Pre-service and In-service Capacity Building: Lessons Learned from Integrated Management of Childhood Illness (IMCI)

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1 Pre-service and In-service Capacity Building: Lessons Learned from Integrated Management of Childhood Illness (IMCI) Dr Wilson Were Medical Officer Child Health Services 1 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

(IMCI) Dr Wilson Were Medical Officer Child Health Services

2 Outline of Presentation Background What is IMCI? Lessons learnt from IMCI training New training options Conclusion 2 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

3 Major Causes of Death in Neonates and Children Under-five: World Causing > 75% Deaths Newborn problems Pneumonia Diarrhoea Malaria 45% of global under-five deaths are associated with Nutritionrelated factors* Sources: (1) WHO. Global Health Observatory ( (2) *For undernutrition: Black et al. Lancet, IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

factors* Sources: (1) WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.

challenges is how to take them where they are needed.

4 So how do we take effective interventions to those who need them? Effective interventions exist, but one of the main challenges is how to take them where they are needed. 4 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

5 Where are these Interventions Needed Most? Interventions delivered at home, primary health facility and hospital Home/Community 1st level facility Hospital Maternal Health Number of children seen Specialised care Equipment, supplies, case management skills 5 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Home/Community 1st level facility Hospital Maternal Health Number of children

6 Even when provided Quality of Care is a major constraint Clinical care incomplete assessment of patients poor communication with parents irrational treatments & counselling Health system issues access to services or organization of services availability of appropriate medicines, vaccines & supplies support supervision 6 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

issues access to services or organization of services availability of appropriate medicines,

7 IMCI: Key Strategy for Improving Child Health An integrated approach to the well-being of the whole child to:- Reduce death, illness and disability, and Promote improved growth and development. Management of Sick Children Nutrition Immunization Disease Prevention & Promotion of Growth and Development Integrated Management of Childhood Illness 7 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Management of Sick Children Nutrition Immunization Disease Prevention & Promotion of Growth and

8 Main Components of IMCI Community IMCI Policy & Support supervision Knowledge, beliefs and skills of caretakers Improve health worker performance Strengthen health system supports IMCI Training To promote: Holistic assessment of sick children Rapid referral of severely ill children Rational use of medicines Effective communication 8 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

promote: Holistic assessment of sick children Rapid referral of severely ill children Rational use

9 Characteristics of IMCI guidelines for 1st-level health facilities Finding Classification Treatment Danger signs Severe disease Urgent referral Cough or difficulty in breathing Diarrhoea Fever Ear problem Nutritional status/ anaemia Severe disease Disease with specific therapy Disease without specific therapy Urgent referral Specific medical treatment Symptomatic treatment Vaccination status Complete/incomplete Vaccinate 9 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

disease Disease with specific therapy Disease without specific therapy Urgent referral Specific medical treatment

10 Lessons Learnt from IMCI Capacity Building

11 What strategies have been used in IMCI Training? In service training: Targeting health workers in service Pre-service training: Targeting health professionals in training institutions 11 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Pre-service training: Targeting health professionals in

12 What is the Target of IMCI Training? Who? All health workers managing children Nurses, clinical assistants & doctors Medical, nursing or paramedical students Which conditions? Major causes of mortality: Pneumonia, diarrhoea, malaria, meningitis, acute malnutrition, HIV, preventive, neonatal problems, etc. What level of care Primary level health facilities Hospital OPD 12 IAEA International Symposium on MAM, Vienna, Austria 03 June

13 Why In-Service Training? To improve performance of health workers by: Familiarization with national guidelines Ensuring that health workers in practice are aware of new evidence based best practices Refresher training/continuing medical education Ensuring improved quality of care for severely ill children. 13 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Ensuring that health workers in practice are aware of new evidence based best practices

Methods of Capacity Building Reading knowledge Skills training/clinical practice Scenarios/discussions Drills & role plays Job aides - Charts Facilitators Evaluation

14 Methods of Capacity Building Reading knowledge Skills training/clinical practice Scenarios/discussions Drills & role plays Job aides - Charts Facilitators Evaluation Skill sessions are conducted in small groups Clinical practices sessions on cases with signs in facilities 14 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Skill sessions are conducted in small groups Clinical practices sessions on cases

15 Why IMCI Pre-service Training? Pre-service training is recognized as an opportunity to: Prepare graduates to support and follow national policies and guidelines Broaden health system coverage by trained health workers in a sustainable manner Improve the cost-effectiveness of training Reach practitioners in both the public and private sectors 15 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

national policies and guidelines Broaden health system coverage by trained health workers in a

16 What does it take to introduce into Pre- Service Education 16 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

17 Facilitating factors for Introducing IMCI into curricula Strong commitment of the MOH staff Involvement of key medical and paramedical faculty Introduction coinciding with review of curriculum or beginning of new training program Critical mass of IMCI trained preceptors 17 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

with review of curriculum or beginning of new training program Critical mass of IMCI

18 Challenges

19 Challenges of In-service Training High cost of centralized tutor-based training Inadequate supply of training materials (modules) Frequent attrition of trained staff Limited to public health facilities Releasing essential staff for off-site training Reluctance to locally apply learned skills. 19 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

public health facilities Releasing essential staff for off-site training Reluctance to

Challenges in Pre-service training Strengthening multiple technical areas for Pre-Service Education Essential newborn care Paediatric HIV Care and treatment

20 Challenges in Pre-service training Strengthening multiple technical areas for Pre-Service Education Essential newborn care Paediatric HIV Care and treatment Management of common childhood illnesses Adolescent health and development Infant and young child feeding 20 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

Management of common childhood illnesses Adolescent health and development Infant

21 Faculty Level Challenges Students need to know every condition Students need to learn about the most high tech diagnostic tools and drugs Curriculum is already overloaded!!! 21 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

22 Institutional level challenges Preference for lecture-style classes with limited interactive and skill-oriented teaching Large class sizes in classes Inadequate or non-functioning facilities(e.g. audiovisual, training materials) Coordination between different academic programmes and units (e.g., paediatrics vs. community medicine) Few trained or motivated preceptors 22 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

23 New Options For IMCI Training

24 Innovative computer based training 24 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

25 Training player the concept READ SEE PRACTICE TEST 25 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

26 How ICATT can be used? Selflearning Teaching tool ICATT Reference Update Test 26 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

IMCI Distance Learning IMCI http://www.who.

27 IMCI Distance Learning IMCI 27 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

28 DL Materials Vs IMCI In-service Modules 28 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

29 Paper-based IMCI Distance Learning: principles and experiences Target: Health workers who cannot leave their clinics for too many days or private practitioners Blended learning for motivation: Face-to-face meetings with facilitators, for orientation, review of progress and clinical practice Access to a mentor/tutor in person, or thru mobile etc. IMCI skills practice in home facilities Group study/clinical practice is encouraged 29 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

30 Conclusion Capacity building should: Focus on core competences Focus on pre-service training Use in-service training for refresher training & CME. Avail several options and approaches suitable for different settings 30 IAEA International Symposium on MAM, Vienna, Austria 03 June 2014

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Planning, Implementing and Evaluating Pre-Service Training

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Planning, Implementing and Evaluating Pre-Service Training WORKING DRAFT: AUGUST 2001 Department of Child and Adolescent Health and Development (CAH) Family