Progress in Implementation of Child Health Programme
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Transcript of Progress in Implementation of Child Health Programme
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: Sri LankaDr. Neil Thalagala (MBBS,MSc,MD)
Programme Manager Early Child Developement & Special Needs
Family Health Bureau, Ministry of Health
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Sri Lankan Child Health Program
Tertiary Care Hospitals (curative)
Secondary care hospitals(curative)
PHC
PreventivePrimary care hospitals (Curative)
National Child Health program (Design, M&E @ Central )
Community based care (Implementation)
LRH (1)
TH(16),PH (12),BH (44)Total 72
DH (161)PU (95)RH(182)CD&MH(59)CD(441)Total 938
MOH teams(329)
DISTRICT COORDINATORS
MOMCH (25) 329 divisions
Sri Lankan Child Health System
25 Administrative
District
329 Health Districts
(MOH AREAS )
FURTHER DIVIDED IN
TO 6690 PHM AREAS
Welfare System in a MOH District
Households
Primary care hospital
MOH Office
Field clinics
Secondary care
Tertiary care hospitals
POPULATION 60000- 150000
Pre-schools/schools
PHM AREA
FOR 3000 PEOPLE
EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS
IN THE COUNTRY
1000-3000 births year 5000 to 15000 Under 5 children
MOH (1-2)
PHNS (2) SPHI (1)
SPHM (2)
PHMS(15-25) PHIS (10-15)
Welfare System in a MOH District
Households
Primary care hospital
MOH Office
Field clinics
Secondary care
Tertiary care hospitals
POPULATION 60000- 150000
Pre-schools/schools
PHM AREA
FOR 3000 PEOPLE
EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS
IN THE COUNTRY
Secondary//Tertiary care Hospitals
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Nuwara Eliya, Hatton 376878 Badulla 161269Rathnapura 102384 Kandy 92869Galle 17257Total 806128
806128 18,797,252
4.29%
Under estate health programPHDT
ESTATE SECTOR POPULATION
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Epidemiology / burden of childhood diseases:19
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
0
5
10
15
20
2522.5
20.2 20.5 20.020.9
21.8
17.916.8 16.3
15.213.7 13.5
12.6
19.0
12.010.4
Year
Rat
e
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• Under 5 mortality 1992-2007
Epidemiology / burden of childhood diseases:
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1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 20100
20
40
60
80
100
120
140
160
140
82.3
72.4
57 53.247.5 45.1
34.4
24.219.3 16.5 13.3 10.1 8.4
75.5
49.2 45.3
34.2 33.3 29.7 2722.7
16.2 12.8 12.5 9.2 7.4 5.9
53.959.8 62.6 60 62.6 62.5 59.9
65.9 66.9 66.375.8
69.273.2 70.2
IMRNMR% NN deaths
Under 5 mortality =10.4
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Epidemiology / burden of childhood diseases:
LBW
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1993 2000 2007 2008 2009 2010 20110
2
4
6
8
10
12
14
16
18
2018.7
16.7 16.6
13.513
13.712.7
13.9
DHSH509%
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Epidemiology / burden of childhood diseases:
Causes of IMR 2009 % IUGR, Prematurity and LBW 609 21.7 Congenital malformations 507 18.1 Birth asphyxia / Intrauterine hypoxia 443 15.8 Other Perinatal causes 417 14.9 Septicaemia / Meningitis 227 8.1 Pneumonia 138 4.9 Other respiratory disease 37 1.3 Malignancies 13 0.5 Diarrhoea and Gastroenteritis 2 0.1 Other / Un specified 412 14.7 Total 2805 100.0
IMCI Implementation
• IMCI WAS NOT ADAPTED AS A GENERIC PACKAGE
• LIMITED APPLICATION • DEVELOPMENTOF STANDARD
GUIDELINES FOR MANAGING COMON ILLNESSES
• TRAINNED ONLY Estate Medical Assistants
15
Newborn health • ENCC Course adapted: Year 2007• Other training courses:
– Neonatal Advanced Life Support Course (One day)
– Breastfeeding Promotion and Support in a Baby Friendly Hospital A 20 hour course for maternity staff
– WHO/UNICEF 40 hour Breastfeeding Counseling Course
Newborn Health
Healthcare Providers
Total No. No. Trained %
Medical Officers including Pediatricians (60) and Obstetricians (3)
810 525 64.8
Nurses 2526 545 21.5
Midwives 2684 525 19.6
Volunteers - -
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In-Patient (Hospital) care of sick newborns and children
•NOT ADAPTED
Special need program• National Strategic plan for special need children
developed • Community based parent mediated model for
children with special needs being piloted • PHC training program was developed • PHC workers in Colombo and Puttlum district
trained• A model EDC is being established •
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CFD interventions for all by parents
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24……………60 Age in months
Bi
rth c
ohor
t 37
5000
Developmental screening By parents using ECDSBy PHC workers using a developmental scale designed for Sri Lanka
Delays & Deviations
< 18 months
Non Specific Early Interventionsby parents
supervised byPHC workers Special need
interventions by parents / PHC workers / therapists jointly
Special need screening for ASD/CP etc…
> 18 months
Screening by mothers/PHC
MOH
Assessment &Follow up
Parent education
Parent counseling Early intervention
center
Home
Clinic
Pre school
Training of parents care givers on interventionFunction as a day care center Staff training
Parent mediated intervention
Case management model
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CHW approach for care of sick newborns and children
District implementing CHW approach
Total No. of Distt
Implementing Districts
%
Home based newborn care
0
Sick child package 0
Healthy child package (ECD) 25 17 68
Any review of the experience Currently being done
Child Health Indicators • Neonatal Mortality Rate• Infant Mortality Rate • Perinatal Mortality Rate• Under five Mortality Rate • % Infant registered • % infants visited at home by area PHM• % infants attending CWC• Low birth weight index• % weighing• % moderate underweight• % severe underweight• % overweight • Immunization coverage
InfantPreschoolar 1-2 yrs & 3-5 yrs
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Future PlansStrengthening and scale-up plans for Next 2
years • IMCI: Capacity development OPD staff/N&E• Develop national strategic plan on Child Health • Develop NSP on IYCF• Completion of adapting & systematizing of SPR on MCH
& FP • Healthy Child (ECD) package: Being scaled up to N&E• Capacity development of health care workers on ENCC
and BFHI and LM• Evaluation of impact of ENCC training• Quality assurance system for newborn care introduced
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Future PlansStrengthening and scale-up plans for Next 2
years
• Scaling up of NSP on special needs
• Develop and implement a Surveillance system
on child mortality and establishment of a child death review system
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