Experiences with introduction of the IMNCI register for

Experiences with introduction of the IMNCI register for managing sick children aged less than 5 yearsin Zimbabwe Improving Routine Data for Child Health in National Health Information Systems: Africa Regional Workshop Johannesburg, South Africa 19 -22 September 2017 Presented by: Leocadia Mangwanya – USAID/MCHIP Project Dr Mkhokheli Ngwenya – Ministry of Health

Presentation Outline § Technical aspects of IMNCI § What is IMNCI and what were the gaps § Process of Development § Adoption of the quality checks § QI Performance dashboard § Lessons learnt § IMNCI Indicators/data elements for 0 -2 months and 2 -59 months IMNCI registers

Technical aspects of IMNCI and identified gaps § IMCI is a WHO and UNICEF integrated approach to child health that also focuses on holistic management of a sick child § Adopted by Zimbabwe in the year 2000 and rolled out nationally § With MCHIP support, Mo. HCC integrated the newborn component into IMCI IMNCI in 2012 § Gaps § Documentation of children seeking health care services not standardized; § Difficult to assess quality of care by supervisors

The IMNCI Register (Assess, Classify and Treat tool) Before adoption by Mo. HCC

Process of Development of IMNCI register • USAID/MCHIP supported Mo. HCC to develop a tool to standardise documentation • Tool was pilot tested using a before –after intervention in two districts in Manicaland to: – evaluate the impact of the IMNCI register – Assess usefulness of tool during supportive supervision – Evaluate user friendliness

IMNCI register pilot findings § 90% of HWs agreed that the IMNCI register was useful and user friendly: § Well organized § Comprehensive § The information flow was good

IMNCI tool pilot findings “This tool helps me to coach student nurses seconded to Biriiri Rural Hospital. It also helps HWs at m hospital to manage the child holistically, even those not trained in IMNCI” – SIC Elizabeth Tinofa, Biriiri Rural Hospital, August 2013

IMNCI tool pilot findings “The IMNCI tool has immensely helped us in the management of sick children below the age of 5 years. All one has to do is follow the columns in the tool to make sure you give the ultimate treatment to the child”

Adoption of the IMNCI register § Findings of the pilot were used for advocacy through the national Mo. HCC level Child Survival (CS) TWG meetings § Mo. HCC and partners adopted the tool for national use and name was changed from TOOL to REGISTER § Resources for mass printing of the register were leveraged through the CS TWG platform.

IMNCI Register § After adoption by Mo. HCC

Lessons learnt • The IMNCI tool is a multi-purpose tool useful as: – a register – an On-the-job training tool – a data capturing tool – a job aid – a continuous QI tool – supportive supervision tool • Makes adherence to IMNCI protocol easy • 90% of Health Care Workers stated that the register was indeed user friendly • Significant improvement in IMNCI quality performance scores in the province after introduction of tool from a baseline average of 34% in 2014 to 72% in 2017.

District Buhera Chimani Chipinge Makoni Mutare Mutasa Nyanga Overall Health Facility Birchenough Bridge Buhera Rural Hosp Murambinda Muzokomba RHC Nyashanu RHC Biriiri Rural Hosp Chimani Hosp Mutambara Nyanyadzi Rusitu Chibuwe RHC Chipinge D. H. Mt Selinda St Peters Checheche Tanganda RHC Headlands RHC Makoni Rural Hosp Nedewedzo Rusape D. H. Weya Rural Hosp Marange Rural Mutare Provincial Odzi Rural Hosp Sakubva Polyclinic St Andrews Bonda Mission Hauna D. H. Old Mutare St Peters Mandeya Zindi RHC Avilla Mission Elim Mission Mt Mellery Nyanga D. H. Regina Coeli Baseline Jun-14 5. 00% 18. 40% 3. 10% 43. 60% 11. 90% 86. 70% 64. 00% 28. 40% 61. 10% 82. 90% 18. 30% 64. 40% 29. 80% 23. 70% 45. 20% 26. 30% 28. 80% 57. 10% 16. 20% 48. 80% 43. 50% 7. 10% 83. 80% 74. 40% 46. 70% 16. 80% 6. 60% 2. 50% 6. 50% 13. 10% 52. 30% 13. 30% 11. 40% 29. 30% 21. 10% 34. 10% IMNCI 2 nd Mar 16 63. 40% 58. 60% 28. 00% 67. 40% 60. 70% 88. 90% 72. 90% 93. 50% 90. 20% 76. 30% 71. 70% 93. 30% 92. 40% 89. 80% 85. 90% 30. 70% 66. 70% no data 63. 20% no data 64. 70% 31. 20% 76. 20% 94. 80% 57. 70% 79. 20% 72. 00% 74. 90% 66. 20% 69. 40% 91. 40% 92. 00% 81. 30% 89. 10% 85. 30% 73. 30% IMNCI 3 rd External 76% 57% 83% 89% 60% 95% 91% 83% 91% 87% 90% 95% 71% 97% 45% 89% 63% 79% 43% 80% 56% 88% 86% 40% 100% 89% 86% 94% 79% 87% 98% 100% 97% 81% 4 th Jun-17 50% 46% 67% 60% 52% 66% 57% 54% 67% 61% 81% 63% 75% 83% 80% 84% 90% 77% 89% 75% 69% 95% 87% 91% 80% 63% 55% 42% 78% 74% 95% 84% 66% 72%

Lessons learnt § Use of the IMNCI register requires minimal staff orientation and even those not formally trained in IMNCH formally can use it § Acceptance of an additional register by Ministry of Health may prove to be a challenge and may take long § Obtaining leadership commitment is key § Adoption of registers may require proof of effectiveness through a pilot study • Indicators may be used for Performance based financing

Key IMNCI Indicators/data elements The 2 -59 months Register The 0 -2 months Register § § § Very severe disease/local infection § Diarrhoea § Jaundice § Gonococcal Eye infection § HIV status § Nutrition § Immunisation Danger signs Cough Diarrhoea Fever Ear problems Nutrition and anaemia Method of feeding HIV/AIDS Immunisation Vitamin A. supplementation

THANK YOU! SIYABONGA ! TATENDA