analytic review of imci in the context of child health

1. Presentation at Health Summit, April, 2005 Team members: Dr. Kobina Atta Bainson (leader) Dr. Samuel Tetteh Kwashie Ms. Beatrice Appah Dr. Bob Pond

2. Outline of presentation Background Objectives and methodology of review Child health context and key findings Recommendations for improving child health Scaling up IMCI.

3. Background Ghana signed up to achieving MDGs goals and targets 2003 GDHS: under five mortality increasing after two decades of decline Concerns about not achieving the MDG targets and goals Review child health strategies, with focus on IMCI

4. Broad Objective Review IMCI strategy in the context of child health and recommend actions to improve scaling up of IMCI

5. Methodology Rapid appraisal involving Desk review Field work in four districts in four regions Key informant interviews and focus group discussions Data analysis Debriefing of key stakeholders Review and planning meetings.

13. Can Ghana Achieve the MDGs?

14. Implications of policy reforms GPRS: medium term strategy for national development; but no targets to achieve MDGs PoW: focus on reducing inequalities; plans to scale up IMCI Under-five child policy (1999): no MDGs targets; outdated regimens; no policy goal.

15. Implications of policies National drug policy and essential drugs list: no decision on home administration of amodiaquine-artesunate; co-trimoxazole not administered at community level and implications for home based management of fevers; National health insurance: universal coverage by 2009; children under 18 covered if both parents or proven single parent

16. Progress with programme indicators

21. Child health interventions and strategies Ghana implementing cost effective interventions but coverages vary greatly Targetting interventions: twin track approach; universal and categorical targeting of the poor

22. Improving the skills of health workers; 2) Improving the health system; 3) Improving household and community practices

23. IMCI case management achievements Revision of child health records Adaptation of WHO standard protocol for case management. Revision of the CHEST kit. Increased capacity of providers in managing childhood illnesses Post training follow-up

24. IMCI: achievements in health system strengthening Revision of the national drug policy to make 2nd line drugs available to health centres Development of integrated supervisory checklist

25. IMCI: achievements in community and family practice Identified and introduced 16 key community practices to promote child health Development of home-based communication strategy for children A draft manual for training community volunteers Development of feeding guidelines for under-5 children Community based growth promotion Child health component for CHPS

26. Organisation and Management Good collaboration between ICD and PH division nationally but weak in regions Planning and budgeting: inadequate budgeting for child health activities in some districts and irregular financial flows Quality assurance: considerable progress but need to do more Monitoring and supervision: requires urgent attention

27. Recommendations to improve child health Prioritize neonatal health: increase professional skilled attendance; include neonatal deaths in maternal mortality survey; review system for managing the sick newborn Malnutrition requires urgent attention Review child health policy Interagency committee on maternal and child health

28. Recommendations to improve child health �cont�d Increase advocacy for child health Strengthen current institutional reforms Strengthen collaboration with district assemblies Specific interventions: co-trimoxazole administration at home IMCI should be model for preservice and inservice training; community IMCI should be integrated into CHPS

29. Scaling up IMCI Strong support by senior managers; involve RDHS Operational feasibility: IMCI should not exist as an organisational entity; involve Regional Clinical Care units; Ownership by Regional & District Health services Training: focus in the short term on medical assistants and CHOs; strengthen pre-service training; decentralize training Financial feasibililty: increase donor inflows in short term; resource shift to regions and districts in medium term.

30. Options for going to scale with facility IMCI Pre-service: Kintampo (2004), RN schools (2005), CHN and medical schools (when ?) Additional funding required -- 1.8 billion cedis ($210,000) Earmarked funding for the 11 day course: Additional funding required -- 6.6 billion cedis ($750,000) Abbreviated (6 day course) � Reduce costs, but also considerably reduce impact �District-based course� � Largely non-residential and district funded. Challenge to give participants good clinical practice with various types of seriously ill children (e.g. severe pneumonia, severe dehydration, sick young infants) Additional funding required � 3.0 billion cedis ($330,000)

31. We thank you for caring!!!