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Bernadette Daelmans Coordinator Policy, Planning and Programmes

Caring for newborns and children in the community: a package of training materials for community health workers. Bernadette Daelmans Coordinator Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health WHO, Geneva.

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Bernadette Daelmans Coordinator Policy, Planning and Programmes

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  1. Caring for newborns and children in the community: a package of training materials for community health workers Bernadette Daelmans Coordinator Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health WHO, Geneva

  2. Too many children are not reached with essential interventions Source: countdown to 2015, June 2010

  3. How can we contribute to increasing coverage? Increase the availability of services Increase access to care for newborns and children available close to home Make interventions simpler to implement Improve the quality of services provided Strengthen the linkages between health facilities and community-level care providers (including promotion of care-seeking)

  4. Extending care to the community: Joint statements UNICEF-WHO Diarrhoea Pneumonia Severe acute malnutrition Home visits for newborn care

  5. Translating evidence into practice UNICEF/WHO training materials Caring for the sick child in the community Caring for the newborn at home Caring for the child's healthy growth and development

  6. Caring for the sick child in the community Referral of children with danger signs and severe acute malnutrition Treatment in the community Diarrhoea Fever (malaria) Pneumonia Caring for the child's healthy growth and development Care-giving skills and support for child development Infant and young child feeding Prevention of illness Family response to child’s illness Summary of content of the materials • Caring for the newborn at home • Promotion of ANC and skilled care at birth • Care in first week of life • Recognition and referral of newborns with danger signs • Special care for low-birth-weight babies

  7. Design of the materials • Age range:Addresses needs of children age 0-59 months • Holistic: Cares for the newborn and child, not single disease conditions • Structure of training: sequential introduction (or independent use) of components, on the-job skills reinforcement • Level of literacy of community health workers:Literate – grade 5-8 level • With health system or NGO system: Requires adaptation to national policies, training, regular supplies, supervision, link to IMCI in first- and referral care facilities

  8. Caring for the sick child in the community • Identify signs of illness • Diarrhoea • Fever • Chest indrawing • Fast breathing • Severe malnutrition • Refer child with danger signs(or other problems) and begin treatment • Treat diarrhoeaat home(ORT and zinc) • Treat fever(antimalarial) andfast breathing (antibiotic) at home

  9. Caring for the sick child in the community • Sick Child Recording Form • CHW training manual • Facilitator guide • Video and photo flip chart • Chart booklet • Inpatient instructor guide • Outpatient guide • Job aids Duration: 6 days, includes 2 inpatient and 5 outpatient clinical practice sessions

  10. Caring for the newborn at home Two home visits during pregnancy Home visit on the day of birth if home delivery; if delivery at facility then soon after returning home Additional visits during first week of life: days 3 and 7 For low birth weight infants: additional visits on days 2 and 10 Optimal timing of contacts to promote key family practices after the neonatal period are being defined Duration 6 days, 2 clinical practices in HF, 2 home visits: to pregnant women, and newborns and mothers after childbirth

  11. Caring for the newborn at home:Job Aides Counselling cards Mother and Baby card Referral note CHW register

  12. Caring for the child's healthy growth and development • Promote growth: Counsel on breastfeeding and complementary feeding • Stimulate the child’s development:Play and communicate • Prevent illness:Immunization, ITNs, hand-washing • Respond to illness

  13. Caring for the child's healthy growth and development Individual counselling during home visits - themes Infant and young child feeding Early child development Prevention of illness Careseeking Group sessions - themes Infant and young child feeding Early child development Safe and clean environment Prevention of injuries and accidents Careseeking

  14. Status of implementation Caring for the sick child in the community Introduced in numerous countries, including Malawi, Philippines, Zambia Adapted versions in Egypt, Sudan, Uganda, Yemen Version with RDT tested in Uganda, final version on Web Caring for the newborn at home Based on work in Ghana and south Asia; tested in Cambodia, India, Kenya, Philippines Introduced in DR Congo, Malawi, Nigeria, Uganda, Zambia, Zimbabwe, Senegal, India Adaptations of illustrations for South Asia and for Africa

  15. Status of development Caring for the child's health growth and development Tested in Philippines in March 2011 Revised version tested in India September 2011 Illustrations being developed in 3 sets for use in: Europe / Latin America Asia Africa

  16. Programmatic pathway for improving survival and health IMPLEMENTATION OF ACTIVITIES Advocacy for child health Human, material and financial resource mobilization Human resource capacity development Communication with families & communities Health system supports strengthened Progress tracked IMPROVED Availability and access to health care Quality of care Demand for care Knowledge of families and communities INCREASED POPULATION-BASED COVERAGE of key effective interventions IMPROVED SURVIVAL AND HEALTH Other determinants

  17. Programmatic requirements Policies Adaptations Sustainable human resource plan Linkages with health services for maintaining performance Supervisory system Logistics and supply Referral and counter-referral

  18. Countries need to adopt relevant policies Source: Countdown to 2015, June 2010

  19. Defining indicators and data collection methods for iCCM

  20. Next steps • Build additional training capacity in 3 packages • Develop programmatic guidance (planning, adaptation, monitoring implementation, evaluating) • Finalize indicators and methods for measuring quality of care and make available • Investigate how to resolve bottlenecks such as motivation, retention, and quality performance • Scale up and document processes, lessons learned, best practices

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