IMPLEMENTATION OF IMCI STRATEGY IN NABEUL TUNISIA

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IMPLEMENTATION OF IMCISTRATEGY IN NABEUL
TUNISIA
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INDICATORS

• Surface area (en hectars)
• Population  655 000 (6,5)
• Health Districts  14
• Regional Hospitals  3
• District Hospitals  8
• Emergency service
• Outpatient service (General medicine other
  specialties)
• Medicine ward
• Maternity ward
• Dentistry
• Radiology
• Laboratory
• Pharmacy

Nabeul
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INDICATORS

• Physicians MOH Private
• GP  141
  101
• Specialist  70 112
• Paramedics in PHC Facilities 307
• 1 physician/ 1500 population
• 3 paramedics/ PHC facility
• 1 PHC Facility/ 5500 population

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DEMOGRAPHIC DATA

• Growth Rate  1.1
• Infant mortality Rate  18
• Rate of delieveries at the hospital  97
• Family planning Rate 75
• Vaccination coverage gt 95 for all vaccines.
• Proportion of children 0-5 ans  9(58.950)
• Curative service 7 children / day of
  consultation 100 000 children /year (in all
  HF)
• Well child consultation  14 children /
  vaccination session 58000 children /year
• Ante natal consultations 10 women/ midwife
  consultation 100 000 women/an

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EPIDEMIOLOGIC SITUATION
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ORGANISATION OF PHC SYSTEM
Development/ implementation of National policies
MOPH PHC DPT.
Training
University Hospital
Developmental work
Supervision-follow up
Planning
Managing national programs
Monitoring - Evaluation
Provision of material, drugsetc
Development of guidelines
REG. DIR. HEALTH PHC DPT.
Training
Regional Hospital
Supervision-follow up
Managing the implementation of national programs
Referral circuit
DISTRICT
Training
District Hospital
Supervision-follow up
Managing the implementation of national programs

• Implementation of programmes
• Curative care
• Preventive care

6/6
PHC FACILITES MCH
Collection of health information
Management of drugs, materials supplies
1 5/6
HEALTH POSTS
Vaccination
FP Ante-natal care
Health Education
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Flow of patients
Child
Healthy
Sick
Growth monitoring
Feeding recommendations
BF counselling
Well child clinic
Accident prevention
Oral hygiene
Care for development
Vaccination
Physician absent
Physician available
1. Registration/ reception
1. Registration/ reception
2. Screening paramed.
2. Tri decide - paramedic
Health education waiting area
3. CM - Physician
Urgent referral
Urgent referral
Treat diarrhoea, Home care f/up
3. IMCI register
4. Counsel - registration - paramed
3. Conseils IMCI register
5. Pharmacy
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IMCI IN NABEUL

• Two districts implemented IMCI Nabeul Ville (6
  HF) Menzel Bouzelfa (1 HF)
• Selection Criteria
• Presence of motivated staff
• Collaboration between the members of district
  management team.
• Good health indicators

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IMCI implementation health facilities
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IMCI milestones

• Oct. 02, Training of physicians (13)
• Oct - Nov. 02, April 03 Training of paramedics
  (26)
• Nov. 02 Beginning of IMCI implementation in the
  field.
• Nov. 02 up to date, supervisory visits close
  monitoring (Regional level), the frequency of
  which has been adjusted according to the
  performance of health facility team.

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IMCI milestones

• Nov. 02 training on communication skills for
  paramedics
• Nov. 02 up to date, sensitization sessions of
  the community (3 before the IC community w/shp, 2
  after the w/shp)
• Dec. 02, Follow up visit by the central team
  WHO.
• March 03, refresher courses for paramedics
• July 03, Orientation sessions for health staff on
  the healthy child component of IMCI, and
  beginning of its implementation in the field.

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TRAINING AND FOLLOW UP OF HEALTH PROVIDERS
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Conclusions

• Improvement of health providers performance
• Better identification of severe cases especially
  for the age group 0 2 months.
• Systematic checking for anemia, ear problems,
  refractory errors, screening of developmental
  problems, care for development.

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CONCLUSIONSImproved health providers skills
assessment skills
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RESULTS OF FOLLOW UP
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CONSTRAINTS

• The flow of patient and task distribution at
  health facility level, was not clear in the
  beginning of the implementation.
• Distribution of tasks among the regional staff
  members in relation to IMCI not well defined.

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CONCLUSIONS AND LESSONS LEARNT

• Presence of motivated staff should be one of
  district selection criteria.
• When planning for training, replacements should
  be considered.

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CONCLUSIONS AND LESSONS LEARNT

• Team work is essential cooperation between
  technical and administrative staff
• Internal supervision is essential need to
  strengthen the supervisory skills of physicians
  working in health facilities.
• Collaboration between different levels (central,
  regional, local) is indispensable for the success
  of implementation, consolidation of the
  achievements and sustainability.

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CONCLUSIONS AND LESSONS LEARNT

• Close monitoring by international, national,
  regional and local levels is essential to
• provide necessary technical support,
• ensure successful implementation of the
  strategy,
• early problem solving,
• skill reinforcement,
• motivation of the health staff.

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CONCLUSIONS AND LESSONS LEARNT

• The health providers adhered to the IMCI
  guidelines because
• They felt more confident in managing children
• More value was given to the paramedics role.
• Caretaker satisfaction due to
• The good quality of health service offered to
  children.
• Their involvement in the community component