Integrated Management of

Neonatal & Childhood Illnesses

(IMNCI)

State Institute of Health and Family Welfare, Jaipur

 Introduction

 WHO/UNICEF have developed a new approach

to tackling the major diseases of early childhood
called the Integrated Management of Childhood
Illnesses (IMCI)

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Developments Related to Child Health
 1978: EPI
 1984: UIP
 1985: Oral Rehydration Therapy1
 1990: UIP and ORT universalized,
ARI as a pilot in26 districts
 1992: CSSM
 1997: RCH-1
 2005: NRHM and RCH II
Ø


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 Why IMNCI


Ø Reduce infant and child mortality rates

Ø Improving child health & survival
Ø IMR reduced from 114 (1980) to 53 (2008)-
SRS bulletin
Ø Decline not uniform across states
Ø 8 states including Rajasthan are below
national average
Ø Malnutrition and low birth weight (LBW) are
contributors to the about 50% deaths
among infants and children under 5 years of
age
Ø
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 IMNCI Beneficiaries

Ø Care of Newborns and Young Infants

Ø
(infants under 2 months)
Ø Care of Infants (2 months to 5 years)


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Care of Newborns and Young Infants
(infants under 2 months)
Ø Keeping the child warm
Ø Initiation of breastfeeding immediately after
birth
Ø Counseling for exclusive breastfeeding
Ø Cord, skin and eye care
Ø Recognition of illness in newborn and
management and/or referral
Ø Immunization
Ø Home visits in the postnatal period
Ø
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•
Care of Infants (2 months to 5 years)
Ø Management of diarrhoea, acute respiratory
infections (pneumonia) malaria, measles,
acute ear infection, malnutrition and anemia
Ø Recognition of illness and at risk conditions and
management/referral
Ø Prevention and management of Iron and Vitamin
A deficiency
Ø Counseling on feeding for all children below 2
years
Ø Counseling on feeding for malnourished children
between 2 to 5 years
Ø Immunization


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IMNCI Components and
Intervention areas
Improve health Improve health Improve family &
worker skills systems community
practices

Case management District & Block Appropriate Care

standards & planning and seeking
guidelines management

Training of facility- Availability of Nutrition

based public health IMNCI drugs
care providers

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Improve health Improve health Improve family &
worker skills systems community
practices

IMNCI roles for Quality Home case

private providers improvement and management &
supervision at adherence to
health facilities – recommended
public & private treatment

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Improve health Improve health Improve family &
worker skills systems community
practices

Maintenance of Referral Community

competence pathways & services planning
among trained services & monitoring
health

Health
Information
System

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Components of IMNCI

Ø Training
Ø Effective implementation
ØImprovements to the health system
ØImprovement of Family and
Community Practices
Ø Collaboration/coordination with other
Departments

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Training


Ø IMNCI is a skill based training in both

facility and community settings
Ø Broadly, two categories of training are
included
Øfor medical officers
Øfor front-line functionaries including
ANM’s and Anganwadi Workers
(AWW’s)


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Effective implementation


Ø Improvements to the health system

ØEnsuring availability of the essential
drugs
ØImprove referral to identified referral
facility
ØReferral mechanism
ØFunctioning referral centers
ØEnsuring availability of health workers/
providers at all levels
ØEnsuring supervision and monitoring
through follow up visits

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Effective implementation


Ø Improvement of Family and Community

Practices
Ø Counseling of families and creating awareness
which includes:
ØPromoting healthy behaviors
ØIEC campaigns
ØCounseling of care givers and families
ØDuring home visits identify sickness and
focused BCC for improving newborn and
child care practices


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 Collaboration/coordination with other Departments
ØInvolvement of ANM and Anganwadi
workers of ICDS
ØInvolvement of grass-root functionaries of
other sectors
ØActive involvement of PRI, self help groups
and women’s groups


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 F-IMNCI
 From November 2009 IMNCI has been
re -baptized as F-IMNCI, (F -Facility
based management) with added
component of-
ØAsphyxia Management and
ØCare of Sick new born at facility
level, besides all other
components included under
IMNCI


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Institutional Arrangements

Ø State Level


Ø District Level


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State level Institutional Arrangements

Ø Appoint Nodal Officer

Ø Set up a co-ordination Group
Ø Review progress
Ø Arrange logistics
Ø Create pool of State level trainers
Ø Selection of priority districts
Ø Identify the State Nodal institute for training
Ø Improvement in family and community practices



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District level Institutional Arrangements

Ø Appoint District Coordinator

Ø Set up an IMNCI Coordination Group
Ø Train District Trainers.
Ø Develop a detailed plan for implementation
Ø Ensure timely supplies & logistics,
supervision and follow-up
Ø IEC activities


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 Training in IMNCI

Focus on Skill Development



Ø Hands-on training
Ø

ØVisits to hospitals
ØField visits and visits to the homes of
sick children


Ø
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 Training in IMNCI

 Training at two levels



ØIn-service training for the existing

staff


ØPre-Service Training


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Type of Personnel to be Durati Package Place of
Training trained on to be Training
used

Clinical Medical Officer 8 daysPhysician Medical

skills and Pediatrician Package college
training /District
Hospital
Health workers 8 daysHealth District
ANMs, LHVs, Workers Hospital
Mukhya sevika Package
CDPO’s and
AWWs

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Type of Personnel to Durati Package Place of
Training be trained on to be usedTraining

Superviso Medical 2days Supervisor Medical

ry Skills Officers, y Skills college
Training Pediatricians, package /District
CDPO’s LHVs Hospital
and Mukhiya
Sevikas)

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 Training of Trainers

Ø All pediatricians in the district



Ø Selected medical officers from CHCs and

block PHCs


Ø Selected staff nurses and LHVs and CDPO’s

and Mukhiya Sevikas from ICDS

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 Number to be Trained

Ø District of average size about 1800 health staff

will need to be trained
Ø

Ø Number of the staff of other departments

should included in consultation with the
concerned district officers
Ø

Ø Staff belonging to a PHC areas may be taken

up fully before moving to another PHC area

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Training Institutions
Ø
Ø State Level


Ø District Level


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State Level Training Institutions

ØIdentify a Regional Training Centre



ØThe Departments of Pediatrics and

Preventive & Social Medicine in each
college


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District Level Training Institutions

Ø District hospital for training of medical

officers


Ø CHCs/operational FRUs etc for training

of health workers
•

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 Follow-up Training (FUT)

 The Follow-up Training is designed to improve

supportive supervision for 2 days which may
either be clubbed with Clinical skills training or
conducted within 6-8 weeks of the initial Clinical
skills training

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 Pre-Service Training


Ø Pre-service training in medical colleges

include training of undergraduate students
and interns
Ø ANM, AWW, and Staff Nurses’ training
schools need to include IMNCI in their
training schedules

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 Funding Arrangements
Ø National Level training: by the Government of
India
Ø State Level training: State project funding
requirements for the following in NRHM/RCH-
II-PIPs
Ø District Level training: State project funding
requirements for the following in NRHM/RCH-
II-PIPs
Ø At District Training Cell (in the District
Hospital)
Ø At other Training Centres within the
District (Maximum two in identified
CHCs/PHCs)
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 Funding Arrangements

Ø Translation, printing and supply of

training material


Ø Field-level Monitoring Support, Follow up

and Coordination


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Navjat Shishu Suraksha Karykram
(NSSK)
 Launched on September 15, 2009. Focuses

on:


ØPrevention of Hypothermia
ØPrevention of Infection
Ø

ØEarly initiation of Breast feeding and

Ø

ØBasic Newborn Resuscitation



•
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 Objectives: NSSK

Ø One trained person at institutional facility,

where deliveries take place


Ø NSSK will train healthcare providers at the

district hospitals, community health
centres and primary health
•

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 Limitations of IMNCI

Ø Outpatient Facility Based



Ø Community activities not given adequate

focus


Ø Training centre of attention



Ø Vertical initiatives in Non IMNCI districts

sorely lacking


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 

 Thank you