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

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

3. ICATT’s activities Organization at National, provinces and district
TOT ICATT (6-8 participant/district)
ICATT Training (10 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.

4. 1. Adaptation

5. 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

6. Additional Component

7. 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.

8. 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,

9. 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.

10. 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).

11. 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

12. 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

13. 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

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

15. 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.

16. 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 ( )
DL – Indonesia, Boyolali
74.7 ( )
Individual – Tanzania, Ifakara
75 ( )
Individual – Peru
73.1 ( )
LCD projected - Tanzania, Ifakara
76.1 ( )
LCD projected – Tanzania, Kilosa
89.6 ( )
LCD projected - Peru
72.8 ( )

17. 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)

18. 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

19. 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)

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

21. Thank you

22. 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

23. 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

24. 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

25. 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