Nigeria national iccm implementation framework
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The Nigeria's National ICCM implementation Framework is a 'one national iCCM Implementation Model' describing the activities expected to be carried out at the different levels of government, with clear programme boundaries, roles and responsibilities of individuals, organizations and other players. This framework also shows the pattern of information flow for iCCM in the country.
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Nigeria national iccm implementation framework
- 1. The Federal Ministry of Health Nigeria TheNational IntegratedCommunityCaseManagement (iCCM)ImplementationFramework A roadmap to iCCM implementation in Nigeria ...healthy children, happy family Integrated Community Case Management
- 2. 2 Foreword In recognition of the absence of a frame work for the implementation of Integrated Community Case Management (iCCM), the Federal Ministry of Health and stakeholders in the maternal, newborn and child health community developed the framework on iCCM in Nigeria. This framework builds on the existing platform of the National guideline on iCCM implementation in Nigeria following its adoption in 2012. The intervention targets the three major childhood diseases namely Malaria, Diarrhoea and Pneumonia which contribute 58% of under five mortality. In addition, the iCCM implementation framework is anchored on the Child Health Policy, the Decision Tree and other ancillary documents and presents an overarching frame for the iCCM national scale up. It aims to achieve a “ONE NATIONAL iCCM MODEL” with clear programme boundaries such as policy, coordination, case management, commodity security logistics, advocacy, resource mobilization, monitoring, evaluation and quality assurance as well as the role of the private sector in expanding access to iCCM. Finally, I reiterate that iCCM framework will create the enabling environment for the provision of uniform, qualitative and sustainable child health care services and recommend that all players in the iCCM millue will use this framework to guide their activities. L.N Awute, mni Permanent Secretary Federal Ministry of Health. September 2015 The National iCCM Implementation Framework
- 3. 3 Acknowledgements The Federal Ministry of Health in collaboration with MNCH stakeholders developed the national framework on Integrated Community Case Management (iCCM) in line with emerging issues in child health. The Ministry would like to extend its sincere thanks and gratitude to individuals, iCCM taskforce members and organizations who contributed considerable time in the development of the framework. I commend the support of our development partners notably WHO and USAID/TSHIP JSI for the time and resources committed to the development of the framework. Gratitude to all other partners for their technical inputs I also wish to acknowledge the technical contributions and understanding of the Consultant 'tomowo Faduyile who facilitated the process of developing the document. Special appreciation goes to the staff of the Child Health Division of Family Health Department, under the guidance of Dr A. R Adeniran for providing excellent leadership and unflinching commitment throughout the entire process that made the development of the frame work a reality. Dr Wapada I. Balami, mni Director, Department of Family Health / Chairman iCCMTask Force. September, 2015 The iCCM ImplementationNational Framework
- 4. 4 Table of Contents The iCCM ImplementationNational Framework ACKNOWLEDGEMENTS 03 TABLE OF CONTENTS 04 FOREWORD 02 ACRONYMS 05 LIST OF CONTRIBUTORS 19 REFERENCES 20 BACKGROUND 07 THE NATIONAL iCCM IMPLEMENTATION LOGIC MODEL 11 THE NATIONAL iCCM IMPLEMENTATION FRAMEWORK 09 THE NATIONAL iCCM PERFORMANCE MEASUREMENT MATRIX 15 THE NATIONAL iCCM IMPLEMENTATION FRAMEWORK
- 5. 5 Acronyms The iCCM ImplementationNational Framework BCC CBO CRA CMAM CHAI CHEWs CORPS CSO CSWG CTC DFATD EU FMoH HC Hws HMIS HR iCCM IEC IMCI IMNCH JCHEW JSI Behavioral Change Communication Community-Based Organizations Child Right Act Community Management of Acute Malnutrition Clinton Health Access Initiative Community Health Extension Workers Community Oriented Resource Persons Civil Society Organizations Child Survival Working Group Core Technical Committee Department of Foreign Affairs, Trade and Development European Union Federal Ministry of Health Health Centre Health Workers Health Management Information System Human Resource Integrated Community Case Management Information, Education Communication Integrated Management of Childhood Illness Integrated Supportive Supervision Integrated Maternal, Newborn and Child Health Junior Community Health Extension Workers John Snow Research and Training Institute Inc. ARFH Association of Reproductive and Family Health ISS
- 6. 6 Acronyms The iCCM ImplementationNational Framework LGA M&E MDGs NDHS MOH NHSDP NPHCDA PHCs PPMVs PPP RAcE SMoH SOP TSHIP TOT TV TWG U5 U5MR UNICEF USAID WDC WHO Local Government Area/Authority Monitoring and Evaluation Millennium Development Goals Nigeria Demographic and Health Survey Ministry of Health National Health Strategic Development Plan National Primary Health Care Development Agency Primary Health Care/Centres Propriety Patent Medicine Vendors Public Private Partnership Rapid Access Expansi State Ministry of Health Standard Operating Procedure Targeted States High Impact Projects Training of Trainers Television Technical Working Group Under 5 years Under- five Mortality Rate United Nations Children’s Fund United States Agency for International Development Ward Development Committee World Health Organization
- 7. 7 In the efforts to reduce child mortality rate, the Nigeria government developed the National Child Policy, Integrated Maternal, Newborn and Child Health (IMNCH) strategy and other child survival interventions such as Integrated Management of Childhood Illness (IMCI), Community Management of Acute Malnutrition(CMAM) and community case management of Malaria(CCM) which are all incorporated into the NSHDP. In the past two decades, the need to accelerate reduction in this vulnerable group became critical though gradual impact have been made. However, there is still a huge gap in the coverage of appropriate cost-effective curative interventions for common childhood illness, in spite of available 1 robust policies, strategies, guidelines and interventions to address child health in Nigeria . 2 According to NDHS 2013, majority of under-five death about 68% occurs at home . The Integrated Community Case Management (iCCM) of childhood illness is one strategy that provides community-based curative interventions while working to strengthen the health system. Since the delivery of health services is either weak or non-existent in rural, hard-to-reach areas of Nigeria, iCCM takes curative care to homes and communities where access to facility-based 3 services is low . The Integrated Community Case Management (iCCM) Strategy presents a platform for acceleration of the management of childhood diarrhea, malaria, pneumonia at the community and referral of sick newborn, children with any danger signs or severe malnutrition to the health facility 4 ,thus contributing to the significant reduction of mortality attributed to these conditions . The iCCM ImplementationNational Framework THE NATIONAL INTEGRATED COMMUNITY CASE MANAGEMENT (iCCM) IMPLEMENTATION FRAMEWORK IN NIGERIA Background
- 8. 8 Since the introduction of iCCM in Nigeria in 2013, four states are currently implementing the strategy in Abia and Niger states under the WHO-RAcE/DFATD project and Adamawa and Kebbi states (UNICEF/EU). Nigeria is at the stage of scaling up iCCM nationally and therefore requires an implementation framework that will serve as a 'one national model' with clear programme boundaries. The framework will serve as a charter from where federal, states, local governments and organizations can frame their plan of actions for iCCM. This is not a stand-alone document; it is a framework that shows in a simply logical flow how iCCM is to be implemented at all levels in Nigeria. The detailed guideline and state specific process is in the National iCCM Guideline and 4 iCCM DecisionTree for State Level, Nigeria , respectively. The objective of the National iCCM implementation framework is to have “ONE NATIONAL iCCM IMPLEMENTATION MODEL” which can be adopted at various levels of implementation. The iCCM ImplementationNational Framework Objective
- 9. 9 The National iCCM Implementation Framework describes the activities expected to be carried out at the different levels of government, with clear programme boundaries, roles and responsibilities of individuals, organizations and other players. This framework also shows the pattern of information flow for iCCM in the country. The Federal level consists of the Federal Ministry of Health and its agencies, partners and Non- Governmental Organizations (NGO). The role at this level focuses on policy direction, coordination, guideline and standard settings, monitoring and evaluation. The State level consists of the State Ministry of Health, its agencies, partners and NGO. It assumes a similar overarching role while adopting and adapting the national policies for the state. In addition, the State level ensures effective implementation of iCCM. The Local Government Level consists of the LGA Health Department, partners, Community Based Organizations (CBO). It plays a coordination role and also provides oversight of iCCM implementation at the PHC and Community level. The CHEWs/JCHEWs/CORPs are the key human resource for iCCM. They are trained to assess, classify and treat the sick under five children when necessary or else referral to the PHC for further care. They are to be equipped with uninterrupted medicines and supplies and regularly supervised. The Private Sector consists of several NGOs, CSOs, ProfessionalAssociations and Individuals. It will support and participate at every level of implementation of iCCM for example the selection and monitoring of CORPs. The iCCM ImplementationNational Framework THE NATIONAL iCCM IMPLEMENTATION FRAMEWORK
- 10. 10 The iCCM ImplementationNational Framework F E E D B A C K S P R I V A T E S E C T O R E N G A G E M E N T S THE NIGERIA iCCM IMPLEMENTATION FRAMEWORK 3 STATE LEVEL -CTC [SMOH, DEVELOPMENT PARTNERS/NGO] Adopt/Adapt Adopt/Adapt N Coordination of Partners; Capacity Building; Resource ational Guideline, Develop Plans; Advocacy & Sensitization; Mobilization; Supervision Plan; Referral Facilities Strengthened; Monitoring & Evaluation; Supply Chain System Mgt. LGA LEVEL [LG HEALTH DEPT, PARTNERS/NGO] Capacity Building; Supportive Supervision; Strengthened iCCM Referral Facilities; Operational Plan; Effective Community Entrance; Strengthened WDC; Supply Chain System Mgt; Monitoring & Evaluation. PRIMARY HEALTH CARE CENTER Communities; Monitoring; Commodity Security; Community Based Info System; Data Collation iCCM Referral; Provision of Case Management, oversees & supervises CORPs in targeted CHEWS / JCHEWS / CORPs COMMUNITY LEVEL Promote Health Seeking behavior; Assess, Classify & Treat U5 in line with Guideline; Refer when appropriate; Documentation; Community & Social Mobilization HOUSEHOLD [CAREGIVERS OF UNDER 5 CHILDREN] Practice Good Care seeking behavior; Adherence to treatment; Identify danger signs to seek further care FEDERAL LEVEL - FMOH iCCM TASKFORCE [FMOH, DEVELOPMENT PARTNERS/NGO] Coordination; Policy Direction; Guideline and standard setting; Implementation Plan; Partnership; Advocacy; Resource Mobilization; Capacity Building; Commodity Security; Operational Research and State Support/Roll Out, Monitoring & Evaluation; Technical Assistance; Supportive Supervision. WDC, COMMUNITY GATEKEEPERS Selection of CORPs; Participate in Planning; Implementation; Monitoring and Resource Mobilization; Community & Social Mobilization; Commodity Security and Community Security.
- 11. 11 The National iCCM Implementation Logic Model is a frame that helps to structure 7 the main elements of a project, highlighting the logical linkages between them . It consists of the inputs, activities, outputs and the outcomes of the iCCM programme that culminates into the overall goal and objectives of the programme. The iCCM Implementation Logic model focuses on the key thematic areas namely Demand Creation, Access, Quality, Advocacy and Policy Environment with emphasis on the different level of implementation namely Federal, States, LGAs and Community. The expected outputs and outcomes at these levels are harnessed to have a uniform national approach to planning and implementation of iCCM thus 3 contributing to the reduction of morbidity and mortality of under-fives . The iCCM ImplementationNational Framework THE NIGERIA iCCM IMPLEMENTATION LOGIC MODEL 3,7
- 15. 15 The National iCCM Performance Measurement Matrix reveals the key expected results from the iCCM implementation framework and logic model. These results are linked to the key indicators needed to measure them. The iCCM Performance measurement matrix focuses on the country approved Monitoring and Evaluation Indicator as captured in the National Guideline for iCCM. This is in line with the Global Good Practices in eight key thematic areas namely Policy and Coordination; Costing and Financing; Human Resource for iCCM; Supply Chain Management; Service Delivery and Referral; Communication for Behaviors and Social Change; Supervision and QualityAssurance and lastly Monitoring & Evaluation and HMIS. The Performance Measurement Matrix shows the indicators to be tracked, when to track them, the set targets and the responsible persons/organizations for its data generation. This shows a quick win progress of iCCM implementation at the different levels of care. The iCCM ImplementationNational Framework THE NATIONAL iCCM PERFORMANCE MEASUREMENT MATRIX 3,6
- 19. 19 List of Contributors Federal Ministry of Health 1. Dr. Wapada Balami, mni Director, FHD/FMOH 2. Dr. A. R. Adeniran H/Child Health, FMOH 3. Mr. Alex Omoru DD/MNCH FMOH 4. Tinu Taylor DD/CS FMOH 5. Pharm Tile Titus DD FDA/FMOH 6. Thompson K. C. FMOH 7. Franca Okafor FMOH 8. Dr. Hadiza S. Idris FMOH 9. Dr. Bose Ezekwe iCCM Desk Officer, FMOH 10. Dr. Femi James FMOH 11. Dr Seyi Omokore FMOH 12. Helen Akhigbe FMOH 13. Bayode A. H FMOH 14. Adama Abdul FMOH 15. Elue D. C. FMOH NPHCDA and other FMOH Agencies 16. Dr Nnenna Ezeigwe National Coordinator NMEP 17. Dr. Val Obijekwu SMO NPHCDA 18. Dr Nnenna Ogbulafor NMEP 19. Dr. Sam Obasi NPHCDA 20. Dr Sola Oresanya 21. Dr Femi Ajumobi NMEP 22. Mrs Chinwe Ezeife NPHCDA 23. Dr Isa Kawu NMEP 24. Dr. Bakunawa G. Bello NPHCDA 25. Dr Akannu Ogechi NDACDA Development Partners 26. Dr. Mbewe Andrew WHO 27. Dr. Nosa Orobaton USAID/TSHIP JSI 28. Dr. Amos Bassi USAID/TSHIP 29. Dr. Kennedy Ongwae UNICEF 30. Dr. Francis Ohanyido USAID/TSHIP 31. Prof. Otolorin Dipo JHPIEGO 32. Dr. Oyinbo Manuel Save the Children 33. Dr. Nkeiru Onuekwusi UNICEF 34. Dr. Joy Ufere WHO 35. Dr Lynda Ozor WHO 36. Dr. Olayinka Farouk USAID/TSHIP 37. Dr. Chinwoke Isiguzo SFH 38. Dr. Funke Fasawe CHAI 39. Dr. Kolawole Maxwell Malaria Consortium 40. Chinedu Egwuonwu ARFH The iCCM ImplementationNational Framework 41. Dr Abidemi Okechukwu USAID 42. Kachi Amajor IPATH 43. Ronke Atamewaleu Marie Stopes 44. Dr Lazarus Eze ARFH 45. Paulette Ibeka CHAI 46. Dorathy Payi CHAI 47. Tiwadayo Braimoh CHAI 48. Dr. Bamidele Abegunde USAID /TSHIP 49. Anthony Edozieuno Christian Aid 50. Daniel Salihu UNICEF 51. Josephine Okide UNICEF 52. Yetunde Oke USAID/MAPS 53. Ogechi Onuoha SFH/ESMPIN 54. Ogedegbe Ewomazino ARFH 55. Chukwumalu Kingsley Save the Children 56. Jennifer Anyanti Dr SFH 57. Ufuoma P. Obi Mariestopes Nigeria 58. Onosi Ifesemen USAID/DELIVER 59. Nomtai Kaduno USAID /TSHIP 60. Charity Ibekwe NURHI 61. Obinna Odika UNICEF 62. Priscilia Ikparen 63. Nanlop Ogbureke Christian Aid, UK 64. Omowunmi Omoniwa CHAI 65. Elizabeth Igharo USAID/DELIVER ‘tomowo Faduyile George Consultant/TSHIP JSI (2015) [The National iCCM Implementation Framework development]
- 20. 20 References 1. Demographic and Health Survey (2013), 2. Integrated Maternal, Newborn and Child Health Strategy (2012), Nigeria 3. National Guideline for the implementation of iCCM of common childhood illness in Nigeria (2013) 4. National Malaria Strategic Plan (2014 – 2020), Nigeria 5. iCCM CountryAction Plan –Nigeria (2014). CCM Central. Retrieved on 6-12-2015 from http://ccmcentral.com/wp-content/uploads/2014/03/Country-Action-Plan- Nigeria.pdf 6. CCM Global Indicators Chart. Retrieved on 6-12-2015 from http://ccmcentral.com/wp-content/uploads/2014/03/CCM Global indicators Chart. pdf 7. DFID, (2002). Department for International Development of the United Kingdom, Tools for Development: a handbook for those involved in development activity (2002): Retrieved on 6-19-2015 from www.dfid.gov.uk/pubs/files/toolsfordevelopment.pdf 8. WHO/UNICEFjoint Statement on iCCM (2012) UNICEF. Retrieved on 8-23-2015 from http://www.unicef.org/health/files/iCCM_Joint_Statement_2012.pdf 9. Integrated Community Case Management (iCCM) Decision Tree for State Level, Nigeria. (2014). Nigeria The iCCM ImplementationNational Framework
- 21. TARGETED STATES HIGH IMPACT shipshipPROJECTS World Health Organization CLINTON HEALTH ACCESS INITIATIVE Save the Children an alliance of johns Hopkins University innovating to save lives Jhpiego Paediatric Association of Nigeria (PAN) evidence for action mother babies alive Mamaye! F HS USAIDFROM THE AMERICAN PEOPLE JSI Research & Training Institute, Inc. JSI