Introduction of IMNCI Register for Managing Sick Children in Zimbabwe

1. Experiences with introduction of the IMNCI register for managing sick children aged less than 5 yearsin Zimbabwe Improving Routine Data for Child Health in National Health Information Systems: Africa Regional Workshop Johannesburg, South Africa 19-22 September 2017 Presented by: Leocadia Mangwanya – USAID/MCHIP Project Dr Mkhokheli Ngwenya – Ministry of Health

2. Presentation Outline • Technical aspects of IMNCI • What is IMNCI and what were the gaps • Process of Development • Adoption of the quality checks • QI Performance dashboard • Lessons learnt • IMNCI Indicators/data elements for 0-2months and 2-59 months IMNCI registers

3. Technical aspects of IMNCI and identified gaps • IMCI is a WHO and UNICEF integrated approach to child health that also focuses on holistic management of a sick child • Adopted by Zimbabwe in the year 2000 and rolled out nationally • With MCHIP support, MoHCC integrated the newborn component into IMCI IMNCI in 2012 • Gaps • Documentation of children seeking health care services not standardized; • Difficult to assess quality of care by supervisors

4. The IMNCI Register (Assess, Classify and Treat tool) Before adoption by MoHCC

5. Process of Development of IMNCI register • USAID/MCHIP supported MoHCC to develop a tool to standardise documentation • Tool was pilot tested using a before –after intervention in two districts in Manicaland to: • evaluate the impact of the IMNCI register • Assess usefulness of tool during supportive supervision • Evaluate user friendliness

6. IMNCI register pilot findings • 90% of HWs agreed that the IMNCI register was useful and user friendly: • Well organized • Comprehensive • The information flow was good

7. IMNCI tool pilot findings “This tool helps me to coach student nurses seconded to Biriiri Rural Hospital. It also helps HWs at m hospital to manage the child holistically, even those not trained in IMNCI” – SIC Elizabeth Tinofa, Biriiri Rural Hospital, August 2013

8. IMNCI tool pilot findings “The IMNCI tool has immensely helped us in the management of sick children below the age of 5 years. All one has to do is follow the columns in the tool to make sure you give the ultimate treatment to the child”

9. Adoption of the IMNCI register • Findings of the pilot were used for advocacy through the national MoHCC level Child Survival (CS) TWG meetings • MoHCC and partners adopted the tool for national use and name was changed from TOOL to REGISTER • Resources for mass printing of the register were leveraged through the CS TWG platform.

10. IMNCI Register • After adoption by MoHCC

11. Lessons learnt • The IMNCI tool is a multi-purpose tool useful as: • a register • an On-the-job training tool • a data capturing tool • a job aid • a continuous QI tool • supportive supervision tool • Makes adherence to IMNCI protocol easy • 90% of Health Care Workers stated that the register was indeed user friendly • Significant improvement in IMNCI quality performance scores in the province after introduction of tool from a baseline average of 34% in 2014 to 72% in 2017.

13. Lessons learnt • Use of the IMNCI register requires minimal staff orientation and even those not formally trained in IMNCH formally can use it • Acceptance of an additional register by Ministry of Health may prove to be a challenge and may take long • Obtaining leadership commitment is key • Adoption of registers may require proof of effectiveness through a pilot study • Indicators may be used for Performance based financing

14. Key IMNCI Indicators/data elements The 2-59 months Register The 0-2 months Register Very severe disease/local infection Diarrhoea Jaundice Gonococcal Eye infection HIV status Nutrition Immunisation • Danger signs • Cough • Diarrhoea • Fever • Ear problems • Nutrition and anaemia • Method of feeding • HIV/AIDS • Immunisation • Vitamin A. supplementation

15. THANK YOU! SIYABONGA ! TATENDA