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Child Health Program 
Ravi K Mishra 
Public Health Officer 
Central Regional Health Directorate, Hetauda
Medical 
causes of 
infant 
mortality and 
morbidity 
Neonatal mortality 
Low birth weight 
 Birth injuries and difficul...
Post neonatal 
and pre school 
children 
mortality 
 Diarrhoel disease 
Acute respiratory infection 
 Other communicabl...
Causes of child 
morbidity 
Malnutrition 
 Infection- diarrhea, diphtheria, tetanus, whooping cough, measles, eye 
and s...
Identification 
of “at risk” 
babies 
It is necessary to identify particularly those “at risk” and give them 
special ince...
Child Health 
Program of 
Nepal 
Immunization 
Nutrition 
Community Based Integrated Management 
of Childhood Illness (...
National 
Immunization 
Programme 
The National Immunization Programme (NIP) is a high priority 
programme (P1) of Govern...
 Nationwide Surveillance of vaccine preventable diseases (AFP, 
Measles like illnesses, MNT and AES) is conducted through...
NATIONAL 
IMMUNIZATION 
PROGRAM IS 
GUIDED BY: 
NEPAL HEALTH SECTOR SUPPORT PROGRAM- II (NHSP IP II) 
Comprehensive Mult...
GOAL 
GOALS 
To reduce child, mortality, morbidity and disability associated with 
vaccine preventable diseases 
OBJECTIV...
Objective 2: Ensure access to vaccines of assured quality and with 
appropriate waste management 
Key strategies: 
 Stren...
Objective 4: Maintain maternal and neonatal tetanus elimination 
status 
Key strategies: 
 Achieve and maintain at least ...
Objective 5: Initiate measles elimination 
Key strategies: 
 Achieve and sustain high population immunity to reduce measl...
Objective 7: Strengthen and expandVPD surveillance 
Key strategies: 
Expand VPD surveillance to include vaccine preventab...
National 
Immunization 
Schedule 
SN Type of Antigen Against Disease Age 
1 BCG TB At Birth 
2 DPT Hep B Hib, 1st 2nd 3rd ...
MAJOR 
ACTIVITIES 
CARRIED OUT 
IN FY 2069/70 
(2012/2013) 
Micro plans updated in 19 districts of Central Development Re...
Nutrition
Section I 
1. Mortality and 
nutrition status of 
children and women 
in Nepal 
2. Global initiatives in 
nutrition 
3. Na...
Mortality and 
nutrition 
status of 
children and 
women in 
Nepal
Mortality 
status of 
children and 
women 
Without improvement in Nutrition, further 
Sources: Nepal Demographic an Health...
Nutrition 
status of 
children and 
women 
Source: Nepal Demographic an Health Survey 2011
Classification 
for assessing 
severity of 
malnutrition 
by prevalence 
ranges among 
children under 
5 years of age 
Ind...
Problem of 
micro-nutrient 
deficiencies is 
still serious 
46% 
90 
80 
70 
60 
50 
40 
30 
20 
10 
0 
Prevalence of anem...
Infant & 
Young Child 
Feeding (IYCF) 
practices in 
Nepal – 
Breastfeeding 
45% of newborns are breastfed within the firs...
Infant & Young 
Child Feeding 
(IYCF) practices 
in Nepal – 
Complementary 
feeding 
Source: Nepal Demographic an Health S...
Global 
initiatives in 
nutrition – 
SUN and 
REACH 
Initiating Partners 
REACH focuses on scaling-up 
nutrition (SUN) act...
National 
nutrition 
policy and 
strategy 
Overall objective: 
To reduce child and maternal mortality through nutritional ...
Strategies 
Strategies 
 Protect, promote and support optimal feeding practice of children 
through IYCF expansion, incre...
Adopting the 
multi-sector 
approach for 
nutrition 
 Need of multi-sector 
approach 
 Need of a nutrition 
architecture...
Multi-Sector 
Nutrition Plan 
Framework
Section II 
National 
nutrition 
programmes
National 
nutrition 
programmes 
Infant and Young Child 
Feeding (IYCF) programme 
1. Basic IYCF package training to HWs 
...
1. IYCF 
practices: 
Breastfeeding 
and 
Complementary 
feeding F = Frequency 
A = Amount 
T = Texture 
V = Variety 
A = A...
2. Integrated 
Management 
of Acute 
Malnutrition 
(IMAM) 
programme 
Previously known as 
Community based 
Management of ...
IMAM programme service model in district 
Ilaka HF / PHC 
DHO / DPHO 
Hospital / SC &/ OTP 
Community SHP / HP 
Ilaka HF /...
3. Nutrition 
Rehabilitation 
Homes (NRHs) 
Hospital 
NRH 
Management of 
acute malnutrition 
in the facility
4. 
Micronutrient 
deficiencies 
control 
programmes 
1. National Vitamin A 
Programme 
2. Intensification of Maternal 
& ...
1. National Vitamin A Programme 
DHO / DPHO 
Health 
Facility 
Region / Centre 
Vitamin A: 6-59 months 
De-worming: 12-59 ...
Postpartum Vitamin A 
House 
Within 6 weeks of delivery 
Dose: 1 capsule = 2,00,000 IU
2. Intensification of Maternal & Neonatal 
Micronutrient Programme (IMNMP) 
DHO / DPHO 
180 
tablets 
45 
tablets 
Supply ...
3. Iodine Deficiency Disorder (IDD) Control 
Programme 
World fit for children target on micronutrients 
• 90% HH use adeq...
4. IYCF and Baal Vita Community Promotion 
Programme 
Community 
6-23 months 
Supply 
Recording & 
reporting 
DHO / DPHO 
...
5. Flour fortification Programme 
Government of Nepal adopted wheat flour 
fortification as one of the national 
strategie...
6. Fortified flour distribution programme 
Karnali & 
Solukhumbu 
6-23 months
Growth monitoring in 
health facility 
5. Community 
based growth 
monitoring 
programme Growth monitoring in 
outreach cl...
6. School 
health and 
nutrition 
programme 
(SHNP) – a 
joint 
programme of 
MoHP & MoE
School health and nutrition programme 
Supply 
Supply 
Recording & reporting 
Supply during orientation (Public only; 1 Fi...
School health 
and nutrition 
programme 
(SHNP) 
coverage
COMMUNITY BASED INTREGRATED 
MANAGEMENT OF CHILDHOOD ILLNESS 
(CB IMCI) AND NEONATE CARE
COMMUNITY 
BASED 
INTEGRATED 
MANAGEMENT 
OF CHILDHOOD 
ILLNESSES 
(CB‐IMCI) 
An integrated package of child-survival 
in...
In 1997, the IMCI program was initiated in Mahottari 
district as a pilot. 
Based on the recommendations it was decided ...
Vision 
Contribute to survival, healthy growth and 
development of under five years children of Nepal. 
Achieve MDG 4 by...
To reduce under five mortality from the current rate of 
54/1,000 live births to 38/1,000 live births and infant 
mortali...
Reduce frequency and severity of illness and death 
related to ARI, Diarrhoea, Malnutrition, Measles and 
Malaria. 
Cont...
The following strategies have been adopted by CB-IMCI 
program: 
1. Improving knowledge and case management skills of 
hea...
2. Improving overall health systems 
Carry out CB-IMCI program maintenance activities as per 
the recommendations made by...
3. Improving family and community practices 
Disseminating key behavioral message through FCHVs 
to families and communit...
1. Management of sick children below 2 months of age 
2. Management of sick children 2 months to 5 years of age 
 Managem...
Major activities carried out in FY 2069/70 include the 
following: 
Capacity building training to CB-IMCI Focal Persons. ...
Community 
Based 
Newborn Care 
Program 
(CB‐NCP) 
The 2006 and 2011 Nepal Demographic and Health Survey have 
shown that...
The goal of CBNCP is to reduce neonatal 
mortality (NMR) through the sustained high 
coverage of effective community based...
Expansion of CB-NCP in new 5 districts (Bajura, Pyuthan, 
Rupandehi, Udayapur and Dadeldhura) 
Intensive monitoring of C...
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Child health program in Nepal

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Child health program in Nepal

  1. 1. Child Health Program Ravi K Mishra Public Health Officer Central Regional Health Directorate, Hetauda
  2. 2. Medical causes of infant mortality and morbidity Neonatal mortality Low birth weight  Birth injuries and difficulty in labor  Congenital anomalies Hemolytic disease of new born Condition of placenta and cord  Diarrhoel disease Acute respiratory infection  Neonatal tetanus
  3. 3. Post neonatal and pre school children mortality  Diarrhoel disease Acute respiratory infection  Other communicable disease e.g. TB, Measles, whooping cough etc.  Mal nutrition  Congenital anomalies Accidents
  4. 4. Causes of child morbidity Malnutrition  Infection- diarrhea, diphtheria, tetanus, whooping cough, measles, eye and skin problems  Parasitic infestation Accidents cause disability
  5. 5. Identification of “at risk” babies It is necessary to identify particularly those “at risk” and give them special incentive care because it is those at risk babies that contribute to largely to perinatal, neonatal, infant mortality. The basic criteria for identifying these babies include  Birth weight less than 2.5kg Twins  Birth order 5 and more  Artificial feeding 2nd and 3rd degree malnutrition  Failure to gain weight during three successive months  Children with PEM, diarrhoea Working mother/ one parent
  6. 6. Child Health Program of Nepal Immunization Nutrition Community Based Integrated Management of Childhood Illness (CB-IMCI) and newborn care
  7. 7. National Immunization Programme The National Immunization Programme (NIP) is a high priority programme (P1) of Government of Nepal. Immunization is considered as one of the most cost-effective health interventions. At present, National immunization Programprovides vaccine against 10 diseases. An immunization service is provided through static clinic at health facilities, outreach clinics and mobile clinics  In addition, immunization service is also provided through private, NGO/INGO clinics andmedical colleges especially inmunicipalities.
  8. 8.  Nationwide Surveillance of vaccine preventable diseases (AFP, Measles like illnesses, MNT and AES) is conducted through sentinel network of “Acute Flaccid Paralysis” (AFP) surveillance system supported byWHO/IPD. National Immunization Programme
  9. 9. NATIONAL IMMUNIZATION PROGRAM IS GUIDED BY: NEPAL HEALTH SECTOR SUPPORT PROGRAM- II (NHSP IP II) Comprehensive Multi Years Plan of Action (2011- 2016)
  10. 10. GOAL GOALS To reduce child, mortality, morbidity and disability associated with vaccine preventable diseases OBJECTIVESANDSTRATEGIES Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at national and district level by 2016 Key strategies:  Increase access and utilization to vaccination by implementing RED strategies in every district Enhance human resources capacity for immunization management  Strengthen immunization monitoring system at all levels  Strengthen communication, social mobilization, and advocacy activities  Strengthen immunization services in themunicipalities GOALS, OBJECTIVES AND STRATEGIES
  11. 11. Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management Key strategies:  Strengthen the vaccine management system at all levels Objective 3: Achieve and maintain polio free status Key strategies:  Achieve and maintain high immunity levels against Polio by strengthening routine immunization and conducting high quality national polio immunization campaigns. Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine  Achieve and maintain certification standard AFP surveillance GOALS, OBJECTIVES AND STRATEGIES
  12. 12. Objective 4: Maintain maternal and neonatal tetanus elimination status Key strategies:  Achieve and maintain at least >80% TT2+ coverage for pregnant women in every districts Conduct Td follow up campaigns in high risk districts Expand school based immunization program Continue surveillance of NT GOALS, OBJECTIVES AND STRATEGIES
  13. 13. Objective 5: Initiate measles elimination Key strategies:  Achieve and sustain high population immunity to reduce measles incidence to elimination level  Investigate all suspected measles like outbreaks with program response Use platform ofmeasles elimination for Rubella / CRS control  Continue case-based measles surveillance Objective 6: Accelerate control of vaccine-preventable diseases through introduction of new and underused vaccines Key strategies:  Introduction of new and under-used vaccines (rubella, pneumococcal, typhoid, rota) based on disease burden and financial sustainability GOALS, OBJECTIVES AND STRATEGIES
  14. 14. Objective 7: Strengthen and expandVPD surveillance Key strategies: Expand VPD surveillance to include vaccine preventable diseases of public health concern.  Strengthen and expand laboratory support for surveillance. Objective 8: Continue to expand immunization beyond infancy Key strategies: Consider for booster dose of currently used antigen based on evidence and protection of adult from potentialVPDs. GOALS, OBJECTIVES AND STRATEGIES
  15. 15. National Immunization Schedule SN Type of Antigen Against Disease Age 1 BCG TB At Birth 2 DPT Hep B Hib, 1st 2nd 3rd Diptheria, Pertusis,Tetanus, Hepatitis B Hemophilus Influenza b 6 Week 10 Week 14 week 3 Oral Polio , 1st 2nd 3rd IPV Poliomylitis 6, 10, 14 week 14 week 4 PCV Pneumonia, Meningitis 6, 14 week 9 month 5 Measles- Rubella Measles, Rubella 9 month 6 JE Japanese Encephilitis 13-23 month
  16. 16. MAJOR ACTIVITIES CARRIED OUT IN FY 2069/70 (2012/2013) Micro plans updated in 19 districts of Central Development Region (CDR)  Municipal immunization micro plan reviewed in 8 municipalities Training of Trainer's on vaccine and cold chain management conducted in all 5 regions Training of Trainer's on cold chain repair maintenance conducted in 3 regions Immunization Performance Review (conducted at all level)  Internal review of VPD surveillance  Cold chain strategic guideline development and endorsement Vaccinators training guideline development One round of Polio campaign in 75 districts and 2nd dose of OPV clubbed with MRcampaign Measles rubella campaign in 60 districts in 2012 and 15 districts in 2011  Continued Integrated Vaccine Preventable Diseases Surveillance  Initiation of declaration of fully immunization VDC/Municipality
  17. 17. Nutrition
  18. 18. Section I 1. Mortality and nutrition status of children and women in Nepal 2. Global initiatives in nutrition 3. National nutrition policy and strategy 4. Adopting the multi-sector approach for nutrition
  19. 19. Mortality and nutrition status of children and women in Nepal
  20. 20. Mortality status of children and women Without improvement in Nutrition, further Sources: Nepal Demographic an Health Survey 2006 & 2011 child mortality reduction is less likely The Lancet Series on Maternal and Child Undernutrition 2013 MDG Target: 134/100,000
  21. 21. Nutrition status of children and women Source: Nepal Demographic an Health Survey 2011
  22. 22. Classification for assessing severity of malnutrition by prevalence ranges among children under 5 years of age Indicator Severity of malnutrition by prevalence ranges (%) Low Medium High Very high Stunting <20 20-29 30-39 >=40* Underweight <10 10-19 20-29* >=30 Wasting <5 5-9 10-14* >=15 * Nepal Source: http://www.who.int/nutgrowthdb/about/introduction/en/index5.html
  23. 23. Problem of micro-nutrient deficiencies is still serious 46% 90 80 70 60 50 40 30 20 10 0 Prevalence of anemia in under 5 years children 6-8 9-11 12-17 18-23 24-35 36-47 48-59 Mountain Hill Terai Total Age in months NATIONAL AVERAGE 70 60 50 40 30 20 10 0 67.7 36.2 35 27.6 36.2 47.6 38.9 33 26.5 19.2 33.1 26.1 19.5 35.9 22.5 28.8 44.9 42.6 32.7 49 41.9 Prevalence of anemia in women (15-49 years) Source: Nepal Demographic an Health Survey 2011
  24. 24. Infant & Young Child Feeding (IYCF) practices in Nepal – Breastfeeding 45% of newborns are breastfed within the first hour of life, and 85% within the first day. Source: DHS 2011 – Tables 11.3 & 11.6 and DHS 2006 – Tables 12.2 & 12.5 and WHO recalculation of 2006 data based on new IYCF indicators, published in WHO “Indicators for assessing infant and young child feeding practices. Part 3: Country Profiles
  25. 25. Infant & Young Child Feeding (IYCF) practices in Nepal – Complementary feeding Source: Nepal Demographic an Health Survey 2011
  26. 26. Global initiatives in nutrition – SUN and REACH Initiating Partners REACH focuses on scaling-up nutrition (SUN) actions Scaling up of evidence-based-cost-effective interventions to prevent and treat under-nutrition with special focus on 1000 days “window of opportunity’ Adopting multi-sector approach which includes integrating nutrition in relevant sectors
  27. 27. National nutrition policy and strategy Overall objective: To reduce child and maternal mortality through nutritional interventions Specific objectives: Reduce general malnutrition among children and women, i.e. stunting, underweight, wasting, low BMI Reduce Iron Deficiency Anemia among children, children under age 2 year and pregnant women Maintain and sustain Iodine Deficiency Disorders and Vitamin A Deficiency control activities Improve maternal nutrition  Align with multi-sectoral nutrition initiative Improve Nutrition related behavior change and communication Improve Monitoring and Evaluation for Nutrition related Programmes/Activities Source: DoHS Annual Report 2011-12
  28. 28. Strategies Strategies  Protect, promote and support optimal feeding practice of children through IYCF expansion, increasing coverage of GM Reduce IDA through iron tablet supplementation to pregnant, adolescents, preschool and school deworming and flour fortification  Increase accessibility and Social Marketing of 2-Child Logo iodized packet salt  Bi-annual mass supplementation of VA to under 5 years children  Gradual expansion of the School Health and Nutrition activities in all districts BCC for changing dietary practices for improved maternal and child nutrition practices Expansion of Community as well as facility based Management of Acute Malnutrition through IMAM and rehabilitation homes Source: DoHS Annual Report 2011-12
  29. 29. Adopting the multi-sector approach for nutrition  Need of multi-sector approach  Need of a nutrition architecture  Identify information and HR gaps
  30. 30. Multi-Sector Nutrition Plan Framework
  31. 31. Section II National nutrition programmes
  32. 32. National nutrition programmes Infant and Young Child Feeding (IYCF) programme 1. Basic IYCF package training to HWs and FCHVs (7) 2. Integrated IYCF and Baal Vita Community Promotion Programme (15) 3. IYCF linked with Child Cash Grant Programme (5) 4. SUAAHARA/USAID promoting ENA and EHA (20) 5. Agriculture and Food Security Project (AFSP) (20) 6. Knowledge-based Integrated Sustainable Agriculture and Nutrition (KISAN) (19) 7. Sunaula Hazar Din (15)
  33. 33. 1. IYCF practices: Breastfeeding and Complementary feeding F = Frequency A = Amount T = Texture V = Variety A = Active feeding H = Hygiene Age specific
  34. 34. 2. Integrated Management of Acute Malnutrition (IMAM) programme Previously known as Community based Management of Acute Malnutrition (CMAM) Programme IMAM Program began in 2007/8 and in 2012/13 the program covered 11 districts. IMAM manages acute malnutrition in children age 6-59 months through inpatient and outpatient services at the community level.
  35. 35. IMAM programme service model in district Ilaka HF / PHC DHO / DPHO Hospital / SC &/ OTP Community SHP / HP Ilaka HF / PHC Hospital PHC FCHV Region / Centre SHP / HP Recording of new cases, referral, follow up (6-59 months) Recording & reporting Supply
  36. 36. 3. Nutrition Rehabilitation Homes (NRHs) Hospital NRH Management of acute malnutrition in the facility
  37. 37. 4. Micronutrient deficiencies control programmes 1. National Vitamin A Programme 2. Intensification of Maternal & Neonatal Micronutrient Programme (IMNMP) 3. Iodine Deficiency Disorder (IDD) Control Programme 4. IYCF and Baal Vita Community Promotion Programme 5. Flour fortification Programme 6. Fortified flour distribution programme
  38. 38. 1. National Vitamin A Programme DHO / DPHO Health Facility Region / Centre Vitamin A: 6-59 months De-worming: 12-59 months Vitamin A capsule De-worming tablet Reporting Recording VAS piloting to reach the unreached: 6-11 months Supply 6-11 months: ½ capsule i.e. 1,00,000 IU 12-59 months: 1 capsule i.e. 2,00,000 IU 12-23 months: ½ tab i.e. 200 mg 24-59 months: 1 tab i.e. 400 mg
  39. 39. Postpartum Vitamin A House Within 6 weeks of delivery Dose: 1 capsule = 2,00,000 IU
  40. 40. 2. Intensification of Maternal & Neonatal Micronutrient Programme (IMNMP) DHO / DPHO 180 tablets 45 tablets Supply Recording & reporting Recording & reporting Region / Centre Supply Dose: 1 IFA tab i.e. 60 mg iron + 400 μg folic acid Once 1 tab i.e. 400 mg of de-worming table to pregnant women after 1st trimester
  41. 41. 3. Iodine Deficiency Disorder (IDD) Control Programme World fit for children target on micronutrients • 90% HH use adequately iodized salt Iodized Salt Social Marketing Campaign – ISSMaC approach
  42. 42. 4. IYCF and Baal Vita Community Promotion Programme Community 6-23 months Supply Recording & reporting DHO / DPHO Recording & reporting Region / Centre Supply Protocol: 60 Sachets of MNP supplement for 2 months (on daily use basis) for children with age group 6-23 months Pilot: Makwanpur, Parsa, Gorkha, Rasuwa, Palpa, Rupandehi Roll out: Achham, Bardiya, Dadeldhura, Dang, Rukum, Kapilbastu, Sankhuwasabha, Sunsari, Morang
  43. 43. 5. Flour fortification Programme Government of Nepal adopted wheat flour fortification as one of the national strategies to reduce iron deficiency anemia in Nepal. Nepal Government made flour fortification at roller mills mandatory in August 2011 based on satisfactory voluntary fortification experience. Nepal has become the first country in South Asia to have mandatory legislation for fortification at roller mills.
  44. 44. 6. Fortified flour distribution programme Karnali & Solukhumbu 6-23 months
  45. 45. Growth monitoring in health facility 5. Community based growth monitoring programme Growth monitoring in outreach clinic Monthly growth monitoring from 0-23 months Growth monitoring combined with IYCF Operational feasibility of new CH card: Dang, Jumla, Rukum and Udayapur
  46. 46. 6. School health and nutrition programme (SHNP) – a joint programme of MoHP & MoE
  47. 47. School health and nutrition programme Supply Supply Recording & reporting Supply during orientation (Public only; 1 First Aid Kit box/school) Private & Public Grade 1 - 10 EMIS Adolescent iron Region / Centre Refilling by HF & SMC Private & Public Grade 1 - 10 Private & Public Grade 1 - 10 RC Supply Supply Recording & reporting Recording & reporting Recording & reporting Recording & reporting
  48. 48. School health and nutrition programme (SHNP) coverage
  49. 49. COMMUNITY BASED INTREGRATED MANAGEMENT OF CHILDHOOD ILLNESS (CB IMCI) AND NEONATE CARE
  50. 50. COMMUNITY BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (CB‐IMCI) An integrated package of child-survival interventions and addresses major childhood killer diseases like Pneumonia, Diarrhoea, Malaria, Measles and Malnutrition in 2 months to 5 years children in a holistic way. CB-IMCI also includes management of infection, Jaundice, Hypothermia and counselling on breastfeeding for young infants less than 2 months of age.
  51. 51. In 1997, the IMCI program was initiated in Mahottari district as a pilot. Based on the recommendations it was decided to include a community component, enabling mobilization of community health workers (VHWs and MCHWs) and FCHVs to provide CDD, ARI, Nutrition and Immunization services to the community As a result the Community based ARI and CDD (CBAC) program was merged into IMCI in 1999 and is now called the Community Based Integrated Management of Childhood Illness (CB-IMCI). CB-IMCI Program has covered 75 districts by the end of fiscal year 2066/67 (2009/2010). Newborn component was added to CB-IMCI in 2004. COMMUNITY BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (CB‐IMCI)
  52. 52. Vision Contribute to survival, healthy growth and development of under five years children of Nepal. Achieve MDG 4 by 2015. Goal To reduce morbidity and mortality among children under-five due to pneumonia, diarrhoea, malnutrition, measles and malaria. VISION AND GOALS
  53. 53. To reduce under five mortality from the current rate of 54/1,000 live births to 38/1,000 live births and infant mortality from the current rate of 46/1,000 live births to 32/1,000 live births by 2015. To reduce neonatal mortality from the current rate of 33/1,000 live births to 16/1,000 live births by 2015. To reduce morbidity among infants less than 2 months of age. TARGETS
  54. 54. Reduce frequency and severity of illness and death related to ARI, Diarrhoea, Malnutrition, Measles and Malaria. Contribute to improved growth and development. OBJECTIVES
  55. 55. The following strategies have been adopted by CB-IMCI program: 1. Improving knowledge and case management skills of health service providers CB-IMCI aims to improve the skills of health service providers through Training to all health service providers on CB-IMCI including zinc treatment for diarrhea; Regular integrated review and refresher trainings to health service providers; Inclusion of CB-IMCI component in the curriculum of pre-service medical and paramedical schools; Technical support visit from higher levels to respective institutions; central to regional to district to HFs to FCHVs Capacity building training to the CB-IMCI focal persons of the districts STRATEGIES
  56. 56. 2. Improving overall health systems Carry out CB-IMCI program maintenance activities as per the recommendations made by IMCI technical working group and global context. Improve logistic supply. Regularize mother’s group meeting. Strengthen reporting system at all levels. Strengthen supervision and monitoring. STRATEGIES
  57. 57. 3. Improving family and community practices Disseminating key behavioral message through FCHVs to families and communities using relevant IEC materials. Reaching the disadvantaged and hard-to-reach communities through reactivated mother’s group meeting. Dissemination of key family practice messages through interpersonal communication. STRATEGIES
  58. 58. 1. Management of sick children below 2 months of age 2. Management of sick children 2 months to 5 years of age  Management of Diarrhoeal Diseases  Zinc Supplementation COMPONENTS OF CB‐IMCI
  59. 59. Major activities carried out in FY 2069/70 include the following: Capacity building training to CB-IMCI Focal Persons. Intensive monitoring of CB-IMCI program districts (in low performing districts). Development and finalization of Referral IMNCI Protocol for Medical Doctors and HWs. CB-IMCI training to newly recruited medical doctors and HWs. Revised IMCI Protocol Training – 2 Districts. Revision of CB-IMCI and NCP IEC materials with printing, editing etc. Celebration of World Pneumonia Day (12 November). Advocacy and marketing of CHX, Zinc, Cotrim, ORS. MAJOR ACTIVITIES
  60. 60. Community Based Newborn Care Program (CB‐NCP) The 2006 and 2011 Nepal Demographic and Health Survey have shown that neonatal mortality in Nepal has been stagnant at 33 deaths per 1,000 live births which account for 61 percent of under 5 deaths. The major causes of neonatal deaths in Nepal are infection, birth asphyxia, preterm birth, and hypothermia. Hence, reduction of high neonatal mortality is an urgent priority for achieving MDG 4. MoHP has binitiated integrated newborn health care package called “Community Based Newborn Care Program (CBNCP)” based on the National Neonatal Health Strategy 2004. The program was implemented as a pilot in 10 districts in FY 2065/66 and further expanded covering 39 districts by the end of FY 2069/70. The plan is to cover all 75 districts by 2015.
  61. 61. The goal of CBNCP is to reduce neonatal mortality (NMR) through the sustained high coverage of effective community based interventions. The specific objectives of CBNCP include: To prevent and manage newborn infection To prevent and manage hypothermia and LBW babies To manage post-delivery asphyxia, and  To develop an effective system of referral of sick newborns GOAL AND OBJECTIVE OF CB‐NCP
  62. 62. Expansion of CB-NCP in new 5 districts (Bajura, Pyuthan, Rupandehi, Udayapur and Dadeldhura) Intensive monitoring of CB-NCP program districts (in low performing districts) Capacity Building Training for New-born Care for health service providers (30 persons) Orientation training on CB-IMCI, CB-NCP and Zinc, CHX to the HWs of private sectors (CBNCP Program Districts) CB-NCP training to newly recruited medical doctors and HWs Construction/renovation of newborn care facilities in 37 sites MAJOR ACTIVITIES
  63. 63. Thank you

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