the past seven days

# CHWs working at time of assessment (or # of CHWs surveyed) +/-2 ++ ++

3. CHWs with supply of key CCM drugs in last 3 months (items reported individually)

# CHWs with no stock outs of more than 7 days of key drugs (AB, ACT, ORS, ZN, timer, RDT) in last 3 months

# CHWs working at time of assessment (or # of CHWs surveyed) +/-2 +3 ++3

4. CHWs supervised in CCM in last 3 months

# CHWs supervised in CCM in last 3 months # CHWs working at time of assessment

(or # of CHWs surveyed) +/-2 ++ ++

5. Supervision in last 3 months with reinforcement of clinical practice

# CHWs supervised in last 3 months with reinforcement of clinical practice (observation of case management, practicing case scenarios, mentoring at a health facility)

# CHWs working at time of assessment (or # of CHWs surveyed) +/-2 ++ ++

Demand-side indicators

Further discussion is needed with implementing partners to propose a core set of indicators in this area.

Utilization indicators

Utilization of services should be tracked in all areas participating in the evaluation.

Defining indicators and data collection methods for iCCM

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Next stepsNext steps

Build additional training capacity in 3 packages

Develop programmatic guidance (planning, adaptation, monitoring implementation, evaluating)

Finalize indicators and methods for measuring quality of care and make available

Investigate how to resolve bottlenecks such as motivation, retention, and quality performance

Scale up and document processes, lessons learned, best practices