The courage to make every life count

Murwa BhattiProgram Manager, Maternal & Child Health

Program, IRDOct 14, 2015 @ HANIF meeting, Nathiagali

electronic Integrated Management of Childhood Illnesses (eIMCI)

Geographical Scope: Muzaffargarh District

Priority Area: Nutrition

Start Date: April 15, 2015

End Date: December 15, 2015

Global Under 5 mortality

Country % of U5 Mortality Burden U5 Mortality Rate per 1000 live births

India 22.3 61 Nigeria 11.3 128 Congo 6.1 99 Pakistan 5.6 72 China 4.1 15 Ethiopia 3.6 77

Sources: United Nations Interagency Group on Child Mortality Estimation (Report 2012) Liu L. et al. Lancet. 2012

Background: Under 5 Children Health

Source: DHS, Nigeria 2013

Two-thirds of child deaths are from preventable or treatable infectious diseases

Malaria

Pneumonia

Diarrhea

Sepsis/meningitis

Measles

Malnutrition

Integrated Management of Childhood Illness (IMCI)

Aims:

WHO & UNICEF started developing strategy in 1992

Strengthening primary health

Identification of true cases

Rationalizing use of drugs

Reducing hospitalization

Reduce: Death, Illness & Disability

Promote: Improved Growth & Development

IMCI implementation in Pakistan

Currently deployed in more than 80% of 135 districts across Pakistan

– Within district coverage limited to few health facilities

– Lack of adherence by community workers

Adopted by Pakistan in 1998

In 2000 - Launched in 2 Punjab districts

Challenges in Implementation

1 2 3 4

Low training coverage

Challenges in Implementation

21 3 4

Inadequate training

Challenges in Implementation

21 3 4

Complex modules and algorithms

Challenges in Implementation

31 2 4

Lack of adherence to protocol

Sick children not properly

assessed and treated

Parents poorly advised

Weak referral mechanism

between community and

healthcare facility

Inability to reduce

morbidity and mortality

Poor Implementation

leads to…

Overall Goal

Reduce child mortality in an outreach setting to prevent and improve the management of common, and potentially life threatening illnesses in children using a mobile health platform

Focus population: low-socio economic class by selecting a district with the very poor indicators through a effectively proven service

delivery structure of LHW program  

Build upon the existing infrastructure of the LHW network to proactively identify and link children and parents to appropriate care

Support the existing healthcare system through LHW capacity building and strengthening the referral network

Through the eIMCI program progress will be directly measured through:

Increase in referrals to target community BHUs and hospitals

Increase in community based care

All < 5 year olds

Inclusion of Dengue, UTI &

TB

Direct enrollment in

interactive reminders program

Direct cellular communication

with CHWs

eIMCI Local Adaptations

Improved monitoring in real time, at scale

01020304

05

Clinical Decision Support System – with screening algorithms to gather patient data and reduce human error

Decreased dependency on quality of training, health workers and supervision

Better implementation of IMCI protocol

Increased screening speed and reduced waiting time

Benefits of electronic-IMCI

eIMCI Application

Implementation Challenges

Availability of LHWs for 11 consecutive days for training is difficult since they spend 9

days a month on polio campaigns

Geographic connectivity and flood warnings

High cost of a 11 day training

Coordination with Punjab Information Technology

Board (PITB)

CORRECT Attributes

C : Credible WHO recommended guidelines

O: Observable Real Time data reporting and results

R: Relevant Refines an LHWs ability to identify and manage an illness

R: Relative Advantage Innovation in technology

E: Easy to install and understandable Easy-to-use smartphone application

C: Compatible Facilitates daily duties of end users (LHWs)

T: Testable Pilot followed by implementation

Key Stakeholders

LHW teams

EPI

Indus Hospital

Local Community

Provincial and District

Health Departments

Other National Programs

eIMCI Scale up plan

International Expansion

END