15 Nov 2011 Regional CH Meeting, Kathmandu 1

Meeting of South-East Asia Regional Programme Managers on Child Health,

Kathmandu, 15 – 18 Nov 2011

Progress in Implementation of Child Health Programme

Country:BHUTAN

Road to MDG 4

Infant Mortality Rate: reduced from 90 in 1990 to 40 per 1000 live births.

ROAD TO MDG 4

15 Nov 2011 Regional CH Meeting, Kathmandu 5

Epidemiology / burden of childhood diseases:

• Main causes of Neonatal Mortality:

1) Prematurity

2) Birth Asphyxia

3)Sepsis

4) Congenital malformation

5) IUGR

Child mortality causes

• Pneumonia

• Diarrhoea

15 Nov 2011 Regional CH Meeting, Kathmandu 6

IMCI Implementation

IMCI implementation started (If yes, year) 1999

Newborn Added (If yes, year) 2009

Number and Proportion of districts implementing IMCI 20(100%)

Number and proportion of MOs trained 50%

Number and proportion of Nurses/other workers trained 95% of BHU staff

Proportion of districts (out of IMCI districts) with 60 % or more health providers trained

100%

IMCI supervisory checklists introduced 2009

Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during

previous year

100%

Proportion of districts (out of IMCI districts) covered with

Follow-up IMCI training 100%

IMCI implementation

IMCI implementation review conducted (If yes, year; National or sub-national)

2011,June

IMCI Health Facility Survey conducted (If yes, year; National or sub-national)

nil

Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI

100%

Pre-Service IMCI teaching/training:

Number and proportion of Medical Schools teaching IMCI

NA

Number and proportion of Nursing Schools teaching IMCI

01 (100%)

ICATT introduced (If yes, year and scale) Not implemented

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IMCI ImplementationKey factors that helped scaling up1. Program Officer with longer duration of posting.2.Core team of IMNCI trainers 3.Recording Forms made available in all the health

centres.4.Implementation of supportive supervision.5.Formation of Child Health Advisory Group (CHAG).Key challenges to scaling up:1.Continuity of supportive supervision( follow up).2.Time constraints of the supervisors.3. Rapid turnover of trained health workers.

15 Nov 2011 Regional CH Meeting, Kathmandu 10

Newborn Health

• ENC Course adapted: Year 2006

• Other training courses:

• Healthcare providers trained:

Healthcare providers Total no. No. Trained %

MO

Nurses

CHW

Volunteers

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In-Patient (Hospital) care of sick newborns and children

• WHO Pocket Book introduced: Year 2006• Training courses for Hospital care done: Yes / No;

Details, If yes:

• Number and proportion of Healthcare providers trained:– MOs:nil– Nurses:nil

• Proportion of hospitals providing pediatric care having oxygen:31 hospitals and 14 BHU I

• Hospital assessment using WHO tools carried out: – Year/s: – How many hospitals covered:

15 Nov 2011 Regional CH Meeting, Kathmandu 12

CHW approach for care of sick newborns and children

District implementing CHW approach

Total No. of Distt

Implementing Districts

%

Home based newborn care 20 Nil 0

Sick child package 20 C-IMNCI(9) 45%

Healthy child package (ECD)

20 nil 0

Any review of the experience

nil

15 Nov 2011 Regional CH Meeting, Kathmandu 13

Programme Review and Management

• CH Short Programme Review introduced, if yes : – Year:2010– National level.

• Programme Management Course introduced, if yes:– Year:Not implemented– National or sub-national:

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Health Management Information Systems (HMIS) and DHS/MICS

• List the key indicators for newborn and child health included in HMIS and DHS/MICS?

1.Number of diarrhoea cases2.Number of pneumonia cases3. Immunisation status.

• How and at what level are the data for these key programme indicators analysed and used by the programmes?

-analysed for Mid term review and whenever required. -to carry out thematic analysis( WHO,UNICEF,MoH)

15 Nov 2011 Regional CH Meeting, Kathmandu 15

Future PlansStrengthening and scale-up plans for Next 2

years • IMCI: expand the F-IMNCI to all the hospitals.• ICATT use:No• CHW Packages:

– Home Based NB Care package:– Sick child package:through C-IMNCI– Healthy Child (ECD)--No

• Referral (Hospital) Care:F-IMNCI• Programme Review and Management:

– CH Short Programme Review:2013– Programme Managers Course:

Future Plans• Nutrition program.

1)Anemia—survey result-(6 to 36 months)age –81% .

Intervention:Fortification of complimentary food.( sprinkles)

Target :same age group

Method:at 6,9,24 and 36 months contact and whenever children come for weighing.Start from 2013.

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Future plans continued

Malnutrition: stunting 33%.

Intervention: strengthen nutrition rehabilitation units in the hospitals.Currently only at JDWNR hospital,Thimphu

Start from:2012-2013

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Future plans

Neonates

1.Set up neonatal Care units at Regional hospitals.

2.Continue the advance training on neonatal care for nurses

3.Continue nurses attachment in the regional hospitals in NICU.

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Future plans for IMNCI

Expand F-IMNCI to all hospitals.

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THANK YOU

TRASHI DELEK

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