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

Targeted coverage of providers at health facility

Health providers targeted for IMCI training include physicians (general practice and paediatricians) and nurses (health service providers and MCH supervisors):

• For low-caseload outpatient health facilities: training of at least a doctor and a nurse managing children less than 5 years old

• For high-caseload outpatient settings (including hospitals’ OPD): training of a number of providers adequate to manage the average caseload of sick children under-five in that facility

Course duration

• Physicians: 11-day courses until late 2002, when 7-day courses introduced to accelerate implementation while ensuring the same results as with the 11-day courses.

• Nurses: 4 days

Materials

Different training materials used for physicians and nurses, to reflect their different responsibilities:

• Physicians: adapted training materials for standard IMCI course—Egypt version—, in English(except for counselling module translated into Arabic in mid-2004).

• Nurses: newly developed materials for Egypt (Arabic)

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

1. Selection of governorates/districts for IMCI implementation

2. Preliminary visit of national IMCI team to the governorates  selected

3. Situation analysis of the districts selected

4. Visit of national IMCI team to discuss the findings of the situation analysis

5. Orientation workshop in the selected governorate

6. District planning workshop

7. Preparation of health facilities prior to implementation

8. Creating a pool of facilitators at local level

9. Training in case management (skills acquisition)

10. Training in facilitation and follow up skills

11. Follow up after training (skills reinforcement)

12. Supervision

13. Documentation

1. Selection of governorates/districts for IMCI implementation

Different criteria have been used to select areas for the Early Implementation Phase and the Expansion Phase, respectively, as follows:

• Early Implementation: criteria based on the rationale to provide initial evidence on IMCI in areas with adequate support to implementation:

1. Leadership and motivation of staff at different levels

2. Districts representing different geographical areas (Upper andLower Egypt, urban and rural areas)

3. Districts with manageable number of health facilities to be covered and followed up during this phase

4. Good health facility physical structure

• Expansion: criteria prioritising high underfive mortality areas:

1. Underfive mortality rate

2. Starting first with the most committed and manageable districts, to show a model for the other districts in the governorate

3. Expanding to two adjacent districts per year.  Top
   

2.  Preliminary visit of national IMCI team to the governorates  selected

1. Brief orientation of decision-makers—Undersecretary of health, and other concerned authorities—to the IMCI strategy and its implementation

2. Joint selection of the districts based on the criteria described in 1.

3. Designation of an IMCI focal point

4. Briefing on the situation analysis tool.  Top

3. Situation analysis of the districts selected 

4. Visit of national IMCI team to discuss the findings of the situation analysis

5. Orientation workshop in the selected governorate

1. Objectives: to orient to IMCI strategy and implementation health staff at governorate, district, and essential selected health facilities level
2. Participants: staff of departments and programmes related to primary health care (PHC), child health, curative medicine, pharmaceuticals, health information service, health education, and head of essential PHC facilities, financial administrator, chief nurses
3. Duration: 1 day
4. Tool: Standard orientation package (Arabic).  Top

6. District planning workshop

1. Objectives: to develop district plans of action for IMCI implementation, describing tasks, responsibilities, time frame, indicators and targets for the three IMCI components.

2. Participants: representatives from no more than 2 – 3 governorates per workshop, including Undersecretary of health, IMCI focal points at the governorate level, staff from the pharmaceuticals and health information service HIS (fixed members for all workshops) at governorate level, district health director, MCH assistant district level, Health education at governorate level and district level, sometimes community representatives. A mixture of new and old governorates is usually followed to learn from the already existing experience.

3. Methodology: Plenary sessions, group work

4. Duration: 3 days

5. Outcome: plans of action for the three IMCI components for each selected district

6. Tool: Guide to district planning workshops Top

7. Preparation of health facilities prior to implementation

1. Reviewing staff’s responsibilities

2. Re-arranging flow of patients

3. Making drugs available (Drug management package)

4. Making necessary supplies and equipment available

5. Monitoring by the central team to facilitate the process and ensure that facilities are ready for implementation. Top

 
8. Creating a pool of facilitators at local level

(see points 9 and 10 below)  Top

9. Training in case management (skills acquisition)

1. Preparation of the selected training site for the governorate

2. Nomination of participants

3. Conduct of training (7-day course for the IMCI case management training at district level since 2002, and 4-day course for nurses)

4. Running of two courses, one after the other one, to facilitate follow-up after training

5. Entering information in the central database on IMCI training. Top

 10. Training in facilitation and follow up skills

1 to 2 courses conducted on average per year. Top

11. Follow up after training (skills reinforcement)

1. Carried out 4 – 6 weeks after training

2. Documented with reports by health facility visited, then compiled as district summaries

3. Data entered in central database on training and follow-up. Top

12. Supervision

1. Training materials on supervision developed in Egypt for supervisors, to strengthen routine supervision at different levels

2. Conduct of supervisory training courses, targeting supervisors based on the existing supervisory system at district level

3. Preparation of reports based on a recording form and giving feedback

4. Strengthening supervision in the future planned for the following areas:

i.   Follow up of supervisors
ii.  Central supervision
iii. Standardization of supervisory reports. Top

13. Documentation

It is one of the main features throughout the process. It is based on performance of doctors and nurses and caretaker knowledge about home care and satisfaction with health services before and after IMCI implementation (follow up visits), quarterly IMCI reports, IMCI activity reports, a database on training courses and coverage (number of courses and staff trained), and the follow up visits. IMCI information has been included in the periodic reports of health facilities and has been incorporated in the Health Information System (HIS) of the Ministry of Health and Population (MOHP) since 2004. The MOHP HIS is computerized from the district up to the central level and connected to a network. Top

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

• For low-caseload outpatient health facilities: training of all health providers managing children less than 5 years old (usually one health provider is working at this level of health facilities).

• For high-caseload outpatient settings (including hospitals’ OPD): training of a number of providers adequate to manage the average caseload of sick children under five in that facility.

Health providers might be physicians, medical assistants, nurses or auxiliaries. Paramedics are allowed to manage children even if there is a physician at the health facility. The physician would in this case be responsible to decide whether to refer to higher level facility severely sick children who have been referred to him/her by paramedical staff.  

Course duration

• All categories of health providers: 11-day courses. All categories of providers are trained in the same course.

Materials

Same training materials used for physicians, medical assistants, nurses and all other categories

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

1. Selection of districts for IMCI implementation

2. Situation analysis of health facilities in the selected districts

3. Orientation workshop in the selected districts

4. Preparation of health facilities prior to implementation

5. Creating a pool  of facilitators at local level

6. Training in case management (skills acquisition)

7. Training in facilitation and follow up skills

8. Follow up after training (skills reinforcement)

9. Supervision

10. Documentation

1. Selection of districts for IMCI implementation

The criteria to select areas for the Early Implementation Phase have been based on the rationale to document the experience adequately and provide initial evidence on IMCI for areas receiving adequate support for implementation:

1. Easy access to the national team to facilitate supervision and monitoring during this phase

2. Good health facility physical structure.  Top

2. Situation analysis of health facilities in the selected districts

1. Analysis of the status of supply and equipment required for IMCI at those health facilities

2. Preparation of a list of items to procure to meet the IMCI requirements. Top

3. Orientation workshop in the selected districts

1. Objectives: to orient to the IMCI strategy and implementation health staff at district and selected health facilities level

2. Participants: staff of primary health care (PHC) facilities in the district, concerned hospital staff and partners

3. Duration: 1 day

4. Tool:  WHO\HQ “IMCI Planning Guide – Guiding experience with the IMCI strategy in a country” Top

4. Preparation of health facilities prior to implementation

1. Reviewing staff’s responsibilities

2. Making drugs available

3. Making necessary supplies and equipment available

4. Re-arranging flow of patients

5. Monitoring by the central team to facilitate the process and ensure that facilities are ready for implementation. Top

5. Creating a pool  of facilitators at local level

Criteria for the selection of facilitators at local level (see also point 8 below):

• High performance during the IMCI case management course

• Availability and commitment Top

6. Training in case management (skills acquisition)

1. Preparation of the selected training site for the district

2. Nomination of participants

3. Conduct of training (11-day course for the IMCI case management training at district level for both physicians and nurses) since April 2004. Top

7. Training in facilitation and follow up skills

• Facilitation skills: One course conducted in May 2004 on facilitation skills to train 6 facilitators

• Follow up skills: the trainee should have received training in IMCI case management and facilitation skills. One course conducted in December 2004 to train 6 supervisors. Top

8. Follow up after training (skills reinforcement)

1. Carried out 4 – 6 weeks after training

2. Adapted follow up tool based on adapted training materials for the country

3. Documented with reports by health facility visited, then compiled into district summaries. Top

9. Supervision

1. Same tools as the follow up visits are used for the supervisory visits

2. Supervisory plans are developed by the national team based on the needs. Top

10. Documentation

It is one of the main features throughout the process. It is based on: follow-up visits to assess performance of doctors and paramedics, health facility support, and caretaker knowledge about home care and satisfaction with health services before and after IMCI implementation; IMCI monthly reports; and a database on training courses (number of courses and staff trained) and coverage. Top