1. The courage to make every life count Murwa Bhatti Program Manager, Maternal & Child Health Program, IRD Oct 14, 2015 @ HANIF meeting, Nathiagali

2. electronic Integrated Management of Childhood Illnesses (eIMCI) Geographical Scope: Muzaffargarh District Priority Area: Nutrition Start Date: April 15, 2015 End Date: December 15, 2015

3. Global Under 5 mortality Country% of U5 Mortality Burden U5 Mortality Rate per 1000 live births India22.361 Nigeria11.3128 Congo6.199 Pakistan5.672 China4.115 Ethiopia3.677 Sources: United Nations Interagency Group on Child Mortality Estimation (Report 2012) Liu L. et al. Lancet. 2012

4. Background: Under 5 Children Health Source: DHS, Nigeria 2013 Two-thirds of child deaths are from preventable or treatable infectious diseases Malaria Pneumonia Diarrhea Sepsis/meningitis Measles Malnutrition

5. Integrated Management of Childhood Illness (IMCI) Aims: WHO & UNICEF started developing strategy in 1992 Strengthening primary health Identification of true cases Rationalizing use of drugs Reducing hospitalization

6. Reduce: Death, Illness & Disability

7. Promote: Improved Growth & Development

8. IMCI implementation in Pakistan Currently deployed in more than 80% of 135 districts across Pakistan – Within district coverage limited to few health facilities – Lack of adherence by community workers Adopted by Pakistan in 1998 In 2000 - Launched in 2 Punjab districts

9. Challenges in Implementation 1234 Low training coverage

10. Challenges in Implementation 2134 Inadequate training

11. Challenges in Implementation 2134 Complex modules and algorithms

12. Challenges in Implementation 3124 Lack of adherence to protocol

13. Sick children not properly assessed and treated Parents poorly advised Weak referral mechanism between community and healthcare facility Inability to reduce morbidity and mortality Poor Implementation leads to…

14. Overall Goal Reduce child mortality in an outreach setting to prevent and improve the management of common, and potentially life threatening illnesses in children using a mobile health platform

15. Focus population: low-socio economic class by selecting a district with the very poor indicators through a effectively proven service delivery structure of LHW program Build upon the existing infrastructure of the LHW network to proactively identify and link children and parents to appropriate care Support the existing healthcare system through LHW capacity building and strengthening the referral network

16. Through the eIMCI program progress will be directly measured through: Increase in referrals to target community BHUs and hospitals Increase in community based care

17. All < 5 year olds Inclusion of Dengue, UTI & TB Direct enrollment in interactive reminders program Direct cellular communication with CHWs eIMCI Local Adaptations

18. Improved monitoring in real time, at scale 01 02 03 04 05 Clinical Decision Support System – with screening algorithms to gather patient data and reduce human error Decreased dependency on quality of training, health workers and supervision Better implementation of IMCI protocol Increased screening speed and reduced waiting time Benefits of electronic-IMCI

19. eIMCI Application

20. Implementation Challenges Availability of LHWs for 11 consecutive days for training is difficult since they spend 9 days a month on polio campaigns Geographic connectivity and flood warnings High cost of a 11 day training Coordination with Punjab Information Technology Board (PITB)

21. CORRECT Attributes C : Credible WHO recommended guidelines O: Observable Real Time data reporting and results R: Relevant Refines an LHWs ability to identify and manage an illness R: Relative Advantage Innovation in technology E: Easy to install and understandable Easy-to-use smartphone application C: Compatible Facilitates daily duties of end users (LHWs) T: Testable Pilot followed by implementation

22. Key Stakeholders LHW teams EPI Indus Hospital Local Community Provincial and District Health Departments Other National Programs

23. eIMCI Scale up plan

24. International Expansion

25. END