Abstract of Dissertation

Agency : IMNCI, Training Need Assessment, Integrated Management, Neonatal and Childhood Illness

Objective : Not Available

Background : During the mid-1990s, the World Health Organization (WHO), in collaboration with UNICEF, developed a strategy known as the Integrated Management of Childhood Illness (IMCI). This strategy was expanded in India to include all neonates and was renamed as ‘Integrated Management of Neonatal and Childhood Illness (IMNCI)’. (Ref: IMNCI paper_IJP, June 2012, author-Hemant D. Shewade & et.al.) The IMNCI strategy was developed to reduce the incidence of the major preventable causes of death of under-5 children in the developing world— pneumonia, diarrhoea, malaria, measles, and malnutrition—by creating a classification system for the treatment of multiple diseases. (Ref: 08 ASHA IMNCI Rajasthan KCCI 2009- Background, author- Martin Abel & et.al.) IMNCI training is designed primarily for skill improvement pertaining to neonatal and child health issues as well as appropriate and prompt management. IMNCI training included service providers called Medical Officer, health workers called Auxiliary Nurse Midwives (ANMs) and Integrated Child Development Scheme (ICDS) workers called Anganwadi Workers (AWWs). One of the major components of this programme is to give training to the health service provider which includes clinical skill training and training in supervisory skills as the backbone of these programmes are these health service providers. The clinical skill training is based on a participatory approach combining classroom sessions with hands-on clinical sessions in both facility and community settings. Broadly, two categories of training are included, one 36 for medical officers and a second for front-line functionaries including ANMs and Anganwadi Workers (AWWs). For ASHA and link volunteers if any, a separate package consistent with IMNCI, focusing on the home care of newborn and children is in preparation keeping in mind their educational status. (Ref: IMNCI operational guidelines for implementation- section A -components) According to March 2012 report of MoHFW, IMNCI is implemented in 453 districts of India and total number of people trained up to 2012 under IMNCI are 5,37,454. Statement of Problem: A study to evaluate knowledge regarding integrated management of neonatal and childhood illness (IMNCI) among service providers. Research Questions: What are the training needs through assessing the knowledge and skills of service providers in IMNCI? Objectives: To assess the present level of knowledge and skills of service providers in different components of IMNCI.

Methodology : A descriptive cross-sectional study was conducted in Porbandar district of Gujarat state. Medical Officers, ANMs from CHC, PHC, SC and AWWs from AWC under Integrated Management of Neonatal and childhood Illness (IMNCI) were assessed in this study. Investigators noted their observations using a skill assessment checklist. Medical Officer, ANM and AWW were the sample unit of study. Sampling: 1. Sampling Technique: Non probability sampling under which purposive sampling was used for the selection of study area and study unit. Thirty percent of total sample was selected from Government Health centres at each level of that particular district. If a district contained 4 CHCs then 3 CHCs were considered for study. Same process was repeated for selection of PHCs, SCs and AWCs. 2. Sample Size: Service providers: 18 Medical Officers, 32 ANMs, 20 AWWs. 3. Selection Process: a) CHCs, PHCs, SCs and AWC were selected on the basis of distance from higher centre i.e., one centre from nearest place and others from farthest place. b) Two Medical officers, one ANM and One AWW were selected from each selected CHC, PHC, SC and AWC. Tools and Techniques for data collection: Research Plan The research consists of a research plan and a predefined schedule. The research plan consisted of following steps. 1. Data Sources: Primary Research: A separate semi structured Questionnaire was designed for the medical officer, ANM, AWW at CHC, PHC, SC and AWC. 2. Research Approaches: Survey Methods: The Quantitative type of survey was done by visiting Community health centre, Primary health centre, Sub centre and Anganwadi centre. A separate semi structured questionnaire (Quantitative) was prepared for interview of Medical officers ANMs and AWWs. Face to face type of interview was taken to assess the training needs of service providers in IMNCI

Findings : This health survey was conducted in Porbandar district of Gujarat state where 18 Medical officers, 32 ANM, and 20 AWW had been interviewed by investigators. Out of these service providers maximum number had work experience below 10 years and sixty seven percent of service providers had taken 8 days IMNCI training. Among the interviewed service providers of Porbandar district, eighty percent service providers had enough knowledge about the universal immunization schedule and breast feeding and complementary feeding practices in under five children. Albeit of functioning of VCNC and IMNCI training given to the service providers, they didn’t have complete knowledge about methods used to check the nourishment level of under five children especially AWW. Only six percent of medical officers had complete knowledge about the treatment of childhood illnesses. Conclusion: IMNCI trained workers especially Medical Officer and ANM performed well in all aspects of Immunization, Nutritional Supplements, and Breast feeding Practices. Medical officer’s performance regarding diagnosis of childhood illnesses is good but in the treatment of these childhood illnesses it is poor. Almost all service providers including MO, ANM and AWW had enough theoretical knowledge about the different 37 components of IMNCI but there is need to transfer this theoretical knowledge in practical way and implement it at the grass route level.

Recommendations : An Informed consent was taken from service providers before start of an interview. Investigators also informed that whatever information they would be giving during interview would be taken as confidential.