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Slide 1 - 1 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Pre-service and In-service Capacity Building: Lessons Learned from Integrated Management of Childhood Illness (IMCI) Dr Wilson Were Medical Officer Child Health Services
Slide 2 - Outline of Presentation 2 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Background What is IMCI? Lessons learnt from IMCI training New training options Conclusion
Slide 3 - Major Causes of Death in Neonates and Children Under-five: World - 2012 Sources: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html) *For undernutrition: Black et al. Lancet, 2013 45% of global under-five deaths are associated with Nutrition- related factors* 3 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 4 - So how do we take effective interventions to those who need them? Effective interventions exist, but one of the main challenges is how to take them where they are needed. 4 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 5 - Home/Community 1st level facility Hospital Specialised care Number of children seen Equipment, supplies, case management skills Interventions delivered at home, primary health facility and hospital Where are these Interventions Needed Most? 5 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 6 - …Even when provided Quality of Care is a major constraint… 6 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Clinical care incomplete assessment of patients poor communication with parents irrational treatments & counselling Health system issues access to services or organization of services availability of appropriate medicines, vaccines & supplies support supervision
Slide 7 - IMCI: Key Strategy for Improving Child Health Nutrition Immunization Disease Prevention & Promotion of Growth and Development Management of Sick Children a 7 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Integrated M nagement of Ch ildhood Illness An integrated approach to the well-being of the whole child to:- Reduce death, illness and disability, and Promote improved growth and development.
Slide 8 - Main Components of IMCI Knowledge, beliefs and skills of caretakers Improve health worker performance Strengthen health system supports IMCI Training Community IMCI To promote: Holistic assessment of sick children Rapid referral of severely ill children Rational use of medicines Effective communication Policy & Support supervision 8 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 9 - Severe disease Urgent referral Disease with specific therapy Specific medical treatment Cough or difficulty in breathing Diarrhoea Fever Ear problem Nutritional status/ anaemia Disease without specific therapy Symptomatic treatment Vaccination status Complete/incomplete Vaccinate Characteristics of IMCI guidelines for 1st-level health facilities 9 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 10 - Lessons Learnt from IMCI Capacity Building
Slide 11 - What strategies have been used in IMCI Training? 11 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 In service training: ►Targeting health workers in service Pre-service training: ►Targeting health professionals in training institutions
Slide 12 - What is the Target of IMCI Training? 12 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 12 Who? All health workers managing children Nurses, clinical assistants & doctors Medical, nursing or paramedical students Which conditions? Major causes of mortality: Pneumonia, diarrhoea, malaria, meningitis, acute malnutrition, HIV, preventive, neonatal problems, etc. What level of care Primary level health facilities Hospital OPD
Slide 13 - Why In-Service Training? 13 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 To improve performance of health workers by: Familiarization with national guidelines Ensuring that health workers in practice are aware of new evidence based best practices Refresher training/continuing medical education Ensuring improved quality of care for severely ill children.
Slide 14 - Methods of Capacity Building Reading - knowledge Skills training/clinical practice Scenarios/discussions Drills & role plays Job aides - Charts Facilitators Evaluation Skill sessions are conducted in small groups Clinical practices sessions on cases with signs in facilities 14 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 15 - Why IMCI “Pre-service” Training? 15 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Pre-service training is recognized as an opportunity to: Prepare graduates to support and follow national policies and guidelines Broaden health system coverage by trained health workers in a sustainable manner Improve the cost-effectiveness of training Reach practitioners in both the public and private sectors
Slide 16 - What does it take to introduce into Pre- Service Education 16 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 17 - Facilitating factors for Introducing IMCI into curricula 17 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Strong commitment of the MOH staff Involvement of key medical and paramedical faculty Introduction coinciding with review of curriculum or beginning of new training program Critical mass of IMCI trained preceptors
Slide 18 - Challenges
Slide 19 - Challenges of In-service Training 19 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 High cost of centralized tutor-based training Inadequate supply of training materials (modules) Frequent attrition of trained staff Limited to public health facilities Releasing essential staff for off-site training Reluctance to locally apply learned skills.
Slide 20 - Challenges in Pre-service training… Strengthening multiple technical areas for Pre-Service Education Essential newborn care Infant and young child feeding Management of common childhood illnesses Adolescent health and development Paediatric HIV Care and treatment 20 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 21 - Faculty Level Challenges “Students need to know every condition” “Students need to learn about the most high tech diagnostic tools and drugs” Curriculum is already overloaded!!! 21 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 22 - Institutional level challenges 22 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Preference for lecture-style classes with limited interactive and skill-oriented teaching Large class sizes in classes Inadequate or non-functioning facilities(e.g. audiovisual, training materials) Coordination between different academic programmes and units (e.g., paediatrics vs. community medicine) Few trained or motivated preceptors
Slide 23 - New Options For IMCI Training
Slide 24 - Innovative computer based training 24 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 25 - Training player – the concept READ PRACTICE TEST SEE http://online.icatt-training.org/se-33276f7522b243e3a45464190ac06475/AdminPage/ 25 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 26 - How ICATT can be used? ICATT Self- learning Reference Test Update Teaching tool 26 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 27 - IMCI Distance Learning IMCI http://www.who.int/maternal_child_adolescent/documents/9789241506823/en/ 27 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 28 - DL Materials Vs IMCI In-service Modules 28 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 29 - Paper-based IMCI Distance Learning: principles and experiences Target: Health workers who cannot leave their clinics for too many days or private practitioners Blended learning for motivation: Face-to-face meetings with facilitators, for orientation, review of progress and clinical practice Access to a mentor/tutor in person, or thru mobile etc. IMCI skills practice in home facilities Group study/clinical practice is encouraged 29 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014
Slide 30 - Conclusion 30 | IAEA International Symposium on MAM, Vienna, Austria | 03 June 2014 Capacity building should: Focus on core competences Focus on pre-service training Use in-service training for refresher training & CME. Avail several options and approaches suitable for different settings
 

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