REPUBLIC OF SUDAN USE OF IMCI HFS RECOMMENDATIONS by zed18012

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									  REPUBLIC OF SUDAN
  USE OF IMCI HFS
RECOMMENDATIONS
PHASES OF IMCI IMPLEMENTATION




                      1998 Early
                      implementation

                      Expansion
                      2000

                      Expansion
                      2001
                      Expansion
                      2000 2002
          SURVEY METHODOLOGY
 66 health facilities of 136 IMCI Implementing
     facilities randomly selected

 Cases enrolled:
          - initial visit.for the child
          - with any non-surgical condition

 enrollment card, 4 forms and qualitative
     observation sheet

 6 teams: 2 surveyors and one supervisor
     visiting one health facility/ day
      Results of the Survey
Stance; for re-planning and
   reorganizing program
   implementation at all levels

 Useful to monitor progress towards
    the achievement of the child
    health- related Millennium
    Development Goals
PROVIDING AN EQUATABLE ACCESS TO CARE
     FOR THE MOST VULNERABLE GROUP
                                                   *

Finding 1
 54.3% of (364) children were under 2 years old
 71% of the cases with severe classifications
were children less than 2 years old


REC.1: Consideration should be given to
protecting children below 2 years old,
especially from poor families, by issuing a
policy and establishing mechanisms to
provide them „free‟ or at very low cost
essential drugs
PROVIDING AN EQUATABLE ACCESS TO CARE
     FOR THE MOST VULNERABLE GROUP
Finding 2
 Drugs availability index in health facilities was
  5/6 for the essential oral treatment, 8.3/12 for
  the non injectable drugs and 2.6/4 for the pre-
  referral drugs

  REC.2: States should be committed to
  make essential drugs regularly available to
  health facilities where IMCI trained staff
  work
                 Actions taken
Meetings with the Federal and States
 ministers of health:
The followings have been discussed
Vitalization of the Presidential decree of „free‟
 provision of essential drugs for under fives

 Provision of free pre-referral treatments in 1st
  level health facilities

 Unification of drugs dispensing systems

An integrated protocol for implementation of
 malaria free drugs has been jointly formulated
 with the Malaria directorate and is agreed upon by
 the federal minister
PROVIDING AN EQUATABLE ACCESS TO CARE
             FOR CHILDREN
Finding 3
 47% of the health facilities with weekly
  immunization services didn‟t provide vaccination
  on daily bases


REC.3: States should actively promote the
 implementation of the “open vial” policy to
 reduce the missed opportunities for
 immunization
              Actions taken
Discussion of the recommendation with
 Federal EPI program:
Agreement to:
 Implement the open vial policy in IMCI
 early implementing states
 jointly conduct a Study on the efficiency
 of using the policy in increasing the
 routine immunization coverage
           SKILLS REINFORCEMENT
Strengthening follow up visits after training:
Findings 1
  Only 23% of the cases were seen by trained
  health workers who received „follow up‟ visit within
  2 months of their training
 inadequate quality visits
REC.1:
 The Federal and State levels should jointly
 plan to develop and commit adequate human
 resources to „follow up‟ visits
conduct follow up‟ visits timely and according
 to standard methodology
                Actions taken
Agreement       with the States’ PHC directors,
 IMCI States’ coordinators and the national
 service administration :
 Recruiting doctors from States and the
 national service department to work in IMCI
 team in the States
 Plan to train the assigned doctors on
 supervisory skills and programme management
 was set.

 Perform quality follow up‟ visits according to
 the standard methodology.
             SKILLS REINFORCEMENT
Improving the basic skills of health providers:
Findings 1
 77% of the surveyed cases were managed by
 medical assistants
 Low level of basic clinical and communication
 skills in untrained HW.


REC.1: strengthening the curriculum of pre-
 service training of medical assistants
                 Actions taken
Areas of introduction on the Medical Assistants‟
 curriculum was identified and agreed upon on a
 workshop for review and endorsement of the
 Medical Assistants‟ curriculum
A committee was formulated to develop IMCI
 manual for MAs. Pre service training
       IMPROVING SUPERVISION
Findings
  Only 50% of the health facilities received
  routine supervisory visit in the last 6 months,
  and only 15% of the health facilities have
  recommendations of the last visit recorded


REC.: Consideration should be given to
 develop a simple supervisory skills
 training package on child health and
 involving supervisors in IMCI follow-up
 visits
               Actions taken

 A simple supervisory skills training package
 for routine supervision was developed

A plan to test the package was also developed

Conduction of skills reinforcement sessions at
 rural hospitals for MAs every 2-3 months
 IMPROVING CARETAKERS PRACTICES
Findings
 33% OF Caretakers know at least 2 out of the 7
  danger signs to seek care promptly

 32% of children with reported breathing
  problem were brought to health facility within
  one day

REC.: Health communication activities
 should be conducted as a priority to
 improve family knowledge about the early
 danger signs to seek care promptly
                 Actions taken
IMCI community component planning and advocacy
 workshops

 A core group of trainers was developed in the
 States

 Detailed plans of action for 14 communities were
 formulated

 (280 ) of community health promoters trained on
 priority KFP and started their activities

								
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