The courage to make every life count
Murwa Bhatti
Program Manager, Maternal & Child Health
Program, IRD
Oct 14, 2015 @ HANIF meeting, Nathiagali
electronic Integrated Management
of Childhood Illnesses (eIMCI)
Geographical Scope:
Muzaffargarh District
Priority Area: Nutrition
Start Date: April 15, 2015
End Date: December 15, 2015
Global Under 5 mortality
Country
% of U5 Mortality Burden
India
Nigeria
Congo
Pakistan
China
Ethiopia
22.3
11.3
6.1
5.6
4.1
3.6
Sources: United Nations Interagency Group on Child Mortality Estimation (Report 2012)
Liu L. et al. Lancet. 2012
U5 Mortality Rate per
1000 live births
61
128
99
72
15
77
Background: Under 5 Children Health
Two-thirds of child deaths are from preventable or
treatable infectious diseases
Malaria
Pneumonia
Diarrhea
Sepsis/meningitis
Measles
Malnutrition
Source: DHS, Nigeria 2013
Integrated Management of
Childhood Illness (IMCI)
WHO & UNICEF started developing strategy in 1992
Aims:
Strengthening primary health
Identification of true cases
Rationalizing use of drugs
Reducing hospitalization
Reduce: Death,
Illness & Disability
Promote: Improved Growth &
Development
IMCI implementation in Pakistan
Adopted by Pakistan in 1998
In 2000 - Launched in 2
Punjab districts
Currently deployed in more
than 80% of 135 districts
across Pakistan
– Within district
coverage limited to
few health facilities
– Lack of adherence by
community workers
Challenges in
Implementation
1
2
3
4
Low training coverage
Challenges in
Implementation
1
2
3
Inadequate training
4
Challenges in
Implementation
1
2
3
4
Complex modules and
algorithms
Challenges in
Implementation
1
2
3
Lack of adherence to
protocol
4
Sick children not
properly
assessed and
treated
Parents poorly
advised
Poor
Implementation
leads to…
Inability to
reduce
morbidity and
mortality
Weak referral
mechanism
between
community and
healthcare facility
Overall Goal
Reduce child mortality in
an outreach setting to
prevent and improve the
management of common,
and potentially life
threatening illnesses in
children using a mobile
health platform
Focus population: low-socio economic class by selecting a district with the very
poor indicators through a effectively proven service delivery structure of LHW
program
Build upon the existing
infrastructure of the LHW
network to proactively identify
and link children and parents to
appropriate care
Support the existing healthcare
system through LHW capacity
building and strengthening the
referral network
Through the eIMCI
program progress will
be directly measured
through:
Increase in referrals
to target community
BHUs and hospitals
Increase in
community based
care
eIMCI Local Adaptations
All < 5 year olds
Inclusion of Dengue,
UTI & TB
Direct enrollment in
interactive reminders
program
Direct cellular
communication with
CHWs
Benefits of electronic-IMCI
Clinical Decision Support System – with screening
algorithms to gather patient data and reduce human error
Decreased dependency on quality of training,
health workers and supervision
Improved monitoring in real time, at scale
Better implementation of IMCI protocol
Increased screening speed and reduced
waiting time
01
02
03
04
05
eIMCI Application
Implementation Challenges
Geographic connectivity
and flood warnings
High cost of a 11 day
training
Availability of LHWs for 11
consecutive days for training
is difficult since they spend 9
days a month on polio
campaigns
Coordination with Punjab
Information Technology
Board (PITB)
CORRECT Attributes
C : Credible
WHO recommended guidelines
O: Observable Real Time data reporting and results
R: Relevant Refines an LHWs ability to identify and manage an illness
R: Relative Advantage Innovation in technology
E: Easy to install and understandable Easy-to-use smartphone application
C: Compatible
T: Testable
Facilitates daily duties of end users (LHWs)
Pilot followed by implementation
LHW
teams
Other
National
Programs
EPI
Key
Stakeholders
Provincial
and District
Health
Departments
Indus
Hospital
Local
Community
eIMCI Scale up
plan
International
Expansion
END