Dr. Abdul Rehman Dr. Abdul Rehman PirzadoPirzado

Provincial MnCAH Officer Provincial MnCAH Officer SindhSindh

World Health Organization World Health Organization PakistanPakistan

To reduce significantly mortality and

morbidity associated with the major

causes of disease in children.

To contribute to healthy growth and

development of children.

Launched globally in 1995 Pakistan adapted 1998-2000 First national clinical course 2000 First clinical course in Sindh 2004 Pre-service adaptation in Pakistan 2004 Pre-service adaptation in Sindh 2009 First Pre-service evaluation in Pakistan –

LUMHS 2011. First logbook on Pakistan- LUMHS 2010

High Infant Mortality Rate – 78/000 live births.

High under 5 year mortality rate

Diarrhea, ARI, Malnutrition and Malaria are major

contributors in death of Under 5 children.

Government policy to integrate PHC activities.

PMDC requires to be included in graduate

teaching

RB-03-99WHO Department of Child and Adolescent Health and Development

Separate disease specific clinical

guidelines and training

materials

Separate

disease

specific

training

courses

Health

worker

attempts to

“Integrate”

guidelines

Integrated clinical

guidelines and training

materials

Integrated clinical training courses

Integrated

clinical case

managemen

t

Is not another vertical program

Incorporates elements of diarrhoeal diseases and ARI control program and child oriented aspects of malaria control, nutrition , EPI and other relevant programs

Depends on: effective functioning of essential drugs and EPI program

Demands and Facilitates: active collaboration of all these existing programs

Improves the quality of care of sick children in the primary health care context

Improving case management skills of health Improving case management skills of health workers:workers:

Standard guidelinesStandard guidelines Training (pre-service and in-services)Training (pre-service and in-services) Follow-up after training Follow-up after training

Improving the health system to deliver IMNCI:Improving the health system to deliver IMNCI: Essential drug supply and management Essential drug supply and management Organization of work in health facilitiesOrganization of work in health facilities management and supervisionmanagement and supervision

Improving Family and Community practices Improving Family and Community practices

Classification based on a colour-coded triage systemClassification based on a colour-coded triage system

Yellow - specific medical treatment and advice

Red - urgent pre-referral treatments and referral

Green - simple advice on home management

Assess a child Classify a child’s illnesses Identify treatments for the child. Treatment instructions

counsel the mother to solve any feeding

problems and her own health.

When a child is brought back to the clinic give

follow-up care and if necessary reassess the

child for new problems

Modules include exercises that help in learning

new skills

Modules are to be completed by reading it and

working through the exercises

Exercises supplemented by videos and

photographs.

Clinical practice as part of training

11 day clinical case management11 day clinical case management

FIVE day facilitator CourseFIVE day facilitator Course

THREE day Follow-up after trainingTHREE day Follow-up after training

FIVE day community IMNCIFIVE day community IMNCI

1.1. Exclusive BreastfeedingExclusive Breastfeeding

2.2. Complementary feeding / WeaningComplementary feeding / Weaning

3.3. Micronutrients supplementation for vitamin A, Micronutrients supplementation for vitamin A,

iron and zinc iron and zinc 

4.4. Hygiene. Dispose of faeces and wash hands. Hygiene. Dispose of faeces and wash hands.

5.5. Immunization as per EPI.Immunization as per EPI.

6.6. Preventing Malaria.Preventing Malaria.

7. Promote mental and social development by

responding to a child’s needs for care

8. Home care during Illness

9. Give sick children appropriate home treatment

for infections.

10. Care Seeking.

11. Compliance with advice

12. Antenatal Care

A regional team of 8 consultants from WHO evaluated the

process and outcomes during October 17-20, 2011.

This was 5th evaluation carried out by WHO in Egypt and Sudan.

Objective of the evaluation was to assess whether the

introduction of IMNCI in the department's teaching program in

2010 had led to students’ competence in managing sick

children with common health problems according to the IMNCI

guidelines and make recommendations to further strengthen

the teaching program

The evaluation was carried out according to the standard methodology described in the “Guide to the evaluation of IMCI pre-service education”, developed by WHO Regional Office.

After reviewing the information on the pediatric department and IMNCI teaching process and methodology, the team:

observed several outpatient clinical and theoretical teaching sessions;

visited the library and teaching sites; conducted focus group discussions with students and

teachers in both the pediatrics and community medicine departments;

assessed student knowledge through a written test of multiple-choice questions and case scenarios;

assessed student clinical skills through observation of case management practiced by students.

Finally, the team provided feedback to the vice-chancellor and staff of the University, including the dean and heads and teaching staff of the departments

Overall, the environment at Liaquat University is very supportive to IMNCI teaching, which has formally endorsed it at high level in the institution.

A provincial pre-service training committee has also been established to coordinate this initiative

All teaching staff at the pediatrics department have been trained in IMNCI, with a staff-to-student ratio of 1:13 for both practical and clinical sessions.

More than a third (35%) of total teaching hours are allocated to IMNCI.

Teaching of IMNCI is, in general, consistent with traditional, classical pediatric teaching, well integrated throughout the curriculum and materials, interactive and makes use of a variety of teaching methods, with sessions including the full range of theoretical, practical and clinical sessions.

The outpatient department has been set up in a way conducive to teaching IMNCI, with a smooth flow of patients.

IMNCI-related items have been included in student examinations, with 30% of total marks assigned to IMNCI.

Reference materials are available in the library and regularly used by students.

Approaches to sustain the initiative in the long term have been adopted and teaching has been enhanced based on review of the experience.

Teaching staff’s and students’ attitudes towards IMNCI are very positive, with students greatly appreciating the variety of teaching methods and clinical sessions.

Overall, students performed well in both the knowledge and clinical assessment tests, showing confidence with the topics and clinical skills: 79% of the students assessed obtained an overall score of at least 80% in the case management skill test, based on to the IMCI standard protocol as a gold standard. The two tests have helped identify teaching areas which may be further enhanced.