1. Facility-based Integrated Management of Neonatal and Childhood Illness India

2. Child Health-Approach in RCH-II The IMNCI approach is the centrepiece of newborn and child health strategy in RCH II.

3. IMNCI: What Does It Offer? Assessment & classification of all children presenting to the physician Initiating treatment for all children –Counseling –Initiate Drug treatment –Pre-referral treatment and referral advice for serious conditions –Management where referral is not possible

4. IMNCI: What it does not offer? Management of serious sick child: severe pneumonia, severe febrile illness, severe malnutrition, severe persistent diarrhoea, sick young infant with sepsis Severe Jaundice Care at Birth for all newborns Management of Birth asphyxia Emergency Triage & Assessment

5. Evaluation: Facility based Care MANAGEMENT OF Newborn (Health system & skill issue) Care at birth weak Non-availability of protocols Referral link to SBA for sick newborn Issues of logistics Utilization of equipments Human resources  Number  Skills  Team approach MANAGEMENT OF SICK CHILDREN Non availability of protocols Pneumonia and malnutrition emerging threats Linkages with IMNCI classifications Multi skilling of personnel, lab and Equipment supply and standards of Management

6. Core competencies IMNCIFacility based care 1Understand the IMNCI process and rationale and know how to use the IMNCI chart Care at birth 2Communicate with care-takerETAT (Emergency Triage and Treatment) 3Danger signs in children and severe signs in newborns and young infants Using essential equipment 4Main symptoms of key killer diseases in U5 (NB and CH) Essential Procedures 5Malnutrition and anaemiaManage referrals 6Immunization* and vitamin A supplementation Severe Acute malnutrition 7Infant & young child feeding

7. FACILITY CARE : Components Management Of Sick Newborns Management Of Sick Children Management Of Severe Malnutrition Care at Birth for newborn Principle: Avoid delay in initiating treatment. – ETAT

8. Structure of New Package IMNCI IMNCI ETAT (NB) Care at Birth Post-natal Care Sick- New Born LBW ETAT ARI Diarrhoea Fever SAM Referral Management Equipments Procedures

9. Combining the two packages AdvantageDisadvantage True integration Take care of problems of calling participants for repeated trainings (Transfers and Job profile) Addresses issues missing in IMNCI - Care at birth - Initiation of breast feeding - Inpatient management of sick young infant and sick child Addresses issues needing attention such as SAM and ETAT Longer duration of training Venue selection with stringent criteria Multiple facilitators with special skills Need for redesigning the training tools operationalisation issues especially where IMNCI has been rolled out

10. Unified package Duration - 11 days - 6 days for Outpatient management - 5 days for facility-based management