Household & Community IMCI

1. Courtesy of UNICEF Courtesy of Microsoft Courtesy of LifenetsI Courtesy of OFDC Courtesy of PCI Household &Community IMCI A Global Framework built with Local Know-How The Child Survival Collaborations and Resource Group

2. Reduced Mortality Health Worker Skills Health Systems Community Defined Investments $$ Materials Defined Investments $$ Materials The 3 Components of IMCI ? Undefined Little investment $$ Few Materials

3. Durban Mtg consensus on 16 key practices and role of HH/C IMCI in promoting them UNICEF Meetings with NGO particip produces mandate for HH/C IMCI WHO/UNICEF LAUNCHES IMCI Santo Domingo Meeting recog. Importance of HH/C-IMCI CORE Mtg. at PAHO acknowledging role of NGOs in advancing HH/C IMCI IAWG estab with UNICEF leadership to develop HH/C-IMCI guidelines Early efforts focus on Health worker skills and system improvements CORE IMCI WG dedicates focus on HH/C IMCI agenda The HH/C IMCI Timeline: Oct. ‘97 1992 Jun. ‘00 Sept. ‘97 1992-1997 Feb. ‘99 Feb. ‘98 1998-99

4. Reaching Communities for Child Health: Advancing PVO/NGO Technical Capacity and Leadership for Household and Community Integrated Management of Childhood Illness (HH/C IMCI)  Baltimore, Maryland USA January 17-19, 2001 CSTS BASICS II

5. Who the participants were… Non-Governmental OrganizationsProject HOPECRSWorld Vision Project Concern International Medical Care Development Hellen KellerAndean Rural Health Care PLAN Counterpart International International Rescue Committee CARE Minnesota International Health Volunteers ADRA Salvation Army Save the Children Christian Children’s Fund Aga Khan Foundation Health Alliance International Pearl S. Buck International UN OrganizationsUNICEF WHO PAHO Donor OrganizationsUSAID WORLD BANK Public Health Specialists BASICS CSTS Environmental Health Project University Research Center Johns Hopkins School of Public Health AED John Snow MOST World Education DISH

6. Canada Uzbekistan Nepal Honduras Philippines India United States Vietnam Uganda Nicaragua Rwanda Peru Indonesia Kenya Argentina From all around the world…

7. The expertise of 120 participants 3 Important Resources were used… The 4 Intervention Options for HH/C IMCI By Peter Winch 18 Presentations on community strategies that have had an impact on child health

8. 1) How will HH/C IMCI be different than what we are doing now? 2) What will be the relationship between the HH/C IMCI and the other two components? 3) What are the roles of MOH, PVOs, NGOs and donor community in HH/C IMCI? In defining a framework the following questions were important to consider…

9. The Outcome… The driving force of the workshop, and one of its most promising outcomes, was the evolution of a consensus that articulates a clear vision and dynamic framework for community IMCI. It provides governments, NGOs and communities alike with a clear structure for assessing programs, for future programming, and for advocating for resources necessary to fully operationalize HH/C IMCI.

11. Courtesy of FAO Element #1:Improving partnerships between the facilities and the communities they serve

12. Clinic to community Community to clinic Element #1:Improving partnerships between the facilities and the communities they serve • Outreach skills • Interpersonal counseling • Quality of health services Courtesy of Desert Margins Program • Awareness of health services • Appropriate and timely use • Community management • Health information systems

13. Element #1 Examples • Joint village level outreach by community and facility-based providers • Collaborative oversight, management and supervision of health services by community committees • Joint collaboration on community-based health information systems

14. Bi/Multi-lateral Agencies Advocate for and fund partnership development activities; Research successful strategies Ministry of Health Improved service provider and partner NGO Skills building (clinic and community); facilitators; designers of community-based HIS Service user and partner; provider of community health information Community Element #1:Improving partnerships between the facilities and the communities they serve Potential Roles:

15. How do we know if we are implementing Element 1? Element #1:Improving partnerships between the facilities and the communities they serve Validating Questions for Element #1: of IMCI f Have mechanisms been created to formalize community involvement in facility-level management decision-making? Have programs assessed and attempted to improve service quality and demand based on client feedback? Does substantive information sharing between the community and facility occur that affects how and what kind of services are provided?

16. Courtesy of PLAN Element #2:Increasing appropriate and accessable health care and information from community-based providers

17. Health information Community-Based Providers Health Care Community Health Workers Private providers Traditional Healers Traditional Birth Attendants Shopkeepers/Drug sellers Pharmacists Direct Treatment Pre-natal care Immunization Health Surveillance Referral Behavioral Change Communication (BCC) Counseling Awareness Advocacy Element #2:Increasing appropriate and accessable health care and information from community-based providers

18. Element #2 Examples • Training of pharmacy personnel to reduce overuse of antibiotics or to correctly prescribe anti-malarials • Implementation of mini-pharmacy kits managed by community agents • Training of CHWs in case management / counseling using simplified IMCI algorithm

19. Bi/Multi-lateral Agencies Advocate for and fund element 2 activities as a part of HH/C IMCI Ministry of Health Supervision, support and training NGO Trainers, facilitators, service providers Determines service providers, supervises, compensates, complies with counsel Community Element #2:Increasing appropriate and accessable health care and information from community-based providers Potential Roles:

20. How do we know if we are implementing Element 2? Element #2:Increasing appropriate and accessable health care and information from community-based providers • Validating Questions for Element #2: of IMCI f • Are you or your partners working with community providers to help them expand and improve the following services in the community? • appropriate front-line care • referral • surveillance • health information

21. Element #3:Integrating promotion of key family practices for child health and nutrition

22. Element #3:Integrating promotion of key family practices for child health and nutrition A) For physical growth and mental development B) For disease prevention C) For appropriate home care D) For seeking care

23. Element #3 Examples • Promoting key health messages through various strategies, such as: communication and behavior change efforts in malaria prevention (ITNs) • Rehabilitating malnourished children and preventing future malnutrition through the PD/Hearth approach • Promoting access and use of ORS for diarrhea • Participatory assessments to promote community input into health behaviors to be promoted

24. Bi/Multi-lateral Agencies Advocate for and fund element 3 activities as a part of HH/C IMCI Ministry of Health Organize national messages, Educates and counsels in clinic NGO Facilitates identification of priority behaviors, helps adapt and deliver messages via appropriate mechanisms Determines priority behaviors, helps identify appropriate ways of communicating message Community Element #3:Integrating promotion of key family practices for child health and nutrition Potential Roles:

25. How do we know if we are implementing Element 3? Element #3:Integrating promotion of key family practices for child health and nutrition Validating Questions for Element #3: of IMCI f Element 3: Are you or your partners helping families to employ key family practices through effective social and behavioral change strategies?

26. Multi-Sectoral Platform The focus of the multi-sectoral platform is similar to addressing primary health (Alma Alta): • Water and Sanitation • Education • Income generation • Agriculture

27. #1 CONDUIT FOR TRANSFERRING IMPORTANT HEALTH MESSAGES TO THE COMMUNITY AND FAMILY Multi-Sectoral Platform Examples tend to fall in one of three categories

28. Incorporating handwashing messages into water and sanitation programs Building preventive messages on HIV/AIDS into a credit program Training agricultural extensionists to promote proper weaning foods Using schools to train students as youth community health promoters Multi-Sectoral Platform Examples of this would be...

29. #2 ALLIGNING DIFFERENT SECTORS TO ADDRESS BARRIERS TO CHANGE FOR KEY HEALTH PRACTICES Multi-Sectoral Platform

30. Increasing water and sanitation programs to address preventable causes of diarrhea Mobilizing income generation efforts to break down the economic barrier to ITN purchase Multi-Sectoral Platform Examples of this would be...

31. #3 MULTI-STAKEHOLDER PLANNING Multi-Sectoral Platform And...

32. How do we know if we are optimizing the MSP? Multi-Sectoral Platform Validating Questions for MSP: of IMCI f Are you or your partners working with or through other (non-health) sector entities in ways that improve child health?

33. How does HH/C IMCI link with facility-based IMCI? How can you apply HH/C IMCI without a health facility? Frequently Asked Questions

34. Do you really need all the elements and the MSP? How do they link together? Frequently Asked Questions