Pre-service component of Integrated Management of Childhood Illness in Nepal

1. Pre-service component of Integrated Management of Childhood Illness in Nepal Prof. Pushpa Raj Sharma Focal Person

2. IMCI Pre-serviceAchievements • 1995: IMCI introduced in the country. • 1998: IMCI review/planning meeting. • IOM identified as a place to introduce IMCI as Pre-service training. • Focal person identified.

3. A meeting was held in the faculty to introduce the IMCI in the paediatric teaching and faculty accepted to introduce IMCI to 17th batch of students ,1998.

4. IMCI Pre-service training in IoM Achievements: • Country review meeting of IMCI in 1998 recommendation : to explore for options to include IMCI in the pre-service training, then IoM was identified as a possible site to introduce the IMCI pre-service training, • A meeting of paediatric faculty members and representatives of SEARO and HQ/Geneva, a focal person was identified in 1998.

5. Two days workshop was held in the Institute as a “no-cost” basis to brief the IMCI strategy to the faculty member: 9-10 December 1998 A meeting was held in the faculty to introduce the IMCI in the paediatric teaching and faculty accepted to introduce IMCI to 17th batch of students ,1998. Two Faculty members trained in the Inter Country Course on IMCI: 2000

6. 9 Days Teachers Training on IMCI for Nursing Campuses of IOM and Community Medicine of the Maharajgunj Campus of the IOM. Organized by the Department of Child Health: 2001 IMCI introduced in the Nursing Curriculum. In August , 2003 all house officers, PG residents and one faculty member trained in 11 days course of IMCI: Organized by the Department of Child Health, IOM.

7. Paediatric teaching: • At the 2nd phase (third year) and in the 3rd phase (fourth year) at the Department of Child Health. The teaching faculty consists of 3 professors, 1 associate professor and 2 lecturers • Teaching / learning activities: • 3rd year • Class room teaching: three days a week to develop the cognitive skill. • Clinical teaching: done as a bedside clinical teaching where they develop psychomotor skills, problem based learning • Students come in the group of 15 for three months

8. Paediatric teaching: • 4th year • Junior intern along with the Postgraduate residents and house officers. • Bedside procedures, emergencies, inpatients and outpatients, seminars and clinical discussions. • Supervised by consultants, bedside clinical procedures, assists postgraduate residents in emergencies, inpatient ward and give treatments from the outpatient dpt. • -5th year (Senior internship) • Time allocated for theory: 105 hours, practical: 347 hours

9. ** ** ** ** ** ** ** ** ** ** ** ** 1 2 3 4 5 6 7 8 9 10 11 12 IMCI IN OPD with prior readings from module Morning Case Discussion Classroom Introduction emphasizing signs used for IMCI and its scientific basis **

10. Teaching/Learning Materials Achievements * Adopted generic version, ^ Develop by the Department  • Theory classes: • *Slides of ARI and Readings on Diarrhoea developed by the WHO, Transparencies of the standard IMCI course, Handbook of paediatric problems published by HLMC, *Generic IMCI handbook with adaptation, ^IMCI Teacher’s guide for theory classes, *IMCI chart booklet used in standard IMCI course. • OPD sessions • *Chart booklet, Picture book of standard IMCI course, Enlargement of charts, Video of standard IMCI course, *Case recording forms of IMCI standard course, ^Teacher’s guide for OPD sessions • Problem solving seminar - *Case histories of the standard 11 days course. • Assessments • *GenericMCQ with adaptation. Generic observation checklist with adaptation.

11. Assessment of students • The students scores were as follows:a.Psychomotor SkillRange of Score (% of Golden standard)Assessment 80 -100 Classification 90 -100 Identify treatment 90 -100.b.Cognitive skill Total scoreRange of ScoreCase management process 8 5 - 7 Assessment 28 22 - 28 Feeding problems 6 5 - 6 Treatment 8 6 - 8 Counseling 6 6 - 8 Follow-up 8 7 - 8

14. IMCI Pre-serviceAchievements • First IMCI pre-service meeting 8-9 March, 2001 • 11 Days training 17-27th Sept. 2001 • 5 days training 8-12 October 2001 • First Follow-up of IMCI teaching in the different medical colleges: April 2003.

15. IMCI Pre-serviceAchievements • IOM introduces IMCI in Nursing Campuses: 2002 • Training of teachers of Paramedical schools: 2002 • Publication of the IMCI Students Module in Nepali: 2002 • Agreement on introducing IMCI in CTEVT: 2003.

16. IMCI Pre-serviceAchievements • IMCI pre-service workshop in BPKIHS, Dharan: 2002 • IMCI incorporated in the Undergraduate teaching in BPKIHS • Follow-up of IMCI pre-service undergraduate teaching in different medical colleges of the country: -28th August, 2003.

17. Challenges • Still it needs to be introduced in the curriculum of Kathmandu university • One of the main difficulty is the continuous supply of the IMCI handbook, case recording forms and assessment tools. The department does not have enough funds to supply freely to the students.

18. Thank you If you want to share other information with pediatricians please use www.prsharma.com.np