Pneumonia and diarrhoea are two of the leading causes of mortality among children under 5 years in India accounting for 14% and 10% of deaths respectively. In Uttar Pradesh, with a high under five mortality rate, this likely represents a large number of deaths which could be prevented with implementation of known interventions for the treatment of pneumonia and diarrhoea. These interventions are key components of the Global Action Plan for Pneumonia and Diarrhoea (P&D) which provides strategies for protecting, preventing and treating pneumonia and diarrhoea.
PNEUMONIA & DIARRHOEA PROJECT
The Pneumonia and Diarrhoea (P & D) Project of the IHAT UP- TSU intends to reduce under 5 mortality in Uttar Pradesh through improving the quality of community level and primary facility level management of childhood pneumonia and diarrhoea.
It is currently being implemented in 3 districts – Allahabad, Bareilly and Gonda of Uttar Pradesh.
- Improved treatment and referral of childhood pneumonia and diarrhoea by public frontline workers (FLWs) resulting in a decreased case fatality rate.
The IHAT UP TSU is supporting the public FLWs (ASHAs, ANMs, and AWWs) to improve the quantity and quality of their interactions with the households. The TSU is ensuring
provision of job aids and methods to improve outreach planning, the quality of home visits, identification of newborn and childhood illnesses and the linking of the community with available services.
On-site mentoring of the FLWs is provided through a network of 3 community resource persons per TSU focused block. The TSU has designed and is implementing the use of the Enumeration and Tracking Tool (ETT) among ASHAs that acts as a job
aid to map the number of children in their areas and also to create action plans to ensure mothers receive essential counseling on newborn and childhood
health and danger signs to ensure children receive essential health services as per government guidelines and to ensure that unwell children are treated
by the appropriate level of care
- Improved treatment and referral of childhood pneumonia and diarrhoea by private frontline workers (FLWs) resulting in a decreased case fatality rate.
IHAT TSU strategically identify and engage with high-volume private FLWs who are a first level of contact for households seeking treatment for childhood pneumonia and diarrhoea. Ongoing supportive supervision, concurrent monitoring of data and the development of innovative incentive programs in conjunction with the GoUP is conducted to ensure a sustainable model of quality care provided in the community by private FLWs to children under five with pneumonia and diarrheal disease
- Improved treatment and referral of childhood pneumonia and diarrhoea by Block facility staff resulting in a decreased case fatality rate
The IHAT TSU engages with the nurse mentors in blocks as well as the Medical Officers in Charge (MOICs) and additionally provide capacity management support at the district level. Referral systems are also being improved at the Block level facilities
for those children requiring tertiary support for management of severe pneumonia and diarrhoea. The number of children managed at the block level facilities as well as their disease severity and demographic characteristics are tracked in order to determine how these facilities are being used and what gaps remain in the appropriate referral and management of children with pneumonia and diarrhea at block level facilities.
Project Strategies & Highlights
- Implementing community case management of pneumonia and diarrhoea by public front line health workers though case-focused training and supportive supervision.
- The P & D project facilitated in release of multi-stakeholder guidelines by government for the community based management of pneumonia and diarrhoea in UP.
- The project improved the assessment of children for pneumonia and diarrhoea by frontline workers. In June 2016, frontline workers reported assessing 7411 children with diarrhoea and 668 children with pneumonia. This represents 9% and 8% of the estimated cases, respectively, in the intervention areas. In the baseline survey however, no children had sought care with frontline workers for pneumonia or diarrhoea.
- Developed elaborative, pictorial, and easy-to-understand training modules for frontline workers. Accordingly, the team executed trainings of ASHAs and ANMs visits in P&D recognition and referral practices. Trainings were conducted at cluster-level and during individual home-based in all 15 blocks of 3 focus districts.
- Improving the supply chain for key pneumonia and diarrhoea drugs by working closely with government partners.
- Amoxicillin 250 mg DT (dispersible tablet) is now on the essential drug list, a rate contract is issued and procurement and distribution to districts and blocks has started.
- The Project has facilitated improvements in (a) the consistent availability of supplies of Oral Rehydration Solution (ORS) and Zinc, and (b) the availability of supplies of amoxicillin. These drugs are important for ensuring the effective management of P&D cases at the community level. These efforts have resulted in in 87% and 78% of ASHAs having adequate supplies of ORS and Zinc at present.
- Strengthening of Community Health Centres (CHCs) for the provision of child health services using regular monitoring and supportive supervision.
A.Oral Rehydration Solution (ORS) and Zinc corners are now functioning well in at least 1/3 of intervention CHCs. In Bhamora CHC, >40 children completed plan B for diarrhoea with some dehydration in August 2016.
B. From 0%, now 33% of intervention CHCs have essential drugs and supplies, 73% have essential infrastructure and 67% provide essential child health services.
C. The project has also supported in training and capacity building of doctors on management of childhood illnesses. As part of the project, the number of medical doctors trained in F-IMNCI (Facility-based Integrated Management of Neonatal and Childhood Illness) has increased from 11% to 36%.