15 Nov 2011Regional CH Meeting, Kathmandu1 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 2011Regional CH Meeting, Kathmandu5 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 2011Regional CH Meeting, Kathmandu6

IMCI Implementation IMCI implementation started (If yes, year)1999 Newborn Added (If yes, year)2009 Number and Proportion of districts implementing IMCI20(100%) Number and proportion of MOs trained50% Number and proportion of Nurses/other workers trained95% of BHU staff Proportion of districts (out of IMCI districts) with 60 % or more health providers trained 100% IMCI supervisory checklists introduced2009 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

9 IMCI Implementation Key factors that helped scaling up 1. 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 2011Regional CH Meeting, Kathmandu10 Newborn Health ENC Course adapted: Year 2006 Other training courses: Healthcare providers trained: Healthcare providersTotal no.No. Trained% MO Nurses CHW Volunteers

Regional CH Meeting, Kathmandu11 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 2011Regional CH Meeting, Kathmandu12 CHW approach for care of sick newborns and children District implementing CHW approach Total No. of Distt Implementing Districts % Home based newborn care20Nil0 Sick child package20C-IMNCI(9)45% Healthy child package (ECD) 20nil0 Any review of the experience nil

15 Nov 2011Regional CH Meeting, Kathmandu13 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:

15 Nov 2011Regional CH Meeting, Kathmandu14 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 cases 2.Number of pneumonia cases 3. 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 2011Regional CH Meeting, Kathmandu15 Future Plans Strengthening 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

Future plans continued Malnutrition: stunting 33%. Intervention: strengthen nutrition rehabilitation units in the hospitals.Currently only at JDWNR hospital,Thimphu Start from: Nov 2011Regional CH Meeting, Kathmandu17

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. 15 Nov 2011Regional CH Meeting, Kathmandu18

Future plans for IMNCI Expand F-IMNCI to all hospitals. 15 Nov 2011Regional CH Meeting, Kathmandu19

THANK YOU TRASHI DELEK 15 Nov 2011Regional CH Meeting, Kathmandu20