Community Based Integrated Management of Childhood Illness (CB-IMCI)
1 BACKGROUND
In 1997, the CDD/ARI Section of the Child Health Division implemented the Integrated Management of Childhood Illness (IMCI), an integrated package of child-survival Program in Mahottari District as a pilot. It addresses five major killer diseases (diarrhea, pneumonia, malnutrition, measles, and malaria) in a holistic way. Based on the recommendations made in FY 2055/56, Program personnel and EDPs representatives decided to include a community component, enabling mobilization of community health workers (VHWs and MCHWs) and FCHVs to provide CDD, ARI, nutrition and Immunization services to the communities. As a result, the (CBAC) Program merged into IMCI in 1999 and is now called Community Based IMCI (CB-IMCI).
In the beginning CB-IMCI Program was implemented in Nawalparasi, Bardiya, and Kanchanpur districts in FY 2056/57 and gradually expanded to 25 districts of the country by the end of FY 2061/62 in a phased manner. In FY 2062/63 CB-IMCI was further expanded to 8 more districts (Udayapur, Sankhuwasava, Sindhuli, Gorkha, Parbat, Kapilvastu, Jumla and Surkhet) making the total of 33 districts. Out of the 33 districts, CB-IMCI is functional in HF and Community level in 22 districts and where as in 11 districts it is functional at HF level only.
Status of IMCI Training (FY 2062/63)
| Districts | Doctor | Supervisors & others from DHO/ Hospital | PHI | Sr.AHW/
AHW |
HA | Staff
Nurse |
ANM | NGO &
others |
Total |
| Surkhet | 1 | 7 | - | 62 | 6 | 9 | 28 | 7 | 120 |
| Kapilvastu | 2 | 16 | - | 88 | 4 | 4 | 21 | 1 | 136 |
| Gorkha | 1 | 9 | - | 52 | 4 | 3 | 15 | - | 84 |
| Udayapur | 3 | 6 | - | 57 | 1 | 4 | 28 | - | 99 |
| Sindhuli | 1 | 14 | - | 58 | 8 | 2 | 10 | 1 | 94 |
| Jumla | 2 | 4 | - | 41 | 2 | 2 | 7 | - | 58 |
| Parbat | 5 | 1 | 2 | 53 | 3 | 2 | 13 | 5 | 84 |
| Sankhuwasava | 2 | - | 2 | 42 | 5 | 3 | 19 | 8 | 81 |
| Total | 17 | 57 | 4 | 453 | 33 | 29 | 141 | 22 | 756 |
During the FY 2062/63, 756 persons of various categories from eight districts were provided IMCI training. Sixty percent of those were Sr. AHW/AHW followed by ANMs and other categories. The categories of staff trained in IMCI is given in the above table.
Community level training
| SN | Activities | Number of Participants | Total | |||
| Parbat | Sankhuwasabha | Jumla | Surkhet | |||
| 1. | FCHV 1st phase | 494 | 311 | 527 | 876 | 2,208 |
| 2. | VDC/HFOMC | 557 | 373 | 234 | 515 | 1,679 |
| 3. | Mothers€™ Group Orientation | 9,702 | 3,913 | 4,806 | 10,655 | 29,076 |
| 4. | FCHV 2nd Phase Training | 474 | 300 | 506 | - | 1,280 |
| 5. | Traditional Healers Orientation | 197 | 103 | 111 | - | 411 |
Community level Training on IMCI by type of activities in four districts is given in the above table. More than 29,000 of mothers group have participated in the orientation Program. FCHV were provided training in two phases. Visualizing the important role played by the traditional healers, more than 400 traditional healers were also participated in the training program. For details see the above table.
Mothers' Group Orientation
| SN | Activity | Number of Participants | Total | |||
| Parbat | Sankhuwasabha | Jumla | Surkhet | |||
| 1. | Total # of Mothers attended | 9,702 | 3,913 | 4,806 | 10,655 | 29,076 |
| 2. | Total <5 cases examined | 3,198 | 1,182 | 1,950 | 4,436 | 10,766 |
| 3. | Total # of pneumonia cases treated | 179 | 95 | 272 | 415 | 961 |
| 4. | Total severe cases Referred to HF | 21 | 13 | 119 | 79 | 232 |
| 5. | Total ARI cases provided Home therapy | 2,998 | 1,074 | 1,559 | 3,942 | 9,573 |
Source: IMCI Section
Impact of CB-IMCI Program
The figure 2c.1 shows the effectiveness of CB IMCI Program by comparing 3 key indicators of Diarrhea between 25 CB-IMCI districts and 50 non-CB-IMCI districts. The incidence of Diarrhea detection in 25 CB-IMCI districts is lower than those of 50 non-CB-IMCI districts. In the CB-IMCI districts out of total registered Diarrhea cases (373,888) only 1.4% are severe dehydration where as in non-CB-IMCI districts out of total registered cases (411,448) 3.0% are severe dehydration. This could be due to increased accessibility, availability of services as well as ORS packets at any time in the community, timely referral by FCHV and increased health facility use rate by the mothers/caretakers of <5 children.
Similarly, figure 2c.2 shows an impact of CB-IMCI Program by comparing 3 key indicators of ARI between 25 CB-IMCI districts and 50 non-CB-IMCI districts. The incidence and pneumonia detection in 25 CB-IMCI districts is higher than those of 50 non-CB-IMCI districts. In the CBIMCI districts out of total registered ARI cases (760,409) only 1.1% are severe where as in non-IMCI districts out of total registered ARI cases (530,223) 3.5% cases are severe. This could be due to increased accessibility, availability of services at any time in the community, timely referral by FCHVs and increased health facility use rate by the mothers/caretakers of <5 children.
Community-Based ARI and CDD (CBAC)
CDD reactivation was one of the most prominent Programs executed by the Child Health Division. It was designed to help health workers gain professional knowledge, skills, and attitudes regarding WHO standards for case management of diarrhea and acute respiratory diseases.
In FY 2055/56, it was renamed as the Community-based ARI and CDD (CBAC) Program, and combined two other child survival Programs-Nutrition and Immunization. The CBAC Program was implemented in FY 2055/56 in five districts: Siraha, Rautahat, Bara, Rasuwa and Bajura. It was expanded to 6 more districts in FY 2056/57. Out of 11 CBAC districts, 5 have already been converted to CB-IMCI districts and 3 more districts will be taken up this year.
The Program includes the following three main strategies of CDD, ARI, Nutrition and Immunization Programs: (1) recognition of the danger signs of diseases related to CDD, ARI, Nutrition and Immunization; (2) timely referral to nearby health facilities; and (3) improved community support for CDD, ARI, Nutrition and Immunization through group participation and Program management. Support and assistance from communities are encouraged through:
- a) Introduction to the Combined Child Health Package which includes instructional materials as well as supplies for CDD, ARI, Nutrition and EPI;
- b) Emphasis on CDD/ARI Program Management along with case management activities;
- c) Organization of district and VDC orientation Programs to encourage community involvement and active participation; and
- d) Specialized training for all community based health workers and volunteers (VHWs, MCHWs, and FCHVs) to reduce morbidity and mortality due to diarrhea diseases, acute respiratory infections, malnutrition, and vaccine-preventable diseases.
