Progress in Implementation of Child Health Programme

15 Nov 2011 Regional CH Meeting, Kathmandu 1

Meeting of South-East Asia Regional Programme Managers on Child Health,

Kathmandu, 15 – 18 Nov 2011

Progress in Implementation of Child Health Programme

Country: Sri LankaDr. Neil Thalagala (MBBS,MSc,MD)

Programme Manager Early Child Developement & Special Needs

Family Health Bureau, Ministry of Health

15 Nov 2011 Regional CH Meeting, Kathmandu 2

Sri Lankan Child Health Program

Tertiary Care Hospitals (curative)

Secondary care hospitals(curative)

PHC

PreventivePrimary care hospitals (Curative)

National Child Health program (Design, M&E @ Central )

Community based care (Implementation)

LRH (1)

TH(16),PH (12),BH (44)Total 72

DH (161)PU (95)RH(182)CD&MH(59)CD(441)Total 938

MOH teams(329)

DISTRICT COORDINATORS

MOMCH (25) 329 divisions

Sri Lankan Child Health System

25 Administrative

District

329 Health Districts

(MOH AREAS )

FURTHER DIVIDED IN

TO 6690 PHM AREAS

Welfare System in a MOH District

Households

Primary care hospital

MOH Office

Field clinics

Secondary care

Tertiary care hospitals

POPULATION 60000- 150000

Pre-schools/schools

PHM AREA

FOR 3000 PEOPLE

EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS

IN THE COUNTRY

1000-3000 births year 5000 to 15000 Under 5 children

MOH (1-2)

PHNS (2) SPHI (1)

SPHM (2)

PHMS(15-25) PHIS (10-15)

Welfare System in a MOH District

Households

Primary care hospital

MOH Office

Field clinics

Secondary care

Tertiary care hospitals

POPULATION 60000- 150000

Pre-schools/schools

PHM AREA

FOR 3000 PEOPLE

EACH MOH AREA IS DIVIDED IN TO SEVERAL PHM AREAS 6690 PHM AREAS

IN THE COUNTRY

Secondary//Tertiary care Hospitals

15 Nov 2011 Regional CH Meeting, Kathmandu 6

15 Nov 2011 Regional CH Meeting, Kathmandu 7

Nuwara Eliya, Hatton 376878 Badulla 161269Rathnapura 102384 Kandy 92869Galle 17257Total 806128

806128 18,797,252

4.29%

Under estate health programPHDT

ESTATE SECTOR POPULATION

15 Nov 2011 Regional CH Meeting, Kathmandu 8SPR

Epidemiology / burden of childhood diseases:19

92

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

0

5

10

15

20

2522.5

20.2 20.5 20.020.9

21.8

17.916.8 16.3

15.213.7 13.5

12.6

19.0

12.010.4

Year

Rat

e

15 Nov 2011 Regional CH Meeting, Kathmandu 9

• Under 5 mortality 1992-2007

Epidemiology / burden of childhood diseases:

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1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 20100

20

40

60

80

100

120

140

160

140

82.3

72.4

57 53.247.5 45.1

34.4

24.219.3 16.5 13.3 10.1 8.4

75.5

49.2 45.3

34.2 33.3 29.7 2722.7

16.2 12.8 12.5 9.2 7.4 5.9

53.959.8 62.6 60 62.6 62.5 59.9

65.9 66.9 66.375.8

69.273.2 70.2

IMRNMR% NN deaths

Under 5 mortality =10.4

15 Nov 2011 Regional CH Meeting, Kathmandu 11

Epidemiology / burden of childhood diseases:

LBW

15 Nov 2011 Regional CH Meeting, Kathmandu 12

1993 2000 2007 2008 2009 2010 20110

2

4

6

8

10

12

14

16

18

2018.7

16.7 16.6

13.513

13.712.7

13.9

DHSH509%

15 Nov 2011 Regional CH Meeting, Kathmandu 13

Epidemiology / burden of childhood diseases:

Causes of IMR 2009 % IUGR, Prematurity and LBW 609 21.7 Congenital malformations 507 18.1 Birth asphyxia / Intrauterine hypoxia 443 15.8 Other Perinatal causes 417 14.9 Septicaemia / Meningitis 227 8.1 Pneumonia 138 4.9 Other respiratory disease 37 1.3 Malignancies 13 0.5 Diarrhoea and Gastroenteritis 2 0.1 Other / Un specified 412 14.7 Total 2805 100.0

IMCI Implementation

• IMCI WAS NOT ADAPTED AS A GENERIC PACKAGE

• LIMITED APPLICATION • DEVELOPMENTOF STANDARD

GUIDELINES FOR MANAGING COMON ILLNESSES

• TRAINNED ONLY Estate Medical Assistants

15

Newborn health • ENCC Course adapted: Year 2007• Other training courses:

– Neonatal Advanced Life Support Course (One day)

– Breastfeeding Promotion and Support in a Baby Friendly Hospital A 20 hour course for maternity staff

– WHO/UNICEF 40 hour Breastfeeding Counseling Course

Newborn Health

Healthcare Providers

Total No. No. Trained %

Medical Officers including Pediatricians (60) and Obstetricians (3)

810 525 64.8

Nurses 2526 545 21.5

Midwives 2684 525 19.6

Volunteers - -

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In-Patient (Hospital) care of sick newborns and children

•NOT ADAPTED

Special need program• National Strategic plan for special need children

developed • Community based parent mediated model for

children with special needs being piloted • PHC training program was developed • PHC workers in Colombo and Puttlum district

trained• A model EDC is being established •

15 Nov 2011 Regional CH Meeting, Kathmandu 19

CFD interventions for all by parents

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24……………60 Age in months

Bi

rth c

ohor

t 37

5000

Developmental screening By parents using ECDSBy PHC workers using a developmental scale designed for Sri Lanka

Delays & Deviations

< 18 months

Non Specific Early Interventionsby parents

supervised byPHC workers Special need

interventions by parents / PHC workers / therapists jointly

Special need screening for ASD/CP etc…

> 18 months

Screening by mothers/PHC

MOH

Assessment &Follow up

Parent education

Parent counseling Early intervention

center

Home

Clinic

Pre school

Training of parents care givers on interventionFunction as a day care center Staff training

Parent mediated intervention

Case management model

15 Nov 2011 Regional CH Meeting, Kathmandu 22

CHW approach for care of sick newborns and children

District implementing CHW approach

Total No. of Distt

Implementing Districts

%

Home based newborn care

0

Sick child package 0

Healthy child package (ECD) 25 17 68

Any review of the experience Currently being done

Child Health Indicators • Neonatal Mortality Rate• Infant Mortality Rate • Perinatal Mortality Rate• Under five Mortality Rate • % Infant registered • % infants visited at home by area PHM• % infants attending CWC• Low birth weight index• % weighing• % moderate underweight• % severe underweight• % overweight • Immunization coverage

InfantPreschoolar 1-2 yrs & 3-5 yrs

15 Nov 2011 Regional CH Meeting, Kathmandu 24

Future PlansStrengthening and scale-up plans for Next 2

years • IMCI: Capacity development OPD staff/N&E• Develop national strategic plan on Child Health • Develop NSP on IYCF• Completion of adapting & systematizing of SPR on MCH

& FP • Healthy Child (ECD) package: Being scaled up to N&E• Capacity development of health care workers on ENCC

and BFHI and LM• Evaluation of impact of ENCC training• Quality assurance system for newborn care introduced

15 Nov 2011 Regional CH Meeting, Kathmandu 25

Future PlansStrengthening and scale-up plans for Next 2

years

• Scaling up of NSP on special needs

• Develop and implement a Surveillance system

on child mortality and establishment of a child death review system

15 Nov 2011 Regional CH Meeting, Kathmandu 26