Provinces which have started implementing IMCI

Districts which have started implementing IMCI

Health facilities implementing IMCI | Graphs

Health providers trained in IMCI

IMCI case management training courses conducted

IMCI clinical training

• Targeted coverage of providers at health facility

• Course duration

• Materials

Targeted coverage of providers at health facility

Paediatricians, medical officers and paramedical staff (lady health workers, health technicians and ‘dispensers’ attached to the IMCI-implementing facilities).

Course duration

Physicians and paramedical staff: 11-day courses

Materials

Training materials, originally adapted in English, were translated in Urdu. The same materials are used for training of doctors and paramedical staff.

Systematic approach to IMCI implementation at district level: key steps and tools

1. Selection of districts for IMCI early implementation

2. Orientation and planning workshop in the selected provinces

3. District planning workshop

4. Creating a pool of facilitators at local level

5. Training in case management (skills acquisition)

6. Follow up after training (skills reinforcement)

7. Supervision

1.Selection of districts for IMCI early implementation

Criteria to select districts for the Early Implementation Phase included the following:

1. One district to be selected for each of the two provinces

2. Commitment of district managers

3. Presence of a medical college with teaching staff who had been involved in in-service training activities

4. Location away from the provincial capital

5. Good performance in other programmes activities, e.g. National Programme for Family Planning and Primary Health Care, Health Management Information System (HMIS), Expanded Programme on Immunization (EPI), Control of Diarrhoeal Diseases (CDD) and Acute Respiratory Infections (ARI).

Consideration was given later on to the selection of facilities having Lady Health Workers (LHW) attached to them, to establish a link with the IMCI community component. Top

2.  Orientation and planning workshop in the selected provinces

1. Provincial health authorities and clinicians were first invited in all national level meetings, since the introduction of IMCI in the country.

2. Then, orientation and planning workshops were held in each of the two provinces selected for early implementation, attended by provincial and district programme managers and paediatricians, and partners.

3. A provincial management structure was established to coordinate IMCI in the province, with a provincial working group headed by the Secretary of Health and the identification of provincial focal points. Members of the group included relevant programme managers (e.g. EPI, Control of Diarrhoeal Diseases and Acute Respiratory Infections, Health Management Information System), leading paediatricians, partners.

4. A provincial plan of action was prepared based on the national plan of action. Top

3.   District planning workshop

1. District planning workshops were conducted in each district.

2. As for the provincial level, an IMCI working group was formed also at district level, chaired by the Executive District Officer and with a composition similar to the provincial working group described above (programme coordinators for EPI, Control of Diarrhoeal Diseases and Acute Respiratory Infections, Health Management Information System, Primary Health Care and Lady Health Workers; a paediatrician from the district hospital; partners). Two focal points were appointed for IMCI district implementation: one for management and one for training.

3. IMCI was included in the district health plan. Plans on how to provide drugs to IMCI implementing health facilities were discussed. Information on IMCI was to be reported through the existing HMIS: efforts were made to assign existing HMIS codes to the IMCI classifications and link the latter to the HMIS classifications. Top

4.  Creating a pool of facilitators at local level

Efforts were made to develop a pool of facilitators at district level in five-day facilitator training courses, in addition to the national and provincial level, to build capacity and facilitate implementation in the districts.Top

5.  Training in case management (skills acquisition)

Training courses were conducted for paediatricians, medical officers, lady health workers, health technicians and ‘dispensers’ attached to the IMCI-implementing facilities. See the indicators on training on top of the page for details. Top

6.   Follow up after training (skills reinforcement)

1. Carried out a month after training
2. Supervisors were national, provincial and district programme managers and paediatricians
3. Two rounds of follow-up visits were conducted, with encouraging results. Top

7. Supervision

A supervisory checklist has been developed for supervision of staff trained in IMCI. Top

Regions governorates which have started implementing IMCI

Districts which have started implementing IMCI

Health facilities implementing IMCI | Graphs

Health providers trained in IMCI

IMCI case management training courses conducted

IMCI clinical training

• Targeted coverage of providers at health facility

• Course duration

• Materials and methodology

Targeted coverage of providers at health facility

Training of at least 50% of doctors managing children less than 5 years old at health facilities.

Course duration

• Physicians (and nurses in remote health centre and who see patients in the absence of doctors—afternoon shifts—): Training consists of two separate parts, a 5-day course, followed by a 2-day course (skills reinforcement)

• Nurses: 2-day course on triage tasks

Materials and methodology

Clinical guidelines, training materials and overall approach developed in Oman differ from the WHO/UNICEF generic version and reflect a major country adaptation, which involved paediatricians, family physicians and general practitioners in addition to ministry of health central and regional staff. Trainees receive an IMCI manual and a participant module (both developed in Oman) about two weeks before the standard five-day course. After the course, participants return to their facilities with some assignments. Those who have access to a computer receive also an IMCI training CD. The next two-day session is held six weeks later. Participants who satisfy all requirements are awarded a certificate.

Systematic approach to IMCI implementation at district level: key steps and tools

1. Selection of governorates/districts for IMCI implementation

2. Creating a pool of trainers at local level

3. Preparation of health facilities prior to IMCI implementation

4. Follow up after training (skills reinforcement)

5. Supervision

1.   Selection of governorates/districts for IMCI implementation

The following criteria have been used to select the first governorates/regions to implement IMCI:

a. Interest of the regional administration
b. Accessibility (distance) of the region to the central office
c. Availability of staff with training skills
d. Availability of facilities suitable for clinical training

2. Creating a pool of facilitators at local level

Before expanding to new regions, a training course for trainers was carried out, to build capacity for training locally. The training included participant’s pre-view of guidelines and notes and orientation by the trainer. 

3. Preparation of health facilities prior to IMCI implementation

Facilities are provided with “clinical encounter forms”, at least one ARI timer to count the respiratory rate, and at least two copies of the IMCI chart booklet developed in Oman. 

4. Follow up after training (skills reinforcement)

a. Carried out 4 – 6 weeks after training;
b. Lasting 2 days;
c. Conducted in two steps:

i.  Review of clinical guidelines and completion of 18 exercises, before   coming to a training site;  and
ii. Clinical practice with 30 outpatients using a standard form, drills and exercises, and in-patient  sessions at the training site.

This approach is different from the IMCI follow-up visit conducted to the trainee’s own facility, as advised in the generic IMCI approach. The Omani approach relies on the consideration that conducting skill reinforcement sessions at a selected training site provides for more clinical practice and interaction with colleagues from other health facilities, promoting sharing of experiences. Each trainee can also be evaluated by a team of facilitators. This is also possible because health facilities are often similar in structure and staffing. The skill reinforcement process continues at the trainee’s own facility during supervisory visits. 

5. Supervision

A checklist has been developed for this purpose and will be used after testing. While annual audit for child health is integrated with the audit of other topics, IMCI audit is carried out by IMCI supervisors.Top