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?

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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

  • 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

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

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


Intervention delivery approaches aka how do we get the interventions delivered

Interventions (What)

vs.

Strategy/Approach (How)


Causes of child mortality

Causes of Child Mortality

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)

  • 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)

  • 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

BCG=Bacillus Calmette-Guerin (against TB)

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

HepB=Hepatitis B Hib=Hemophilus influenza b


What is the global vaccine coverage rate

What is the Global Vaccine Coverage Rate?


Vaccine coverage

Vaccine Coverage

DPT3 immunization coverage, 2010


Immunization programs multifaceted and complex

Immunization Programs:Multifaceted and complex

12


Cost profile of immunizations

Cost profile of immunizations

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


Malaria

Plasmodium 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

  • Intermittent Preventative Treatment of malaria in pregnancy (IPTp)

  • Prompt treatment with appropriate antimalarials


Malaria treatment resistance

Malaria: Treatment Resistance

Artemisinin Combination Therapy (ACT)


Act coverage

ACT Coverage

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

  • 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


Intervention delivery approaches aka how do we get the interventions delivered

ITN use in sub-Saharan AfricaProportion of children sleeping under an ITN (among all African countries with 2 or more comparable points)

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


Intervention delivery approaches aka how do we get the interventions delivered

ITN use in sub-Saharan AfricaProportion of pregnant women sleeping under an ITN (among all African countries with 2 or more comparable points)

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


Intervention delivery approaches aka how do we get the interventions delivered

22

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


Itn distribution in ghana

ITN Distribution in Ghana


Childhood injuries

Childhood Injuries

  • 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

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)

  • 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

  • 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

  • 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

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

  • 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

  • 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

  • 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

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

  • 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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