Pakistan IMNCI Guidelines and status of Implementation

1. Dr. Abdul Rehman PirzadoDr. Abdul Rehman Pirzado
Provincial MnCAH Officer , WHO Sindh, PakistanProvincial MnCAH Officer , WHO Sindh, Pakistan

2.  To reduce significantly mortality and morbidity
associated with the major causes of disease in
children.
 To contribute to healthy growth and
development of children.
Abdul Rehman Pirzado 2014

3. Is not another vertical program
Incorporates: Elements of diarrheal diseases and ARI
control program and child oriented aspects of malaria
control, nutrition , EPI and other relevant programs
Depends on: Effective functioning of essential drugs
and EPI program
Demands and Facilitates: Active collaboration of all
these existing programs
Improves: The quality of care of sick children in the
primary health care context
Abdul Rehman Pirzado 2014

4.  Improving Case Management Skills of Health Workers:Improving Case Management Skills of Health Workers:
 Standard guidelinesStandard guidelines
 Clinical Case Management (pre and in-service)Clinical Case Management (pre and in-service)
 Follow-up after IMNCI trainingFollow-up after IMNCI training
 Improving the Health System to deliver:Improving the Health System to deliver:
 Essential drugs: supply and managementEssential drugs: supply and management
 Organization of work in Health FacilitiesOrganization of work in Health Facilities
 Management and SupervisionManagement and Supervision
 Improving Family and Community practicesImproving Family and Community practices
Abdul Rehman Pirzado 2014

5. Assess a child
Classify a child’s illnesses using signal lights approach
Identify treatments for the child.
Treatment instructions
counsel the mother to solve any feeding problems and her own
health.
When a child is brought back to the clinic give follow-up care
and if necessary reassess for new problems
Red - urgent pre-referral treatments and referral
Yellow - specific medical treatment and advice
Green - simple advice on home management
Abdul Rehman Pirzado 2014

6. 1.1. Exclusive BreastfeedingExclusive Breastfeeding
2.2. Complementary feeding / WeaningComplementary feeding / Weaning
3.3. Micronutrients supplementation for vitamin A, IronMicronutrients supplementation for vitamin A, Iron
and Zinc and Zinc
4.4. Hygiene: Disposal of faeces and Wash handsHygiene: Disposal of faeces and Wash hands
5.5. Immunization as per EPIImmunization as per EPI
6.6. Preventing MalariaPreventing Malaria
Abdul Rehman Pirzado 2014

7. 7. Promote mental and social development by
responding to a child’s needs for care
8. Home care during Illness
9. Give sick children appropriate home treatment for
infections
10. Care Seeking behaviour
11. Compliance with advice
12. Antenatal Care
Abdul Rehman Pirzado 2014

8.  Launched globally in 1991
 Pakistan adapted 1998-2000
 First national clinical course 2000
 First clinical course in Sindh 2004
 Pre-service adaptation in Pakistan 2004
 Pre-service adaptation in Sindh 2009
 First Pre-service evaluation in Pakistan – LUMHS 2011.
 First logbook on Pakistan- LUMHS 2010
Abdul Rehman Pirzado 2014

9. Total Health
Facilities
Health Facilities
with IMNCI
trained HCP
Coverage
Health care
Providers Trained
1,727 775
45 %
(12 – 100)
2, 257
Good News:
• Government of Sindh has declared IMNCI as SoP for Children U5
• Follow up has been integral part of HRD in 10 districts.
• Follow up has revealed 60 % scores in trained HR
Concerns:
• No policy to procure IMNCI medicine and supplies
• Poor management support
Abdul Rehman Pirzado 2014

10.  Section on Nutrition to be aligned with CMAM
 WHO Growth Charts have been proposed
 Distance Learning IMNCI clinical course
Abdul Rehman Pirzado 2014

11. Abdul Rehman Pirzado 2014