IMCI in Tunisia

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IMCI in Tunisia
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Why Integrated management of child and maternal
health (IMCI) in Tunisia

• 1. Situation prior to IMCI adoption
• Great progress achieved in reducing the under 5
  mortality rate in Tunisia (estimated at 30 per
  thousand in 2000, compared to 50 per thousand in
  1990).
• Combined activities of child health related
  vertical programs reporting and recording tools
  and system, supervisionetc

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Why Integrated management of child and maternal
health (IMCI) in Tunisia

• 2. Adoption of IMCI quality approach that aims
  at further reducing mortality and morbidity and
  promoting child development and growth by
• Addressing the major child and maternal health
  problems specific to Tunisia in a holistic way,
• improving the quality of health care services
  offered to children and
• promoting the child health.

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IMCI Milestones in Tunisia

• IMCI experience in Tunisia started in the year
  2000
• IMCI implementation in the field started in the
  year 2002, with IMCI case management training of
  the health providers.

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IMCI milestones in Tunisia1. Introductory phase

• Year 2000
• IMCI briefing Visit of EMRO staff to MOH, 2000
• IMCI orientation session to key MOH officials,
  central and peripheral MOH staff and Academe,
  2000
• Development of a preliminary national plan of
  action, 2000

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IMCI milestones in Tunisia1. Introductory phase

• National focal point nominated, 2000
• IMCI working group formulated, 2000
• Adaptation working group
• Community component working group
• With a focal point each
• Year 2001
• An IMCI adaptation / planning workshop, January
  2001 with technical support of WHO and UNICEF.

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IMCI milestones in Tunisia1. Introductory phase

• Improvement of the health systemt support
• Recording and reporting system register and
  monthly reports developed
• Organization of work at health facilities
  according to the job description of different
  levels of health providers and the situation of
  each health facility (patients flow)
• Drugs required for child case management included
  in the national EDL

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IMCI milestones in Tunisia2. Early
implementation phase

• Year 2002
• Physicians Adaptation finalized, 2002 (new
  areas maternal health, psychomotor development
  monitoring, care for development, healthy child
  module, visual deficiencies screening)
• Paramedics guidelines developed and finalized,
  2002 (triage, counselling, filling the records,
  monthly report writing)

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IMCI milestones in Tunisia2. Early
implementation phasea. capacity building 2002 -
2003
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IMCI milestones in Tunisia2. Early
implementation phase

• A pre-intervention assessment for health
  providers performance and health system support
  conducted
• IMCI follow up visit conducted it showed
  considerable improvement in health providers
  child case management skills.

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comparison of 22 doctors performances in the 4
IMCI early implementation districtsBefore and
after IMCI implementation 2001 survey, 2002
follow up visit
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IMCI milestones in Tunisia2. Early
implementation phase

• IMCI included in the national/ districts health
  plans
• Planning workshop with the governorate/ district
  teams
• Efforts to improve the referral system IMCI
  orientation of hospital staff

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IMCI milestones in Tunisia2. Early
implementation phase

• IMCI Community component
• Review of existing community interventions, key
  family practices related to child health, health
  education material.
• Identification of gaps and further collection of
  data
• Identification of priorities based on the
  situation analysis
• Development of a preliminary plan of action

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IMCI milestones in Tunisia2. Early
implementation phase

• IMCI review workshop and planning for expansion
  meeting has been conducted, April 2003.
• It revealed the suitability of this strategy for
  the Tuisian child as an approach that succeded to
  improve the quality of health services delivered
  to children at primary health care level

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SPECIFICITES OF IMCI IN TUNISIA

• Addresses both maternal and child health
• Addresses both healthy and sick child
• Strong continued fruitful coordination and
  collaboration among the international
  organizations
• High political commitment at all levels

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SPECIFICITES OF IMCI IN TUNISIA

• IMCI is institutionalized in the health system of
  Tunisia. IMCI included in
• 5-year national plan,
• National plan for children for the next decade,
• National plan to achieve the millenium goals,
• Biennal WHO cooperation plan,
• Annual UNICEF cooperation plan.