1. Nurses Practicing Integrated Management of Childhood Illness (IMCI) in Fiji Litia Ruban, Fiji 21st November, 2012

2. Presentation Outline 1. Objectives of IMCI 2. Introduction 3. Implementation of IMCI Component 4. Way Forward

3. Integrated Management of Childhood Illness (IMCI) Objectives  To reduce significantly global mortality and morbidity with the major causes of disease in children through an integrated approach.  To contribute to healthy growth and development of children

4. Introduction As according to UNICEF Child Mortality Report 2011, the global under-five mortality rate since 1990 has dropped 35 percent—from 88 deaths per 1,000 live births in 1990 to 57 in 2010. The rate of decline in under-five mortality has accelerated— from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010—but remains insufficient to reach MDG 4, particularly in Sub- Saharan Africa, Oceania, Caucasus and Central Asia, and Southern Asia. Only three years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by two thirds between 1990 and 2015

5. Introduction Where is Fiji NOW on the Road “To reduce Child Mortality and Morbidity by 2/3 in the Year 2015”? Fiji’s Level and Trends of Child Mortality for the Last 20 years  Source: Levels and Trends of Child Mortality, Report 2011, Estimates Developed by the UN Inter Agency Group for Child Mortality Estimation (IGME) Under five mortality rate(deaths per 1000 live births) Number of under five deaths (thousands) Infant mortality rate (deaths per 1000 live births) Number of infants deaths (thousands) Neonatal mortality rate (deaths per 1000 live births) Number of neonatal deaths (thousands) Millennium Development Goal target for 2015 Average rate of reduction (percent) 1990 201020151990 -20101990201019902010199020101990201019902010 30 17102.81025150012800

6. Introduction Comparing Fiji’s levels and trends of CMR to other Pacific Islands Source: Levels and Trends of Child Mortality, Report 2011, Estimates Developed by the UN Inter Agency Group for Child Mortality Estimation Country Under five mortality rate(deaths per 1000 live births) Number of under five deaths (thousands) Infant mortality rate (deaths per 1000 live births) Number of infants deaths (thousands) Neonatal mortality rate (deaths per 1000 live births) Number of neonatal deaths (thousands) Millennium Development Goal target for 2015 Average rate of reduction (percent) 1990201020151990 -20101990201019902010199020101990201019902010 Fiji 3017102.81025150012800 Australia 9532.92184215311 Cook Islands 2097400178009500 Marshall Islands 5126173.400402200191200 Papua New Guinea 9061301.912 6547910302345 Samoa 272091.50023170010800 Solomon 4527152.610362300181200 Tonga 251682.20021130011800 Tuvalu 5733192.700442700221400 Vanuatu 3914135.10031120016700 New Zealand 11643.01095104300

7. Introduction In terms of Child Morbidity. Fiji Child Health Review 2010

8. What has Fiji done on the Road “To reduce Child Mortality and Morbidity by 2/3 in the Year 2015”? WHO and UNICEF launched IMCI strategy in the mid – 1990s to reduce deaths from diarrhea, pneumonia, malaria, measles and malnutrition in children younger than 5 years The Ministry of Health, Fiji works in collaboration with WHO/UNICEF to strengthen the implementation of Integrated Management of Childhood Illness (IMCI).

9. Fiji Implementing IMCI Component 1. Improving case management skills of health workers - standard guidelines – upgrading case management & counselling skills -training (pre-service and in-service) - follow-up after training 2. Improving the health system to deliver IMCI - essential drug supply and management - organization of work in health facilities - management and supervision 3. Improving family and community practices

10. Implementing IMCI Components  Improving case management skills of health workers (mainly nurses)

11. IMCI Training in Fiji  National and outreach training done are mainly for the registered nurses while few were doctors and sisters. More than 1000 nurses had been trained from then till to date.  2003, the IMCI component was in cooperated into the nursing curriculum during the curriculum review  First pre service class to take this up was in 2004 and they graduated in 2007  April,2009 ICAAT training was conducted to both pre services/post services at Fiji School of Nursing.

12. Total trained per Year in the Preservice Level …… GRAD/YEARSFIJIOTHER PACIFIC ISLANDS TOTAL 20071713174 2009841094 2010975102 20111092111 20121105115 20131473150 TOTAL71828746

13. Total trained per Year in the Post Service Level …… PROGRAM2009201020112012TOTTOT FijiOPacFijiOPacFijiOPacFijiOPac Adv.Dip.Npract.10 5 PGDip.Midwifery604550 PGCert.Mental Health Nur 15 Post Basic PH15 Bach.PHNur195 TOTAL 2570 745224224

14. IMCI Components  Improving the health system to deliver IMCI

15. IMCI SET UP IN CLINICAL AREAS  ------------

16. IMCI Components  Improving family and community practices

17. Limitations  Inadequate resources  Lack of Management, Coordination andSupervisory Systems  Lack of analysis on child health data.

18. From now 2015 CHILD SURVIVAL PHC Strengthening & revitalization Maternal and Neonatal HealthCare Strengthening Health Information System Child Health- IMCI

19. Vinaka Vakalevu