Intervention delivery approaches aka how do we get the interventions delivered
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Intervention Delivery Approaches AKA How do we get the interventions delivered?. Horizontal. vs. Comprehensive vs. Selective Approaches. Vertical. Social marketing? Reduced cost? Give away?. Target universal population? Target the poor?. Approaches. Disease Eradication/Elimination

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Intervention delivery approaches aka how do we get the interventions delivered
Intervention Delivery Approaches AKA How do we get the interventions delivered?

Horizontal

vs.

Comprehensivevs.SelectiveApproaches

Vertical

Social marketing?

Reduced cost?

Give away?

Target universal population?

Target the poor?

Approaches

Disease Eradication/Elimination

PHC approach?

Integrated approach?

Facility vs. community based approach


Session learning objectives
Session Learning Objectives interventions delivered?

  • Define various strategies for implementing MCH interventions including intersectoral, vertical, comprehensive, primary health care, integrated, social marketing, community-based, facility-based, universal and targeted approaches

  • Describe trends / historical context of various MCH implementation strategies

  • Compare the advantages and disadvantages of the major strategies used in MCH programming

  • Explain the successes and weaknesses of the IMCI strategy as it has been executed


Session structure
Session Structure interventions delivered?

Why studies strategies for intervention delivery?

Historical basis of strategies

Review strategies in the context of VPDs, malaria, injuries

IMCI


Summary interventions to reduce child mortality
Summary: Interventions to Reduce Child Mortality interventions delivered?

2/3 of child deaths could be averted with interventions that are already available and recommended for universal coverage!

however

We need to make better progress in expanding coverage of interventions


Interventions (What) interventions delivered?

vs.

Strategy/Approach (How)


Causes of child mortality
Causes of Child Mortality interventions delivered?

Reproduced from UNICEF ChildInfo website: http://www.childinfo.org/mortality.html and based on Black R et al. Global, regional, and national causes of child mortality in 2008. Lancet. 2010;375:1969–1987.


Expanded program on immunizations epi
Expanded Program on Immunizations (EPI) interventions delivered?

  • Established 1974

  • Individual countries create and implement their own vaccination program policies

  • Universal immunization with standard vaccinations

    • Ensure full immunization of children under age one in every district

    • Eradicate polio, reduce measles and neonatal tetanus deaths

7


Expanded program on immunizations epi1
Expanded Program on Immunizations (EPI) interventions delivered?

  • Expand access to relevant new vaccines

  • Expand target groups to older children, adolescents and adults as needed

  • Work in synergy with other public health programs

8


Basic vaccine schedule
Basic Vaccine Schedule interventions delivered?

BCG=Bacillus Calmette-Guerin (against TB)

DPT=Diphtheria, Tetanus, Pertussis OPV=Oral Polio Vaccine

HepB=Hepatitis B Hib=Hemophilus influenza b



Vaccine coverage
Vaccine Coverage interventions delivered?

DPT3 immunization coverage, 2010


Immunization programs multifaceted and complex
Immunization Programs: interventions delivered?Multifaceted and complex

12


Cost profile of immunizations
Cost profile of immunizations interventions delivered?

The State of the World’s Vaccines and Immunization. WHO/UNICEF. 2002


Malaria

Plasmodium interventions delivered? parasites

Anopheles mosquito--vector

Parasites enter bloodstream via mosquito saliva

Invade red blood cells (RBCs), multiply there, lyse RBCs

Malaria


50 of the worlds population live in malaria endemic areas 90 of deaths in ssa
~50% of the worlds’ population live in malaria endemic areas; 90% of deaths in SSA

Source: UNICEF childinfo.org


Malaria treatment
Malaria: Treatment areas; 90% of deaths in SSA

  • Intermittent Preventative Treatment of malaria in pregnancy (IPTp)

  • Prompt treatment with appropriate antimalarials


Malaria treatment resistance
Malaria: Treatment Resistance areas; 90% of deaths in SSA

Artemisinin Combination Therapy (ACT)


Act coverage
ACT Coverage areas; 90% of deaths in SSA

Among all children who received an antimalarial drug, the proportion of children receiving ACT, African countries, 2007–2010

http://www.childinfo.org/malaria_progress.html

18


Malaria prevention
Malaria: Prevention areas; 90% of deaths in SSA

  • Vector control

    • Indoor Residual Spraying (IRS)

    • Environmental measures (e.g. reduction of standing water)

    • Insecticide Treated Nets (ITNs)

      • High ITN use 17% reduction in childhood mortality


ITN use in sub-Saharan Africa areas; 90% of deaths in SSAProportion of children sleeping under an ITN (among all African countries with 2 or more comparable points)

http://www.childinfo.org/malaria_progress.html


ITN use in sub-Saharan Africa areas; 90% of deaths in SSAProportion of pregnant women sleeping under an ITN (among all African countries with 2 or more comparable points)

http://www.childinfo.org/malaria_progress.html


22 areas; 90% of deaths in SSA

http://www.childinfo.org/malaria_progress.html


Itn distribution in ghana
ITN Distribution in Ghana areas; 90% of deaths in SSA


Childhood injuries
Childhood Injuries areas; 90% of deaths in SSA

  • Burns, pedestrian injuries, drowning, falls

  • 250,000 deaths of children <5 years

  • Most injuries are preventable

  • Multi-sector approach to prevent injuries

  • Simple protocols can reduce fatality and disability


Session structure1
Session Structure areas; 90% of deaths in SSA

Why studies strategies for intervention delivery?

Historical basis of strategies

Review strategies in the context of VPDs, malaria, injuries

Integrated care / IMCI


Problems with unintegrated care and selective programming example of hiv infected woman
Problems with unintegrated care and selective programming: Example of HIV infected woman

TB clinic

FP Clinic

Birth controls, condoms

AIDS treatment center of excellence

T&C, ARVs, PMTCT drugs, condoms

ANC

Health post—

Malaria, other illness


Integrated management of childhood illnesses imci
Integrated Management of Childhood Illnesses (IMCI) Example of HIV infected woman

  • integrated approach

  • to reduce death, illness and disability, and to promote growth and development

  • preventive and curative elements

  • implemented by families, communities and health facilities


Three components of imci
Three Components of IMCI Example of HIV infected woman

  • Improves health worker skills

  • Improves health systems

  • Improves family and community practices


Imci component 1 improve health worker skills
IMCI Component 1: Improve Health Worker Skills Example of HIV infected woman

  • Targets first level health facilities

  • Addresses causes of at least 70% of deaths

  • Case management guidelines

  • Training

  • Supervision

  • Monitoring


Imci addresses most causes of death

Pneumonia Example of HIV infected woman

Diarrhea

Measles

Malaria

Malnutrition

Sepsis

Meningitis

Dehydration

Anemia

Ear infection

HIV/AIDS

Wheezing

IMCI Addresses Most Causes of Death


Imci component 2 improve family and community practices
IMCI Component 2: Improve Family and Community Practices Example of HIV infected woman

  • Community participation

  • Preventive care

    • Immunization

    • Breast-feeding and other nutritional counseling

  • Home care of sick children

  • Recognition of severe illness

  • Care-seeking behavior


Imci component 3 improves health systems
IMCI Component 3: Improves Health Systems Example of HIV infected woman

  • Planning and Management

  • Availability of drugs and supplies

  • Organization of work

  • Monitoring and supervision

  • Referral pathways and systems

  • Health information systems


Imci multicountry evaluation
IMCI Multicountry Evaluation Example of HIV infected woman

  • Training health workers  improved performance

  • Difficult to maintain & expand existing IMCI sites

  • District and national health systems lack sufficient management structure, funding, coordination, supervision, and manpower

  • Low utilization rates of health services IMCI cannot impact child mortality


Improving health worker skills community care and health systems

Clinical Example of HIV infected woman

Assessment

and treatment by health workers

Knowledge,

Beliefs

and skills

caretakers

Capacity, structure

and functions of

health system

Improving Health Worker Skills, Community Care, and Health Systems


Conclusion
Conclusion Example of HIV infected woman

  • Most maternal and child deaths are due to a select number of causes

  • Effective interventions exist that are cost effective, feasible and recommended for implementation and can eliminate 2/3 of childhood deaths

  • Need effective strategies to deliver interventions, especially to the poorest populations

  • Need involved communities and strong health systems


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