Household/Communitiy - IMCI PVOs Developing a Framework

The C/IMCI Timeline: 1992 WHO/UNICEF LAUNCHES IMCI Early efforts focus on Health worker skills and system improvements Santo Domingo Meeting recog. Importance of HH/C-IMCI Sept. 97’ Oct. 97’ UNICEF Meetings with PVO particip produces mandate for HH/C IMCI IAWG estab with UNICEF leadership to develop HH/C- IMCI guidelines Feb. 98’ CORE Working Group on IMCI formed CORE Mtg. at PAHO acknowledging role of PVOs in advancing HH/C IMCI Feb. 99’ Durban Mtg consensus on 16 key practices and role of HH/C IMCI in promoting them Jun. 00’

Reaching Communities for Child Health: Advancing PVO/NGO Technical Capacity and Leadership for Household and Community Integrated Management of Childhood Illness (HH/C IMCI) Baltimore, Maryland January 17-19, 2001 BASICS II CSTS

The CORE Group: Child Survival Collaboration and Resources Group

The CORE Group Conceived in September 1996 by PVOs at annual meeting Established June 1997 with financial support from USAID Board elected April 1998 Legal entity: In progress

The CORE Group Composed of 37 international NGOs who have been awarded USAID Child Survival Grants over the past 16 years Over 80 grants serving over 250 million children and women of child-bearing age Presence in over 140 countries Collectively serve over 600 million beneficiaries

The CORE Group Combined revenues of over US $2 billion/year Rely on indigenous staff & leadership Demonstrated capacity to deliver services, training & technical assistance to the poor Contribute to development through empowerment, capacity building, service delivery and innovation

The Workshop Goal: To e nhance the capacity of CORE PVOs to take g reater l eadership in the d evelopment and i mplementation of n ational and d istrict h ousehold and c ommunity IMCI (HH/C IMCI) Programs Desired Workshop Outcomes:  Clear understanding of the PVO/NGO role in the development and implementation of HH/C IMCI Programs,  Increased understanding and application of lessons learned, better practices, and approaches that can be used in HH/C IMCI programming,  Increased understanding of processes that will enhance PVO/NGO leadership roles in HH/C IMCI at national, district, and community levels,  HH/C IMCI implementation options tool that is related to ongoing PVO/NGO activities.

“The driving force of the workshop, and one of its most promising outcomes, was the evolution of a consensus that articulates a clear vision and dynamic framework for community IMCI. It provides PVOs with a clear structure for assessing programs, for future programming, and for advocating for resources necessary to fully operationalize C-IMCI.”

The participants were equipped with… 1.Their vast experience and knowledge they brought with them examples of successful community-based approaches to child helath by 8 different organizations in 10 different countries around the world. 3.A draft framework policy paper developed by CSTS and BASICS : ‘Community-based Approaches to Child Health’.

The CSTS/BASICS Policy Paper was helpful in laying out 4 ‘Options’ that PVOs have used to improve child health… 1.CLOSER LINKS BETWEEN HEALTH FACILITIES AND THE COMMUNITIES THEY SERVE 2.IMPROVED CARE OUTSIDE OF HEALTH FACILITIES 3.INTEGRATED PROMOTION OF KEY FAMILY PRACTICES CRITICAL FOR CHILD HEALTH AND NUTRITION 4.MULTI-SECTORAL APPROACH TO CHILD HEALTH AND DEVELOPMENT

A key objective of the workshop was to reach consensus on revision and use of the framework to put forward a concise but clear proposal for HH/C IMCI. In doing so the following questions were important to consider 1.How will HH/C IMCI be different than what we are doing now? 2.What will be the relationship between the HH/C IMCI and the other two components? 3.What will be the PVO role in promoting the new framework?

DEFINING A HH/C-IMCI FRAMWORK… “HOUSEHOLD AND COMMUNITY ‘INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES’ IS A METHODOLOGY THAT OPTIMIZES A MULTISECTORAL PLATFORM FOR CHILD HEALTH AND NUTRITION THAT INCLUDES THREE LINKED REQUISITE ELEMENTS”

The 3 Linked Elements Element #1: Partnerships between health facilities and the communities they serve Element #2: Appropriate & accessible care & information from community-based providers Element #3: Integrated Promotion of Key Family Practices critical for child health & nutrition

Why “elements”? “Components” – No: Term already used for the three components of IMCI “Options” – No: Want to explain that all are integral parts of HH/C-IMCI “Definitions” – No: Suggests lack of flexibility in implementation

The Multi-Sectoral Platform (MSP) for Child Health and Nutrition

Multi-Sectoral Platform (MSP) Multisectoral approach similar to Comprehensive Primary Health Care: Water and Sanitation Education Agriculture Income generation Social/Political sector Capacity building etc.

The multi-sectoral platform that must be optimized for HH/C IMCI to be supported and sustained

Principles of HH/C-IMCI HH/C IMCI PRINCIPLES  HH/C IMCI can be implemented at a national, district and/or community level, as appropriate  HH/C IMCI can be implemented with or without components #1 and #2 (Systems or Facility IMCI) as feasible  Elements are requisite for HH/C IMCI (except element #1 if facilities are inaccessible)  HH/C IMCI can be implemented by multiple actors or by a single organization  HH/C IMCI recognizes the importance of curative and preventive interventions in the community for reducing child morbidity and mortality  Phased introduction of promotion of key family practices is acceptable  Phasing of elements is acceptable Formulated by workshop participants

Next Steps The Framework A small working group reviews and refines proposed HH/C-IMCI framework within next two months – by mid-March (CORE, BASICS, CSTS) CORE presents framework to the IMCI IAWG in early February for review, comment and endorsement. Revised framework is sent to all participants in late March for comment and review. Small working group revises framework based on input by May Finalized framework is presented and disseminated at CORE annual May meeting

Next Steps The Workshop Report Workshop report will be disseminated at CORE annual meeting in May including the revised framework Preface of the report will be a open proposal to donor community and partners to enable PVOs to implement and test the proposed HH/C-IMCI framework

Next Steps CORE At the CORE annual meeting in May, each PVO that is interested proposes a plan to use and test the HH/C-IMCI framework Plan is developed at the meeting for the review, within one year of the application of the HH/C-IMCI framework, as used by PVOs at country, district and community levels CORE uses framework, definition and principles to develop short policy paper and advocacy tool