INTEGRATED MANAGEMENT OF CHILD ILLNESS (IMCI) and COMMUNITY INTEGRATED MANAGEMENT OF CHILD ILLNESS (CIMCI)

Zoë-Life is capacitating provincial health structures in IMCI (Integrated Management of Child Illness) and CIMCI (Community Integrated Management of Child Illness). This paediatric health systems programme was developed by the World Health Organisation and UNICEF to improve the quality of healthcare services to children younger than five. Designed to reduce the burden and rate of child death, illness and disability, C/IMCI is regarded as one of the most cost-effective health interventions for achieving this in under-resourced populations.

• In homes and communities, awareness of a sick child's precise vulnerabilities and needs helps families and neighbourhoods to give the correct care, improve household nutrition, and take precautions to prevent infection.

Zoë-Life seeks to enhance community-based care of children by training Community Health-workers on the CIMCI model's 16 key family practices. Our consultant Chris Gibson, a Professional Nurse specialising in CIMCI, equips all Zoë-Life's staff in the model, and a selected team will provide training on it for Community Health-workers.
Our Resource Developers are creating CIMCI resources to complete the package, and Community Health-workers can then empower community members to apply the 16 practices within their homes and community care centres.

• Identifying childhood illnesses accurately at health facilities is highly beneficial because it ensures appropriate combined treatment, effective counselling of caregivers, and streamlined referral of very ill children to critical care.

The IMCI programme can be applied in any outpatient facility, and involves training primary healthcare workers to diagnose diseases and prescribe appropriate treatment at the medical centre, and to refer patients with complications to a district hospital immediately.

Knowing that most children come into clinics with more than one condition, the IMCI model adopts a holistic approach to case-management - with a special follow-up module for HIV management that encompasses antiretroviral therapy and treatment of opportunistic infections. The programme also emphasises disease prevention and follow-up care.

A core feature of the IMCI programme is a set of specific guidelines and tools to capture information while examining patients. Zoë-Life's contribution to mainstreaming IMCI across KwaZulu-Natal is to assist the provincial Department of Health (DoH) by training municipal clinic staff in the model and using the tools, and in monitoring implementation at facility level. Our core IMCI module is an 11-day training package, and our HIV module requires five days.

• To improve overall health systems, one of our specific project goals is to have the ICMI forms incorporated in all paediatric HIV clinical records. Zoë-Life's Paediatric Consultant and IMCI Facilitator, Dr Deidre Pansegrouw, was requested to assist the KZN Department of Health Paediatric Services division with upgrading all provincial hospital and clinic registers in line with IMCI protocols, and to provide an IMCI Quality Assurance tool. Through her established relationships with various key contacts in key provincial government units and NGOs, Deidre has facilitated linkages between them in order to provide co-ordinated feedback to KZN health authorities on IMCI implementation.

Another element of our IMCI programme is to produce a locally-specific training CD, using the World Health Organization's customised ICATT software to consolidate all South African national and sub-national IMCI training materials. Zoë-Life has received permission from the Department of Health to develop this tool for two levels of guidance - the first being for nurses, and the second for doctors - which will shorten the physical contact period needed for training, and make the modules more widely accessible. Nicole Davies, one of Zoë-Life's Resource Developers, will create finished graphics of the learning mind-maps for the CD.