REPUBLIC OF SUDAN USE OF IMCI HFS RECOMMENDATIONS

1
REPUBLIC OF SUDAN USE OF IMCI HFS RECOMMENDATIONS
2
PHASES OF IMCI IMPLEMENTATION
1998 Early implementation Expansion 2000 Expan
sion 2001 Expansion 2000 2002
3
SURVEY METHODOLOGY

• 66 health facilities of 136 IMCI Implementing
  facilities randomly selected

• Cases enrolled
• - initial visit.for the child
• - with any non-surgical condition

• enrollment card, 4 forms and qualitative
  observation sheet

• 6 teams 2 surveyors and one supervisor
  visiting one health facility/ day

4
Results of the Survey

• Stance for re-planning and reorganizing program
  implementation at all levels

• Useful to monitor progress towards the
  achievement of the child health- related
  Millennium Development Goals

5

• PROVIDING AN EQUATABLE ACCESS TO CARE FOR THE
  MOST VULNERABLE GROUP

Finding 1 ? 54.3 of (364) children were under 2
years old ? 71 of the cases with severe
classifications were children less than 2 years
old
REC.1 Consideration should be given to
protecting children below 2 years old, especially
from poor families, by issuing a policy and
establishing mechanisms to provide them free or
at very low cost essential drugs
6

• PROVIDING AN EQUATABLE ACCESS TO CARE FOR THE
  MOST VULNERABLE GROUP
• Finding 2
• Drugs availability index in health facilities was
  5/6 for the essential oral treatment, 8.3/12 for
  the non injectable drugs and 2.6/4 for the
  pre-referral drugs
• REC.2 States should be committed to make
  essential drugs regularly available to health
  facilities where IMCI trained staff work

7

• Actions taken
• Meetings with the Federal and States ministers of
  health
• The followings have been discussed
• ?Vitalization of the Presidential decree of
  free provision of essential drugs for under
  fives
• Provision of free pre-referral treatments in 1st
  level health facilities
• Unification of drugs dispensing systems
• An integrated protocol for implementation of
  malaria free drugs has been jointly formulated
  with the Malaria directorate and is agreed upon
  by the federal minister

8

• PROVIDING AN EQUATABLE ACCESS TO CARE FOR
  CHILDREN
• Finding 3
• 47 of the health facilities with weekly
  immunization services didnt provide vaccination
  on daily bases
• REC.3 States should actively promote the
  implementation of the open vial policy to
  reduce the missed opportunities for immunization

9

• Actions taken
• Discussion of the recommendation with Federal EPI
  program
• Agreement to
• ? Implement the open vial policy in IMCI early
  implementing states
• ? jointly conduct a Study on the efficiency of
  using the policy in increasing the routine
  immunization coverage

10

• SKILLS REINFORCEMENT
• Strengthening follow up visits after training
• Findings 1
• ? Only 23 of the cases were seen by trained
  health workers who received follow up visit
  within 2 months of their training
• ? inadequate quality visits
• REC.1
• ? The Federal and State levels should jointly
  plan to develop and commit adequate human
  resources to follow up visits
• conduct follow up visits timely and according to
  standard methodology

11

• Actions taken
• Agreement with the States PHC directors, IMCI
  States coordinators and the national service
  administration
• Recruiting doctors from States and the
  national service department to work in IMCI team
  in the States
• Plan to train the assigned doctors on
  supervisory skills and programme management was
  set.
• Perform quality follow up visits according to
  the standard methodology.

12
SKILLS REINFORCEMENT Improving the basic skills
of health providers Findings 1 ? 77 of the
surveyed cases were managed by medical assistants
? Low level of basic clinical and communication
skills in untrained HW. REC.1 strengthening the
curriculum of pre-service training of medical
assistants
13

• Actions taken
• Areas of introduction on the Medical Assistants
  curriculum was identified and agreed upon on a
  workshop for review and endorsement of the
  Medical Assistants curriculum
• A committee was formulated to develop IMCI manual
  for MAs. Pre service training

14
IMPROVING SUPERVISION Findings ? Only 50 of
the health facilities received routine
supervisory visit in the last 6 months, and only
15 of the health facilities have recommendations
of the last visit recorded REC. Consideration
should be given to develop a simple supervisory
skills training package on child health and
involving supervisors in IMCI follow-up visits
15

• Actions taken
•  A simple supervisory skills training package
  for routine supervision was developed
• A plan to test the package was also developed
• Conduction of skills reinforcement sessions at
  rural hospitals for MAs every 2-3 months

16

• IMPROVING CARETAKERS PRACTICES
• Findings
• 33 OF Caretakers know at least 2 out of the 7
  danger signs to seek care promptly
• 32 of children with reported breathing problem
  were brought to health facility within one day
• REC. Health communication activities should be
  conducted as a priority to improve family
  knowledge about the early danger signs to seek
  care promptly

17

• Actions taken
• IMCI community component planning and advocacy
  workshops
• A core group of trainers was developed in the
  States
• Detailed plans of action for 14 communities were
  formulated
• (280 ) of community health promoters trained on
  priority KFP and started their activities