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Evidence from community and outreach approaches in Africa

Evidence from community and outreach approaches in Africa. IMCI early implementation phase. IMCI expansion phase. IMCI household and community component in at least 3 districts (18 countries). IMCI in the Eastern and Southern Africa Region.

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Evidence from community and outreach approaches in Africa

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  1. Evidence from community and outreach approaches in Africa

  2. IMCI early implementation phase IMCI expansion phase IMCI household and community component in at least 3 districts (18 countries) IMCI in the Eastern and Southern Africa Region 18 countries in Eastern and Southern Africa Region implement the household and community component of the IMCI strategy The common element:promotion of the key family care practices

  3. The Review2004-2005 • ESAR country experiences with implementing IMCI household and community-based activities (focusing on four countries--Malawi, South Africa, Tanzania, Uganda) • Scientific evidence for the importance of family care practices for a child’s survival, health, and development • Survey evidence on changes in family care practices in four focus countries

  4. Context

  5. By intervention Interventions that have the most direct impact on the child—and could make the most difference… Prevention

  6. Treatment

  7. Percent of total deaths preventable by groups of location associated interventions By location of intervention Health facility outreach includes: zinc, hib vaccine, vitA, tetanus toxoid, nivirapine, clean delivery, measles, IPT and antimalarials Home care includes: breastfeeding, complementary feeding, ITM, WASH and ORT Partial coverage 60% malaria interventions (Abuja target) 70% excl. breastfeeding and all others

  8. Findings

  9. Breastfeeding Children exclusively breastfed up to age 6 months in five ESAR sites (baseline and follow-up) Improving breastfeeding practices could prevent the deaths of 233,000 children in ESAR.

  10. Interventions can improve multiple practices

  11. Accelerated child survival and development (ACSD) in West Africa • Implemented in more than 100 districts in 11 West African Countries • 17 million persons, including 3 million under-5s • Use of three intervention packages

  12. Routine EPI+ • Strengthening routine EPI • Vitamin A supplementation • IMCI+ • Family practices promotion • Exclusive breastfeeding • ORT • ITNs (pregnant and under-5s) • Community management of malaria and ARI • Antenatal care+ (ANC+): • Refocused ANC4 • Tetanus immunization • Intermittent presumptive treatment (IPT) against malaria • Vitamin A (post partum) ACSD packages Concept and aim: three packages covering three service delivery modes, plus strengthening local accountabilities through performance contracts and participatory monitoring Started with limited package: EPI+ & ANC+ & ITNs

  13. ACSD objectives • Jointly with country health ministries, demonstrate rapid progress towards MDG goal 4 • Attain following target coverage within a 2 years period in selected districts • EPI+ and ANC+: 80% • IMCI+: 50% • Pregnant women & under-5s sleeping under ITNs: 60% • Achieve reduction of at least 5%/yr in under-5 mortality rate (U5MR) • 15% U5MR reduction after 3 years (2004) • 25% U5MR reduction after 5 years (2007)

  14. Context

  15. Percent of total deaths preventable by single interventions in Western and Central Africa Region Treatment Prevention

  16. Preventable deaths by location of interventions in Western and Central Africa Region

  17. Results

  18. Pregnant women and under-5s sleeping under ITNs, target districts 2004

  19. ORT coverage for under-5s, target districts 2004

  20. Exclusive breastfeeding, target districts 2004

  21. More than 18000 deaths averted within 3 years* 25% Senegal 21% Mali ABOVE 15% U5MR 18% Senegal expansion REDUCTION GOAL 17% Ghana 16% Benin 14% Guinea Bissau Estimated cost of less than $500 per death averted BETWEEN 10 AND 15% Guinea 12% U5MR REDUCTION 10% Burkina Faso 10% Chad Benin expansion 11% 9% Mali expansion BELOW 10% U5MR 9% Gambia REDUCTION 9% Niger 5% Cameroon 3% Ghana expansion * Using the Lancet child survival model to estimate impact

  22. Conclusions from East and West Africa

  23. Differences and similarities • East Africa • Good community development (excl BF, ORT) • Weaker integration with health system • West Africa • Good integration with health system (ITNs) • Delay in community development (excl BF) • Both • Making a substantial impact now on reduction of U5MR • But, to reach MDG target, need to combine strengths of both • Challenge • Scale-up & sustain household and community component • Build household and community approach into national goals, strategies and programmes, together with relevant resources

  24. And evaluation . . ?

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