Community based integrated management of childhood illness and Community based neonatal care package in Nepal

1. COMMUNITY BASED INTEGRATED
MANAGEMENT OF CHILDHOOD
ILLNESS (CB-IMCI) PROGRAM
AND
CB-NCP PROGRAMME in Nepal
Presented By:
Laxman Bhatta
B.PH 5th semester
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2. Introduction
• In 1997 the IMCI program was initiated in Mahottari districts
as a pilot.
• In 1999 CBAC was merged in IMCI program and now is
called CB-IMCI
• Fiscal year 2o66/67 (2009/2010) CB-IMCI covers all 75
districts.
• CB-IMCI program is an integrated package of child survival
interventions and addresses major childhood killer diseases
(Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition )
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3. Cont……..
• CB-IMCI is for 2 months to 5years children in a holistic way
• CB – IMCI also includes management of infection, Jaundice,
Hypothermia and counseling on breastfeeding for young infants
less than 2 months of age
• FCHVs are the main vehicle of services delivery and also play
key role to increase community participation
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4. Vision
• Contribute to survival, healthy growth and development of
under five years children of Nepal.
• Sustain the achievement of MDG 4 beyond 2015.
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5. Goal
• To reduce morbidity and mortality among children under‐five
due to pneumonia, diarrhoea, malnutrition, measles and
malaria.
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6. Target
• To reduce under‐five mortality from the current rate of
54/1,000 live births to 38/1,000 live
• To reduce Births and infant mortality from the current rate of
46/1,000 live births to 32/1,000 live births by 2015.
• To reduce neonatal mortality from the current rate of 33/1,000
live births to 16/1,000 live births by 2015.
• To reduce morbidity among infants less than 2 months of age.
Source annual report 2011
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7. Objectives
• Reduce frequency and severity of illness and related to
Pneumonia, Diarrhoea, Malaria, Measles and Malnutrition
• Contribute to improved growth and development
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8. Strategy
The following strategy have been adopted by CB-IMCI program
1. Improving knowledge and case management skill of
health service providers.
2. Improving overall Health Systems
3. Improving family and community practices
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9. Major Components
1. Management of sick children below 2 months of age.
2. Management of sick children 2 months to 5 years of age.
3. Management of Diarrheal Diseases
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10. SIGNS CLASSIFY AS IDENTIFY TREATMENT
PNEUMONIA
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11. Key Achievement By Figure
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12. SIGNS CLASSIFY AS IDENTIFY TREATMENT
DIARRHOEA
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13. Treatment of Diarrhoeal disease
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14. SIGNS CLASSIFY AS IDENTIFY TREATMENT
MALARIA
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15. TPP on HSD II 15

16. SIGNS CLASSIFY AS IDENTIFY TREATMENT
MEASLES
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17. TPP on HSD II 17

18. SIGNS CLASSIFY AS IDENTIFY TREATMENT
MALNUTRITION
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19. Achievement on Malnutrition
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20. Major Activities
Major activities carried out in FY 2070/71 include the following:
• Conduction of CB‐IMCI Refresher Training 10 districts ‐ Sankhuwasava,
Saptari, Morang, Myagdi,Jumla, Humla, Dolpa, Banke, Doti, Bajhang
• Training of CB‐IMCI all health workers.
• Referral IMNCI Training
• CB‐IMCI/NCP Orientation Training to HWs of Private Sectors
• Capacity Building Training to CB‐IMCI Focal Persons (EDR and CDR Regions)
• Child Health: CB‐IMCI/NCP
• Celebration of World Pneumonia Day (12 November)
• Conduction of operational Research on increasing access of IMCI/NCP in
underserved areas
• Conduction of efficacy study of Cotrimoxazole
• Initiation of Intensive Monitoring and Supervision in low performance districts
• Advocacy and marketing of CHX, Zinc, Cotrimoxazole and ORS
• Supervision and Monitoring
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21. Other common childhood illnesses
• IMCI Program also focuses on identifying malnutrition, measles,
malaria and other common illnesses among children.
• IMCI Section would actively collaborate with EPI and Nutrition
Sections for the reduction of malnutrition, measles and other
common childhood diseases through generating evidences
relating to changing pattern of childhood disease epidemiology
and strengthening the integrated approach to childhood disease
prevention.
• Further, the issue of childhood TB and HIV is growing and this
issue is also being addressed in the new package currently being
developed.
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22. Community Based Newborn Care
Package (CB‐NCP)
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23. Background
• NDHS-2011 has shown that 33 neonatal death per 1000 live birth
which accounts 61% of under 5 deaths.
• The major causes of neonatal deaths in Nepal are(IBPH)
- Infection
- Birth Asphyxia
- Preterm birth
- Hypothermia
• NDHS-2011 also shows that only 35% of birth take place in
health facility,so the neonatal mortality should be addressed for
achieving MDG 4.
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24. • MoHP has made newborn health a priority and initiated
integrated newborn health care package called “Community
Based Newborn Care Program (CB-NCP)” based on the
National Neonatal Health Strategy 2004.
• The program was implemented as pilot program in 10 district in
FY 2065/66.
• Further expanded covering 39 districts by the end of FY
2069/70. It was further expanded to two districts in FY 2070/71.
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25. TPP on HSD II 25

26. CB-NCP coverage
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27. Goal
• The goal of CB-NCP is to reduce neonatal mortality (NMR)
through the sustained high coverage of effective community
based interventions.
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28. Objectives
The specific objectives of CBNCP include:
• To prevent and manage newborn infection
• To prevent and manage hypothermia and LBW babies
• To manage post‐delivery asphyxia
• To develop an effective system of referral of sick newborns
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29. Data Recording and Reporting System in
CB‐NCP Districts
• The CBNCP uses seven different types of recording and reporting
tools at community and health facility level.
• Out of them, five are for recording and two are for reporting
purpose.
• The recording tools include CBNCP 1, 2 and 3 for FCHVs, CB
NCP 4 for VHW/MCHWS and CBNCP 5 for HFs.
• CBNCP 6 and 7 are data compilation tools that are used by HFs
for reporting all services provided by FCHVs, VHW/MCHWs
and HFs.
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30. Analysis of Achievement
Indicators 2067/68 2068/69 2069/70
N0. of newborn register by FCHV 7859 8065 7893
% of LBW identified by FCHVs among
registered
0.87 0.70 0.58
% of Birth asphyxia initiated stimulate
by FCHV at home among total cases
0.47 0.11 0.13
% of Birth asphyxia treated using Delee
suction by FCHV at home among total
cases
0.06 0.07 0.06
% of Birth asphyxia treated with Bag
and mask by FCHV at home
0.01 0.03 0.06
% of newborn applied chlorhexidine at
home immediately after cord cutting
(Home)
0 0 53.11
% of PSBI cases of 0-28 days 29.78 42.71 42.71
% of 0-28 days newborn received cotrim
P
55.75 76.33 72.35
No of 0-28 days newborn who received
full dose of Gentamycin injection
1143 1174 1180
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31. New Approach: Vision 90 by 20
90%
Coverage
by
2020
Institutional
Delivery
Access to
antibiotics
Access to
ORS and
Zinc
Access to
CHX gel at
Birth
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32. Role OF Health Personnel in Programme
Management
• FHV/MCHV
• Health post/Sub-health post
• DPHO/DHO
• RHD
• CHD
• LMD
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33. Impacts of Program
• Institutional delivery has increased
• Newborn Sepsis identified and treated at community level
• Universal treatment procedure over the district
• Government providing incentives to FCHVs for new born
care
• Community people are satisfied due to no cost for the
treatment
• Decreased neonatal and child morbidity and mortality
• Improvement in other safe-motherhood and Child Health
indicators
• Recognization of FCHVs in the community/ social
mobilization
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34. CONCLUSION
• Over the last decade, Nepal has achieved significant
progress in reducing the under five mortality rate.
• Nepal is one of the country that have reduced under-five
mortality by 50% since 1990 by implementing the
community based child health program.
• It addresses the major childhood illness.
• FCHVs have important roles on CBIMCI at grassroots
level.
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36. References
• Annual report department of Health services FY
2070/71(2014/2015)
• CBIMCI user manual published by CHD
• Hand book of CMIMNCI 2071 by CHD,DoHS Nepal
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37. THANK-YOU
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