ICATT (IMCI-Computerize Adaptation Training Tools) Implementation in Indonesia

ICATT implementation process Adaptation (1) Trial Socialization Adaptation (2) ToT Training (in-service) Operational Research

ICATT’s activities Organization at National, provinces and district TOT ICATT (6-8 participant/district) ICATT Training (10 PH’s, @ 2 participant, doctor and nurse) Internal evaluation meeting: januari 2010 Dissemination stake holder meeting January 2010 Guidelines and curriculum were developed in collaboration with Centre of Health Education and Training – MoH.

1. Adaptation

Adaptation (2) ICATT  IMCI training using computer Started in 2009 Adaptation in: Language Video IMCI video translated into Bahasa Indonesia Video addition Component: + Implementation of IMCI in PHC component Guidelines and curriculum

Additional Component

2. Trial In collaboration with Gadjah Mada University In 2 districts: Boyolali and Banyumas In-service setting Self-learning method: Trainee learnt ICATT at home or Health Centre Monitoring by tutor: once a week (by phone) Participant get; IMCI chart booklet, recording forms and ICATT on DVD or USB.

The Criteria for Training ICATT Many HCs have computers Not far from UGM or Jakarta Committed to implement IMCI There is a need to train staff in IMCI (staff never been trained or needing refresher training) Access to at least 1 computer with correct specifications: spare space of 2.5 Gb, color screen, audio , DVD drive or USB . Head set could be supplied. Commitment to have computer time of 3-5 hours per week for each participant,

Overall organization 3 Working groups was established at the national, provincial and district level National working group: Consist of consultants, MoH, UGM Responsible for the overall coordination incl. development of INO ICATT, documentation, monitoring- evaluation of the training. Roles and responsibilities of the different members of the working group should be clearly defined.

Provincial working group: include 1 PHO and 2 active IMCI facilitators involved in coordination, monitoring and evaluation District working group: include 1 DHO, 1 pediatrician from the District hospital and 2 active IMCI facilitators (who will be the ICATT tutors).

ICATT tutors training 3 days ICATT tutors training Involving the tutors for group A and B plus the coordinator and other selected staff from the working groups and medical/paramedical schools (nursing/midwifery) A total of 24 participants will be involved

ICATT Training (10 PH’s, @ 2 participant, doctor and nurse) Encounter 1 (1 day). Purpose of this encounter: Introduction of IMCI/ICATT Practice on how to use ICATT navigation  explain principles of Assess & Classify child 2 mos – 5 yrs, incl. clinical demonstration. Explain details of course agenda

Encounter 2 for District B Encounter 2 (1 day), in District A Conducted in District Hospital  3 – 4 weeks after encounter 1 Purpose of this encounter: assess the progress of the trainees and solve problems to ensure that the trainees understand the Assess & Classify process (including clinical session) Encounter 2 for District B Will be done by the tutors in the HCs Purpose of this encounter: same as District A

Purpose of this encounter: Encounter 3 (1 day). Will take place in a District Hospital After the trainees would have finished the course  3 - 4 weeks after the second encounter Purpose of this encounter: Assess progress Evaluate knowledge and skills by practice in out-patient clinic. Solve problems

TEST AND CERTIFICATION Preceded by follow up after training = fuat (8 weeks after third encounter) Test will be done during regular meeting in District (1.5 hours)  4 weeks after fuat Purpose of test: Evaluate the knowledge Get certificate (with credit point) if 80% passed the test Other incentives such as IMCI support materials should be considered.

Trial – Study Finding At the end of the training, 82%participants finished the 25 training units in ICATT Training method - Location % Task answer correctly by the participant – mean (range) DL – Indonesia, Banyumas 83.2 (63.3-93.3) DL – Indonesia, Boyolali 74.7 (73.3-83.3) Individual – Tanzania, Ifakara 75 (62.5-79.2) Individual – Peru 73.1 (59.4-82.8) LCD projected - Tanzania, Ifakara 76.1 (56.3-91.7) LCD projected – Tanzania, Kilosa 89.6 (79.2-95.8) LCD projected - Peru 72.8 (62.5-82.2)

Trial – Study Finding IT problems were identified: General comments : Trainees  New learning method, easy to navigate Tutor  Adaptation of ICATT software for other training will be useful IT problems were identified: Installation, transferring profile Execute ICATT from USB stick The video quality should be improved  done in 2011 (funded by USAID)

Challenges IT/ computer related problem: During adaptation: new developed software – bugs Not all IMCI facilitator can operate computer Commitment from trainees – have extra work after working hours

Next Steps Last 2011- 2012 Funded by USAID and MoH regular budget Training for: Master of trainer (National) Trainer (Province and districts – 3 provinces: DKI Jakarta, Banten and West Java) Health workers (nurse/ midwife) in selected health centre in 3 provinces Pre-service setting (DKI Jakarta)

Next Steps Operational Research Compare ICATT and the regular IMCI training Conducted in West Java Will be conducted by University of Indonesia

Thank you

SCHEMA DISTANCE TRAINING IMPLEMENTATION of ICATT FOR PHC HEALTH WORKERS Self learning (introduction IMCI 2-59 month & assestment) Clinical practice Self learning (ICAATT) Clinical practice 3 weeks 4-5 weeks 4 – 8 weeks Monitoring pasca training 1 day 1 day 1 day 1st Meeting in District Introduction IMCI & ICATT Install & Navigation ICATT Patient Demonstration Planning & Scheduling Training 3rd Meeting in District Progress review, Problem Solving , Feed Back Practice with patient Post Test Field visit tutor to PHC CERTIFICATE 2nd Meeting in District Progress review , Problem Soving, Feed Back Practice with patient (Assestment & Classification) Note : After 3rd meeting, PHC will implementation IMCI

31 of 38 (82%) participant finished 25 unit training at the end training the mean of correct answer 23.5 di Banyumas 20.3 di Boyolali The participant interest  28% of participant doing excercise more after ecounter 1 Number of case done by every participant 9 – 69!, compare IMCI training konventional 8 – 12 case

The frekwensi ICATT session & by participant Boyolali (Mean dan rata-rata) Banyumas How many times the participant learn ICATT by them self after Ecounter 1 6.5 (3-16) 8.5 (6-11) How many times the participant learn ICATT by them self after Ecounter 2 9.8 (5-19) 10.2 (4-24) Total 16.3 18.7

Individual Praktic Clinics Boyolali (Mean dan rata-rata) Banyumas Amount of Clinis session by participant after encounter 1 7.2 (2-16) 6.1 (2-11) Amount of Clinis session by participant after encounter 2 9.9 (2-16) 8.2 (4-14) Total 17.1 14.3