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  1. 1. F-IMNCI Presented By: Nikhil Bansal(2006)
  2. 2. IMNCI: WHO/UNICEF have developed a new approach totackling the major diseases of early childhoodcalled the Integrated Management of ChildhoodIllnesses (IMCI)
  3. 3. Why IMNCIReduce infant and child mortality ratesImproving child health & survivalIMR reduced from 114 to 53Malnutrition and low birth weight (LBW) are contributors to the about 50% deaths
  4. 4. Attention to counselling skills to promote exclusive breastfeeding, complementary feeding & micronutrient supplementation is a key strength of IMNCI Malaria* 5% Measles* Other 7% 32% Diarrhoea* 19% Malnutrition* 54% Acute Respiratory Perinatal Infections* 18% 19%* Based on data taken from The Global Burden of Disease 1996, edited by Murray CJL and Lopez AD, andEpidemiologic evidence for a potentiating effect of malnutrition on child mortality, Pelletier DL, FrongilloEA and Habicht JP, AmJ Public Health 1993;83:1130-1133
  5. 5. THE INTEGRATED CASE MANAGEMENT Out Patient Health Facility (up to 5 yrs) Check for Danger Signs Ask about main symptoms Assess Nutrition & Immunization Status Check for other ProblemsClassify Conditions & Identify Management Strategy
  6. 6. Case management strategyPINK CLASSIFICATION: Child needs referral ( Inpatient care)YELLOW CLASSIFICATION:Child needs specific treatment, provide it at home (e.g.Antibiotics, ORS)GREEN CLASSIFICATION: Child needs no medicine, give home care
  7. 7. IMNCI Beneficiaries• Care of Newborns and Young Infants (infants under 2 months)• Care of Infants (2 months to 5 years)
  8. 8. Care of Newborns and Young Infants (infants under 2 months)• Keeping the child warm• Initiation of breastfeeding• Counseling for exclusive breastfeeding• Cord, skin and eye care• Recognition of illness in newborn and management and/or referral• Immunization• Home visits in the postnatal period
  9. 9. Care of Infants (2 months to 5 years)• Management of diarrhoea, ARI malaria, measles, acute ear infection, malnutrition and anemia• Recognition of illness and risk• Prevention and management of Iron and Vitamin A deficiency• Counseling on feeding for all children below 2 years• Counseling on feeding for malnourished• Immunization
  10. 10. IMNCI Components and Intervention areas• Improve health • Improve • Improve worker skills health family & systems community practices• Case • District & • Appropriate management Block Care seeking standards & planning guidelines and managemen t• Training of • Availability • Nutrition facility-based of IMNCI public health drugs care providers
  11. 11. IMNCI Components and Intervention areasImprove health Improve health Improve familyworker skills systems & community practicesIMNCI roles for Quality Home caseprivate providers improvement management & and supervision adherence to at health recommended facilities – treatment public & private
  12. 12. IMNCI Components and Intervention areasImprove health Improve health Improve family &worker skills systems community practicesMaintenance of Referral Communitycompetence pathways & services planningamong trained services & monitoringhealth Health Information System
  13. 13. Components of IMNCITrainingEffective implementation • Improvements to the health system • Improvement of Family and Community PracticesCollaboration/coordination with other Departments
  14. 14. Components of IMNCI TrainingIMNCI is a skill based training in both facility and community settingsBroadly, two categories of training are includedfor medical officersfor front-line functionaries including ANM’s and AWW’s
  15. 15. Components of IMNCIEffective implementation Improvements to the health system • Ensuring availability of the essential drugs • Improve referral • Referral mechanism • Functioning referral centers • Ensuring availability of health workers / providers at all levels • Ensuring supervision and monitoring through follow up visits
  16. 16. Components of IMNCIEffective implementation Improvement of Family and Community Practices Counseling of families and creating awareness which includes: • Promoting healthy behaviors • IEC campaigns • Counseling of care givers and families • During home visits identify sickness and focused BCC
  17. 17. Components of IMNCICollaboration/coordination with other Departments• Involvement of ANM and AWWs• Involvement of grass-root functionaries of other sectors• Active involvement of PRI, SHGs and women’s groups
  18. 18. F-IMNCIFrom November 2009 IMNCI has been re -baptized as F-IMNCI, (F -Facility) with added component of: • Asphyxia Management and • Care of Sick new born at facility level, besides all other components included under IMNCI
  19. 19. Institutional Arrangements• State Level• District Level
  20. 20. State level Institutional Arrangements• Appoint Nodal Officer• Set up a co-ordination Group• Arrange logistics• Create pool of State level trainers• Selection of priority districts• Review progress• Identify the State Nodal institute for training• Improvement in family and community practices
  21. 21. District level Institutional Arrangements• Appoint District Coordinator• Set up an IMNCI Coordination Group• Train District Trainers.• Develop a detailed plan for implementation• Ensure timely supplies & logistics, supervision and follow-up• IEC activities
  22. 22. ng Training in IMNCI • Medic• Clinical • Medical Officer • 8 • Physicia skills and Pediatrician day n al training s Package colleg e /Distri ct Hospit al • Health workers • 8 • Health • Distric ANMs, LHVs, day Worker t Mukhya sevika s s Hospit CDPO’s and Package al AWWs
  23. 23. Type of Personnel to Durat Package Place ofTraining be trained ion to be Training usedSupervis Medical 2days Superviso Medicalory Skills Officers, ry Skills collegeTraining Pediatricians, package /District CDPO’s LHVs Hospital and Mukhiya Sevikas)
  24. 24. Training Institutions• State Level• District Level
  25. 25. State Level Training Institutions• Identify a Regional Training Centre• The Departments of Pediatrics and Preventive & Social Medicine in each college
  26. 26. District Level Training Institutions• District hospital for training of medical officers• CHCs/operational FRUs etc for training of health workers
  27. 27. Follow-up Training (FUT)• The Follow-up Training is designed to improve supportive supervision for 2 days which may either be clubbed with Clinical skills training or conducted within 6-8 weeks of the initial Clinical skills training.
  28. 28. Pre-Service Training• Training of undergraduate students and interns• ANM, AWW, and Staff Nurses’ training schools need to include IMNCI in their training schedules
  29. 29. Thanks….