Child SurvivalZaeem ul haq – Health Advisor, PPQAugust 17, 2012
Every year almost 10 million children die before they reach their fifth    birthday. More than half of these deaths are ca...
CHILD SURVIVAL – GLOBALly
CHILD SURVIVAL – GLOBALly
CHILD SURVIVAL – MDG PROGRESSSOURCE Countdwon Report 2012
CHILD SURVIVAL – MDG PROGRESSSOURCE Countdwon Report 2012
CHILD SURVIVAL – DISPARITIES(Nigeria)                               SOURCE Countdwon Report 2012
CHILD SURVIVAL – global bod~ 48%ChildhoodPathologies                                ~ 36%                                N...
SO WHAT ARE WE DOING  ABOUT IT?
Jones G et al., Lancet 2003Evidence-Based ChildSurvival Interventions (30)                          Darmstadt GL et al., L...
chILD SURVIVAL –Case Definitions   Integrated Management of Newborn and Childhood Illnesses    (IMNCI) – skills of facili...
IMNCI   Integrated Management Childhood Illnesses (IMCI) developed by WHO and    UNICEF in early 1990s to reduce childhoo...
IMCI – programming matrix
Challenges with IMCI    Globally, over 100 countries have adopted IMCI strategy, and achieved        impressive results in...
IMCI – training coverage, global
IMCI – implementation coverage, AFRO/2009
Challenges with IMCI           Low training coverage; high cost of 11 day residential training course ~            $1000 ...
ICcm   Integrated Community Case Management (ICCM) strategy uses simplified    IMCI protocols to treat common childhood i...
Task shifting framework
MYANMAR – Donut approach
ImMUNIZATIONS   Immunizations as part of Child Survival Framework, with programming    across the theory of change, compl...
STILL,WHAT WILL WE DO?
CHILD SURVIVAL – ACCESSwe will;    •    strengthen local health systems; technical and operational support on roll        ...
CHILD SURVIVAL – QUALITYwe will;    •    support* FLHW supervisors and supervisors’ supervisors to assure         quality ...
CHILD SURVIVAL – demandwe will;    •    develop and disseminate culturally sensitive information, to increase         awar...
CHILD SURVIVAL – INNOVATIONwe will;    •    strengthen the global evidence and learning on use of innovative         appro...
CHILD SURVIVAL – POLICY/ADVOCACYwe will;    •    promote formation of (global), national and local partnerships to realize...
IMMUNIZATIONS – ACCESSwe will;    •    strengthen national/district health systems and primary health facilities         t...
IMMNIZATIONS – QUALITYwe will;    •    support* FLHW (e.g. vaccinators, midwives & nurses) on quality         provision of...
IMMUNIZATIONS – demandwe will;    •    develop and disseminate culturally sensitive and comprehensible         information...
IMMUNIZATIONS – INNOVATIONwe will;    •    work with MoH to assess and develop mechanisms to integrate routine         imm...
IMMUNIZATIONS – POLICY/ADVOCACYwe will;    •    promote formation of (global), national and local partnerships to realize ...
POTENTIAL PARTNERSHIPS
CHILD DEATHS AVERTED
FURTHER READING•   NCS A2015, March 2012•   IMNCI Programming Framework•   SOW for Child Survival and    Immunizations pro...
THANK YOU FOR LISTENINGPlease send your feedback to;z.haq@savethechildren.org.uk
Child Survival Programme Framework
Child Survival Programme Framework
Child Survival Programme Framework
Upcoming SlideShare
Loading in …5
×

Child Survival Programme Framework

1,454 views

Published on

an overview of child survival programme

Published in: Health & Medicine, Business
  • Be the first to comment

Child Survival Programme Framework

  1. 1. Child SurvivalZaeem ul haq – Health Advisor, PPQAugust 17, 2012
  2. 2. Every year almost 10 million children die before they reach their fifth birthday. More than half of these deaths are caused by just five preventable and treatable conditions: pneumonia, diarrhoea, malaria, measles and malnutrition, and often by a combination of these.When the most important causes of death in newborns are added, more than eight in ten of these deaths could be avoided if those children received timely and appropriate care.
  3. 3. CHILD SURVIVAL – GLOBALly
  4. 4. CHILD SURVIVAL – GLOBALly
  5. 5. CHILD SURVIVAL – MDG PROGRESSSOURCE Countdwon Report 2012
  6. 6. CHILD SURVIVAL – MDG PROGRESSSOURCE Countdwon Report 2012
  7. 7. CHILD SURVIVAL – DISPARITIES(Nigeria) SOURCE Countdwon Report 2012
  8. 8. CHILD SURVIVAL – global bod~ 48%ChildhoodPathologies ~ 36% Noenatal Pathologies
  9. 9. SO WHAT ARE WE DOING ABOUT IT?
  10. 10. Jones G et al., Lancet 2003Evidence-Based ChildSurvival Interventions (30) Darmstadt GL et al., Lancet 2005. Preventive (15) Curative (8) • Breastfeeding • ORT • Insecticide-treated bednets • Antibiotics for sepsis • Complementary feeding • Antibiotics for pneumonia • Zinc • Antimalarials • Clean delivery • Zinc • Hib vaccine • Newborn resuscitation • Water, sanitation, hygiene • Antibiotics for dysentery • Antenatal steroids • Vitamin A • Newborn temp. management • Vitamin A • Tetanus toxoid • Neverapine/replacement feeding Other Newborn (7) • Antibiotics for PROM • Folic acid • Measles vaccine • Interventions to control syphilis, • Antenatal antimalarial IPTP eclampsia, asymptomatic bacteriuria, and breech • Labor surveillance • Kangaroo mother care
  11. 11. chILD SURVIVAL –Case Definitions Integrated Management of Newborn and Childhood Illnesses (IMNCI) – skills of facility-based health workers Community IMCI (c-IMI) – health promotion on 16 key behaviours and practices Community Case Management (CCM) – community-based health workers delivering Rx for common childhood illnesses Routine Immunizations (RI, EPI) – WHO recommended basic 6 vaccines (OPV, BCG, DPT, HBV, HIB, M), plus 2 newer ones where applicable (PCV & Rota; DPT3 > 50%)
  12. 12. IMNCI Integrated Management Childhood Illnesses (IMCI) developed by WHO and UNICEF in early 1990s to reduce childhood mortality globally comprises three components that all have to be implemented (preferably simultaneously) to ensure success;  improving case management skills of health-care staff  improving overall health systems  improving family and community health practices IMCI standardized evidence-based guidelines for first-level health workers (FLHWs) using effective and easy-to-use tools to tackle major causes of childhood mortality and morbidity Newborn component was included later on
  13. 13. IMCI – programming matrix
  14. 14. Challenges with IMCI Globally, over 100 countries have adopted IMCI strategy, and achieved impressive results in reducing childhood mortality However, despite significant progress, a number of challenges related to its implementation remain; • ensuring periodical updates of national and sub-national IMCI guidelines to respond to local health needs • training and maintaining the knowledge and skills of hundreds of thousands of health workers in IMCI • underserved communities’ lack of access to trained health staffSOURCE: WHO 2009
  15. 15. IMCI – training coverage, global
  16. 16. IMCI – implementation coverage, AFRO/2009
  17. 17. Challenges with IMCI  Low training coverage; high cost of 11 day residential training course ~ $1000 per health worker  Unavailability of lower cost alternatives  Limited on-job training  Poor compliance to protocols  Infrequent supervision & mentoring  Referrals poorly adhered to  Shortage of drugs and job aidsSOURCE: DFID commissioned Review of IMCI implementation in Kenya, Tanzania and Nigeria;Consortium for Research on Equitable Health Systems/LSHTM; 2008-09
  18. 18. ICcm Integrated Community Case Management (ICCM) strategy uses simplified IMCI protocols to treat common childhood illnesses in communities where the distances between them and the nearest health facility are so great that the treatment services are inaccessible Community Health Workers (CHWs) are trained, equipped and supervised to deliver treatment for diarrhoea, malaria and pneumonia; and in some contexts, treatment for dysentry, newborn sepsis and acute malnutrition
  19. 19. Task shifting framework
  20. 20. MYANMAR – Donut approach
  21. 21. ImMUNIZATIONS Immunizations as part of Child Survival Framework, with programming across the theory of change, compliant with global strategies;  Reaching Every District (RED) approach; WHO (2002)  Global Immunization Vision and Strategy; WHO/UNICEF (2006-15)  Global Vaccine Action Plan – Decade of Vaccines (2011-20) Building capacity at district, health facility and community levels;  support district planning and resource management  improving immunization skills of health-care staff  improving overall health systems; cold chain & supply chain systems,  supportive supervision, monitoring & surveillance systems  improve acceptance and uptake of immunization services in communities
  22. 22. STILL,WHAT WILL WE DO?
  23. 23. CHILD SURVIVAL – ACCESSwe will; • strengthen local health systems; technical and operational support on roll out/ scale-up of evidence-based child survival interventions at both community and primary health facility levels (dist. planning/budgeting, service delivery, HMIS, LMIS, cold chain management) • support (T2S2*) first-level health workers (FLHWs) to effectively manage and prevent common and complicated childhood illnesses and conditions, at both primary facility and community levels • partner with Ministries of Health and agencies (UNICEF, WHO) to scale up access to essential child survival interventions in underserved communities *T2S2; training, tools, supplies, supervision
  24. 24. CHILD SURVIVAL – QUALITYwe will; • support* FLHW supervisors and supervisors’ supervisors to assure quality of service delivery at community & facility levels • support development of minimum standards on child survival quality of care with MoH & partners, and work with local authorities, CSO partners and communities to ensure that quality standards are met • strengthen systems to integrate supportive supervision – provide technical and operational support, tools, equipment and supplies, and use innovative approaches such as clinical simulation exercises for FLHWs and community empowerment on use of QA checklists *T2S2; training, tools, supplies, supervision
  25. 25. CHILD SURVIVAL – demandwe will; • develop and disseminate culturally sensitive information, to increase awareness and improve behaviours on prevention and control of common childhood illnesses and conditions • use evidence-based participatory approaches such as community groups and village health committees to increase awareness and uptake of child survival services and promote appropriate health-seeking behaviours • introduce formal linkages between health facilities and communities they serve (HFMC linked to CHC) • mobilize communities on prevention and control of diarrhoea, malaria and pneumonia, importance of exclusive breast-feeding and appropriate child feeding practices
  26. 26. CHILD SURVIVAL – INNOVATIONwe will; • strengthen the global evidence and learning on use of innovative approaches on promoting newborn and child survival • potentially; • DL approaches for FLHW training and CME – HEAT model from OU and ICATT from WHO • empowering community groups, through awareness raising (counter asymmetry of information) & use of checklists for quality assurance and accountability – UCL/ICH • cost of coping with illness analysis, mutual health insurance schemes and VHC as financial intermediaries – LSHTM/LATH/QMU • PBI for FLHWs, incentivized compliance to Rx and referral completion – LSHTM/LATH/QMU
  27. 27. CHILD SURVIVAL – POLICY/ADVOCACYwe will; • promote formation of (global), national and local partnerships to realize the poorest and most marginalized children’s right to access essential health services • strengthen country capacity to determine and set policies and priorities on newborn and child survival, and support development of national policies and strategies on child survival • promote equity in national coverage of essential child survival services and scale-up to underserved communities • advocate for adequate and sustainable financing for effective delivery and scale-up of quality services for promoting child survival in communities
  28. 28. IMMUNIZATIONS – ACCESSwe will; • strengthen national/district health systems and primary health facilities through provision of essential equipment and supplies for EPI services and infrastructure rehabilitation, where needed (dist. planning/budgeting, service delivery, HMIS, LMIS, cold chain management) • support (T2S2*) human resources for EPI at primary facilities and support health authorities on effective planning and implementation of outreach activities to scale-up coverage for unvaccinated children • provide technical and operational support to improve vaccine management and cold chain systems to ensure a reliable supply of vaccines of assured quality *T2S2; training, tools, supplies, supervision
  29. 29. IMMNIZATIONS – QUALITYwe will; • support* FLHW (e.g. vaccinators, midwives & nurses) on quality provision of EPI services and injection safety at facility level • support MoH to set minimum quality standards and operational guidelines for routine immunization (RI) service delivery, and work with CSO partners & communities to improve the quality of RI services • strengthen supportive supervision for EPI facility & outreach staff and support data collection & management systems at community, facility and district levels *T2S2; training, tools, supplies, supervision
  30. 30. IMMUNIZATIONS – demandwe will; • develop and disseminate culturally sensitive and comprehensible information with participation of religious and community leaders, teachers and FLHWs, through use of modern information communication technologies and innovative approaches • use evidence-based participatory approaches such as community groups and village health committees to increase awareness and uptake of routine immunization services • introduce formal linkages between health facilities and communities they serve (HFMC linked to CHC)
  31. 31. IMMUNIZATIONS – INNOVATIONwe will; • work with MoH to assess and develop mechanisms to integrate routine immunization services in PHC systems and MNCH or IMCI programmes • pilot innovative approaches to scale-up quality RI services in partnership with local governments and CSOs – such as alternate vaccine delivery mechanisms • improvise solutions with local partners and authorities, to scale up an essential package of child health services that includes RI, for sustained benefits for newborns, children and mothers
  32. 32. IMMUNIZATIONS – POLICY/ADVOCACYwe will; • promote formation of (global), national and local partnerships to realize the poorest and most marginalized children’s right to access immunization services • support MoH to determine and set policies and priorities for immunization services, to ensure that routine immunization services are integrated with essential package of PHC/MNCH services, and scaled-up to excluded communities in underserved districts • campaign and advocate to promote equity in coverage of EPI services for underserved communities and sustainable financing for strengthened national and district immunization systems for effective delivery and scale-up of quality RI services
  33. 33. POTENTIAL PARTNERSHIPS
  34. 34. CHILD DEATHS AVERTED
  35. 35. FURTHER READING• NCS A2015, March 2012• IMNCI Programming Framework• SOW for Child Survival and Immunizations programming• Good Practice Guide on working with CHWs for Child Survival in Communities• ICCM Toolkit, March 2011• CCM Essentials – Guide for Implementers, 2009
  36. 36. THANK YOU FOR LISTENINGPlease send your feedback to;z.haq@savethechildren.org.uk

×