1. Community IMCI - Ferghana, Uzbekistan Mary E. Skarie, USAID/CAR

3. Under-five Mortality Rates in Central Asia  Uzbekistan: 69 2000 UNICEF MICS  Kazakhstan:71.4 1999 DHS  Kyrgyzstan:72.3 2000 WB ( 96.4 in lowest economic stratum)  Turkmenistan90 2000 DHS  Tajikistan126 2000 UNICEF MICS

4. Existing Uzbekistan Structures Supporting Community-Based IMCI  PHC Physician and nurse home visiting program  Community education system in place from Soviet times  Local neighborhood structure (Mahalla) provides social support network Issues Community-Based IMCI Can Address  Exclusive breastfeeding to age 6 months at only 22% (2000 UNICEF MICS)  61% of children under 3 have anemia (1996 DHS)  Lack of knowledge on prevention/home treatment/professional treatment Diarrhea ARI

5. Community Involvement Schools, Kindergartens, & Youth Centers Primary Health Care Facilities (Healthcare System) Community & Religious Leaders Health Promotion Centers NGOs & CBOs

6. Community IMCI Activities 1.Health campaigns –anemia & general nutrition (target: general nutrition) –ARI –diarrhea –IMCI danger signs (incorporated in diarrhea & ARI campaigns) –breastfeeding (upcoming) 2.Health fairs - PHC sponsored –hygiene –diarrhea –ARI –breastfeeding 3.NGO grant activities –Nabahor: improving client education by visiting nurses and midwives, including weekly bazaar event –Hilol: Mother Support Groups –Ayol Va Salomatlik: improving child health

9. Examples of Community IMCI 4.Training Health Promotion Center staff to conduct ‘community conversations’ and health events (e.g., health fairs) –anemia & general nutrition (target: women and children) –ARI –diarrhea –hygiene 5.Training SVP/SVA health workers for client education –anemia & general nutrition (target: women and children) –ARI –diarrhea –hygiene –breastfeeding

10. Examples of Community IMCI 6.School health lessons –diarrhea –ARI –hygiene –nutrition –transmission of germs/disease 7.School song competition –winner of best song: Diarrhea 8.Cassette with songbook (songs, skits, fables & poems) –hygiene –diarrhea –importance of staying healthy –healthy habits

12. Health Knowledge, Attitude, and Practice Survey This survey was conducted among the population in four locations in Uzbekistan in June 2001: 1)Quva Rayon – a mature rural site (Ferghana Oblast) 2)Ohunbabaev Rayon – a new rural site (Ferghana Oblast) 3)Margilon City – a future urban site (Ferghana Oblast) 4)SyrDarya Rayon – a future rural site (SyrDarya Oblast)

13. Survey Results: Integrated management of childhood illnesses When should a child be seen by a health care worker or taken to a health are facility: a) blood in stoolsd) high temperature b) inability of drinke) breastfeeding poorly c) cold or cough withf) continues to get sicker difficulty breathing Average number of reasons to take a child to a health care provider correctly identified. Quva Rayon = 2Ohunbabaev Rayon = 1.8 Margilon City = 1.4SyrDarya Rayon = 1.6

14. Survey Results: Knowledge about Breastfeeding

15. Future Activities for National Scale-Up Extend previous health campaigns nationally through Institute of Health Expand NGO grants program for "Healthy Communities” Extend school health curriculum nationally through Ministry of Education

16. Future Activities Oblast-wide  Conduct 2 new health campaigns per year  Train visiting nurses and midwives on improved client (child & mother) screening and health education during home visits  Pilot Mother Support Groups at community level  Promote collaboration among all organizations involved in community-based health education through Oblast Health Promotion Working Group