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Progress in Implementation of Child Health Programme

Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011. Progress in Implementation of Child Health Programme. Nepal. Trend of Child Mortality in Nepal. Trend of Nutritional Status of under 5 Children. Causes of neonatal mortality in Nepal.

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Progress in Implementation of Child Health Programme

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  1. Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011 Progress in Implementation of Child Health Programme Nepal Regional CH Meeting, Kathmandu

  2. Trend of Child Mortality in Nepal

  3. Trend of Nutritional Status of under 5 Children

  4. Causes of neonatal mortality in Nepal DHS-2006

  5. Causes of under five mortality in Nepal DHS-2006

  6. IMCI Implementation

  7. IMCI Implementation

  8. Scaling-up of CBIMCI Programme

  9. CB-IMCI Implementation A. Key factors that helped scaling up • Strong government ownership (priority 1 programme) • Partner support (EDPs, Professional Societies, NGOs) • Strong network of health workers and volunteers at community level • Treatment success • Community mobilization and utilization of local resource to support the program and FCHVs, B. Key challenges to scaling up: 1. Cost 2. Quality of training 3. Follow up. 4. Frequent transferred of HF staff and drop FCHVs. 5. Supportive supervision monitoring at all level Regional CH Meeting, Kathmandu

  10. Newborn Health

  11. Community Based Newborn Care Package: A pilot intervention of Government of Nepal • Status: • 61% of U5 mortality is neonatal • 72% of deliveries occur at home (NDHS 2011) • CBNCP and Health facility based newborn care being promoted • On 21 Dec. 2007, MOHP Nepal endorsed the newborn package • The package was piloted in 10 districts in 2009-2010 and is now gradually being scaled up nationwide. • Newborn care interventions • Behavior Change and Communication (BCC) for newborn health • Promotion of institutional delivery and clean delivery practices in case of home deliveries • Postnatal care • Community case management of pneumonia/ Possible Severe Bacterial Infection (PSBI) • Care of low birth weight newborns • Prevention and management of hypothermia • Recognition of asphyxia initial stimulation and resuscitation of newborn baby

  12. Newborn Health • ENC Course adapted: 1997 • Other training courses: CB-NCP training • Healthcare providers trained on CBNCP: Regional CH Meeting, Kathmandu

  13. In-Patient (Hospital) care of sick newborns and children • WHO Pocket Book introduced: Training material adapted and approved • Training courses for Hospital care done: Planned for 2012 • Number and proportion of Healthcare providers trained: • MOs: N/A • Nurses: N/A • Hospital assessment using WHO tools carried out: • Ongoing, will be completed by Dec 2011 • How many hospitals covered: 4 (Central, regional and Sub-regional) Regional CH Meeting, Kathmandu

  14. CHW approach for care of sick newborns and children Regional CH Meeting, Kathmandu

  15. Development of Aama Suraksha Programme • 2005: Initiation of nationwide Maternity Incentives Programme (MIS)—providing transportation incentives to women who have institutional deliveries. • Incorporation of more institution through Safe Delivery Incentives Programme (SDIP) in 2006 • Launching of AamaSuraksha Programme, which combines free delivery care with incentives for women (14th Jan 2009- Magh 1st 2065) aiming at reducing both first and second delay

  16. Aama Suraksha Programme

  17. Free Primary Health Care: • ANC • PNC • Free drugs included in essential drug list: • Iron tablets • Inj TT • Albendazole • Inj Oxytocin (new list) • Inj magnesium sulphate (new list) • Incentive to pregnant woman who completes 4 focused ANC visits--NRs 400

  18. Programme Review and Management • CH Short Programme Review introduced, if yes : • Year: N/A • National or sub-national: N/A • Programme Management Course introduced, if yes: • 5 govt officials trained in Dec 2010 Regional CH Meeting, Kathmandu

  19. Health Management Information Systems (HMIS) and DHS/MICS List the key indicators for newborn and child health included in HMIS and DHS/MICS ARI • Incidence (ARI, Pneumonia, Severe Pneumonia) • % Pneumonia and severe pneumonia among new ARI cases • Case Fatality Rate of ARI • Treatment by antibiotic • % of Cases at (HF, VHW/MCHW, FCHV) CDD: • Incidence (Diarrhoea, Dehydration, Severe Dehydration) • % Dehydration and severe dehydration • Treated with ORS and Zinc and IV fluid • Case fatality rate • % of Cases at (HF, VHW/MCHW, FCHV) Malaria (information available for <5 years) • PV/PF/PM (indigenous and Imported • Clinical Malaria • Suspected/Possible Death • Confirmed Falciparum • Proportion of Malaria cases by Age among total positive cases Proportion of ear infections among reported cases, Proportion of severe malnutrition cases among reported cases, Proportion of Measles like disease. Regional CH Meeting, Kathmandu

  20. Health Management Information Systems (HMIS) and DHS/MICS List the key indicators for new born and child health included in HMIS and DHS/MICS under two months • Percentage of PSBI cases managed by HFs. • Percentage of LBI cases managed by HFs. • Percentage of cases having low/weight and feeding problems managed by HFs. • Percentage of under two months sick young infants referred by CHWs. Regional CH Meeting, Kathmandu

  21. Data Collection/Information Flow Chart Reporting Frequency Health Management Information Systems (HMIS) and DHS/MICS NPC Trimesterly National/ Central MOH National Centers DoHS MD/HMIS Divisions Trimesterly/ Periodic RHD Central/Regional /Zonal Hospital Regional Monthly District Monthly DHO Hospital Catchment area and Community PHC/HP Monthly SHP Regional CH Meeting, Kathmandu Reporting Line Feedback Line VHW/MCHW/FCHV

  22. Future Plans Revitalization/ Strengthening and scale-up plans for Next 2 years • Maintenance/Strengthening of CB- IMCI: • Development of multi years costed plan of Action for IMCI • Revision of IMCI protocol including the job aids and recording/reporting forms of HF and community level • Revision of pre-service curriculum • Development of IMCI referral guideline • Expansion of color coded supervision to all districts • Capacity building of CBIMCI focal person • Development of CBIMCI revitalization package and rapid implementation • Expansion of Community Based newborn Care Package • Assessment of CBNCP package • Monitoring and Supervision • Revision of pre-service curriculum • Referral service strengthening • ICATT use: ICATT platform can be used for university level pre-service training, and in the longer term it can be used at the district level training Regional CH Meeting, Kathmandu

  23. Thank You Regional CH Meeting, Kathmandu

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