Dr. Abdul Rehman Dr. Abdul Rehman PirzadoPirzadoProvincial MnCAH Officer , WHO Sindh, Provincial MnCAH Officer , WHO Sindh, PakistanPakistan

To reduce significantly mortality and

morbidity associated with the major

causes of disease in children.

To contribute to healthy growth and

development of children.

Abdul Rehman Pirzado 2014

Is not another vertical program

Incorporates: Elements of diarrheal diseases and ARI control program and child oriented aspects of malaria control, nutrition , EPI and other relevant programs

Depends on: Effective functioning of essential drugs and EPI program

Demands and Facilitates: Active collaboration of all these existing programs

Improves: The quality of care of sick children in the primary health care context

Abdul Rehman Pirzado 2014

Improving Case Management Skills of Health Workers:Improving Case Management Skills of Health Workers:

Standard guidelinesStandard guidelines

Clinical Case Management (pre and in-service)Clinical Case Management (pre and in-service)

Follow-up after IMNCI training Follow-up after IMNCI training

Improving the Health System to deliver:Improving the Health System to deliver:

Essential drugs: supply and management Essential drugs: supply and management

Organization of work in Health FacilitiesOrganization of work in Health Facilities

Management and SupervisionManagement and Supervision

Improving Family and Community practices Improving Family and Community practices

Abdul Rehman Pirzado 2014

Assess a child

Classify a child’s illnesses using signal lights approach

Identify treatments for the child.

Treatment instructions

counsel the mother to solve any feeding problems and her

own health.

When a child is brought back to the clinic give follow-up

care and if necessary reassess for new problems

Red - urgent pre-referral treatments and referral

Yellow - specific medical treatment and advice

Green - simple advice on home management

Abdul Rehman Pirzado 2014

1.1. Exclusive BreastfeedingExclusive Breastfeeding

2.2. Complementary feeding / WeaningComplementary feeding / Weaning

3.3. Micronutrients supplementation for vitamin A, Micronutrients supplementation for vitamin A,

Iron and Zinc Iron and Zinc 

4.4. Hygiene: Disposal of faeces and Wash hands Hygiene: Disposal of faeces and Wash hands

5.5. Immunization as per EPIImmunization as per EPI

6.6. Preventing MalariaPreventing Malaria

Abdul Rehman Pirzado 2014

7. Promote mental and social development by

responding to a child’s needs for care

8. Home care during Illness

9. Give sick children appropriate home treatment

for infections

10. Care Seeking behaviour

11. Compliance with advice

12. Antenatal Care

Abdul Rehman Pirzado 2014

Launched globally in 1991

Pakistan adapted 1998-2000

First national clinical course 2000

First clinical course in Sindh 2004

Pre-service adaptation in Pakistan 2004

Pre-service adaptation in Sindh 2009

First Pre-service evaluation in Pakistan – LUMHS 2011.

First logbook on Pakistan- LUMHS 2010

Abdul Rehman Pirzado 2014

Total Health Facilities

Health Facilities with IMNCI trained HCP

CoverageHealth care Providers Trained

1,727 77545 %

(12 – 100)2, 257

Good News:

• Government of Sindh has declared IMNCI as SoP for Children U5

• Follow up has been integral part of HRD in 10 districts.

• Follow up has revealed 60 % scores in trained HR

Concerns:

• No policy to procure IMNCI medicine and supplies

• Poor management support

Abdul Rehman Pirzado 2014

Section on Nutrition to be aligned with

CMAM

WHO Growth Charts have been proposed

Distance Learning IMNCI clinical course

Abdul Rehman Pirzado 2014

Abdul Rehman Pirzado 2014