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Academic Consultation on Pre-service Training in Child Health, Penang, Malaysia, 8-12 July 2002 : report

December 31, 2002 World Health Organization

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(WP)/CHDIICP/CHD/3.1/001-E

Report series number: RS/2002/GE/13(MAA)

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REPORT ACADEMIC CONSULTATION ON PRE-SERVICE TRAINING IN CHILD HEALTH

Convened by: WORLD HEALTII ORGANIZATION REGIONAL OFFICE FOR TIlE WESTERN PACIFIC Penang, Malaysia 8 - 12 July 2002

WHO/WPRO LIJ3RARY MANILA. PHILIPPINES

2 1 oel 2004 Not for sale Printed and distributed by: W orId Health Organization Regional Office for the Western Pacific Manila, Philippines July 2002

NOTE

The views expressed in this report are those of the participants in the Academic Consultation on Pre-service Training in Child Health and do not necessarily reflect the policies of the Organization.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Academic Consultation on Pre-service Training in Child Health, held in Penang, Malaysia, from 8 to 12 July 2002.

CONTENTS

SUMMARY ......................................................................................................................... . 1. INTRODUCTION ....... ...... ........................... ........... ...................... ............................... ......... 1.1

3 3 3

1.2 1.3 1.4 2.

Objectives .................................................................................................................... Participan.ts and resource persons .............................................. ...... ...........................

~~:~z:~~~~~~y.::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Session 1: Strengthening the teaching of child health ....... ............................ ............ Session 2: Review of key competencies for child health ........................................... Session 3: Phases for strengthening teaching ............................................................. Session 4: Phase 1 - Orient and plan ..... .............. ............................ .......................... Session 5: Phase 2 - Prepare and conduct teaching ................ .......... ......................... Session 6: Phase 3 - Review and re-plan teacqing .................................................... Session 7: Phase 4 - Evaluate teaching ...................................................................... Session 8: How to move forward in strengthening the teaching of child health in the Western Pacific Region .......................................................................... Evaluation of the consultation .....................................................................................

! 4 4 6 8 9 11 14 15 16 16

PROCEEDINGS ................................................................................................................... 2.1 2.2 2.3 2.4 2.5

2.6

2.7 2.8 2.9 3.

CONCLUSIONS ................................................................................................................... 17 ANNEXES: ANNEX 1 - LIST OF TEMPORARY ADVISERS, CONSULTANT, RESOURCE PERSONS, OBSERVERS AND SECRETARIAT - PROGRAMME OF ACTIVITIES - LIST OF POSSIDLE CORE LEARNING OBJECTIVES - PLANS OF ACTION - CAMBODIA, CHINA, FUl, LAO PEOPLE'S DEMOCRATIC REPUBLIC, MALAYSIA, MONGOLIA, PHILIPPINES, PAPUA NEW GUINEA, AND VIET NAM

ANNEX 2 ANNEX 3 ANNEX 4

Keywords: Child health I Education, medical, undergraduates I Teaching I Malaysia

SUMMARY

The medical, nursing and midwifery teaching institutions have been active partners in advocating national approaches to improve child and adolescent health in the Western Pacific Region. Over the years, the faculty at these institutions have consistently worked for the incorporation of diverse public health approaches in child health to the curricula for undergraduate health professionals as a response from the teaching institutions to the evolving needs of children, adolescents and the community. . Globally, a wide body of experience has accumulated about introducing public health approaches in health sciences education. This experience triggered WHO to review thoroughly the lessons learned. A great number of schools having taken steps independently in the same direction have shared their experience with the Regional Office of the Western Pacific . During this consultation held in Penang, Malaysia from 8 to 12 July 2002, faculty members from 26 teaching institutions attended the meeting. WHO staff from Headquarters, the Western Pacific Regional Office and Country Offices participated also in the event. The objectives of the consultation were: to review the WHOlUnited Nations Children's Fund (UNICEF) Pre-Service Training (a) Planning Guide for Child Health on introducing the teaching of integrated approaches in child health; (b) to introduce participants to tools and materials developed by the Department of Child & Adolescent Health & DevelopmentIWHO for pre-service training in child health with a particular emphasis on Integrated Management of Childhood Illness (IMCI) and discuss additional materials that might be needed;

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(c) to share experiences and lessons learned and strengthen capacity in the Region for orientation, planning, implementation and monitoring of integrated approaches in child health in medical, nursing and midwifery schools; and to outline the next steps for introducing IMCI, breast-feeding counselling and (d) adolescent health and development into pre-service training in the Region. The Academic Consultation was developed into eight session topics that reflected the steps needed to strengthen the process of teaching-learning public health approaches to child health. While the different medical, nursing and midwifery schools had diverse experiences with the introduction of WHO approaches in their curricula, the Consultation provided an excellent opportunity to review and share Regional experiences, and build capacity for further strengthening of child health teaching. The last session of the workshop was dedicated to planning for the future steps in the participating institutions. The action plans were presented during a plenary.

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The participants prepared the following set of conclusions that were openly discussed and agreed upon during a plenary session: 1. The steps proposed in the WHO/UNICEF Pre-Service Training Planning Guide for Child Health are a practical, appropriate and meaningful approach for introducing, implementing and evaluating pre-service curricular activities. It can serve as a model for child health (IMCl, newborn care, infant and young child feeding and adolescent health) and also for other primary health care issues and public health priorities. The introduction of new curricular contents is best understood as a cyclical process which begins with a situational assessment and analysis of epidemiological, demographic patterns and health problems of populations or sub-populations, as compared to the existing curricula and related competencies of health professional graduates. Changes in pre-service education have to be linked with changes in health policies at all levels. Strengthening pre-service education in child and adolescent health has to go hand in hand with implementation of programmes in health services. Pre-service education is closely linked to quality service performance of health professionals. Incorporation of public health approaches in pre-service education is crucial for the strengthening and the sustainability of health programmes in the country. The consideration of cost is necessary for implementing and sustaining new teaching. The sharing of experiences and lessons learned in other countries through provision of concrete examples facilitates the understanding of the process of introducing new child health concepts into pre-service education curricula. Cooperation among institutions within a country and among countries within a region enhances the process of capacity building in neighbouring or nearby countries. The Consultation included methods (small groups, role plays, brainstorming) that provided maximum participation, sharing of experiences and information. This variety of methods can also be applied to future teaching activities to improve training methodologies. The materials and tools introduced contain a substantial body of well-presented information that is easy to use. Support from national and institutional authorities and other stakeholders is necessary to implement changes in pre-service education. To get this support, some advocacy material including success stories may be useful.

6. 7.

10.

11.

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1. INTRODUCTION

Teaching institutions in the Region have been active partners in advocating national approaches to improve child health. Since the early 1990s, considerable experience has been gained in incorporating the Control of Diarrhoeal Diseases (CDD) into the curriculum, and more recently activities have been initiated in a number of institutions in introducing Integrated Management of Childhood llIness (!MCl) and breast-feeding counseling training in the undergraduate programmes for health professionals. Based on analysis of the global experience, further work has been carried out by WHO with the involvement of all Regions, including the development of a comprehensive package for pre-service education in child health which includes a planning guide and teaching, learning and student assessment materials. Diverse experiences in teaching integrated approaches to child health from several institutions in the Region are accumulating. The time to discuss the recent developments in pre-service education of child health has come. There is also need to see how this wealth of experiences and information can be best used and implemented. The Academic Consultation on Pre-service training in Child Health, held in Penang, Malaysia, 8 to 12 July 2002, brought together key members of the academy from 12 countries in the Region to discuss the process, experiences and plans for pre-service education in child health with a particular emphasis on IMCl. It was expected that this meeting would facilitate the development of a pool of resource persons with a good understanding of the process, good knowledge of the tools and materials available, and an ability to support national efforts in strengthening child health in countries of the Region. 1.1 Objectives The objectives of the consultation were to: (a) review the WHOIUNICEF Pre-Service Training Planning Guide for Child Health on introducing the teaching of integrated approaches in child health;

(b) introduce participants to tools and materials developed by CAHlWHO for pre-service training in child health with a particular emphasis on IMCI and discuss additional materials that might be needed; (c) share experiences and lessons learned and strengthen capacity in the Region for orientation, planning, implementation and monitoring of integrated approaches in child health in medical, nursing and midwifery schools; and (d) outline the next steps for introducing IMCl, breast-feeding counselling and adolescent health and development into pre-service training in the Region. 1.2 Participants and resource persons

Faculty staff of more than 20 academic institutions from 12 countries in the Region attended the consultation as temporary advisers. Among these participants were deans, directors, principals, department heads, senior lecturers and teachers who had diverse degrees of exposure to IMCl and other WHO public health approaches. There were three observers from different teaching institutions.

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One ~onsultant and five other resource persons were invited due to their vast experience in IMCI teachmg in their respective institutions. The secretariat was composed of WHO staff, two from Headquarters, six from the Western Pacific Regional Office and two from Country Offices. The total number of attendees was 39 (see Annex 1). 1.3 Organization

The Academic Consultation was held at the City Bayview Hotel Penang, in Penang, Malaysia, from 8 to 12 July 2002. Prior to the Consultation, a two-day meeting of resource persons was held to finalize the preparations. Locally, the Penang State Health Department provided assistance with all the logistics involved. In order to review the events ofthe day and make necessary adjustments, a facilitators' meeting was held each evening. 1.4 Opening ceremony

Dr U.H. Susantha de Silva, WHO Representative to Malaysia, gave the opening speech on behalf of Dr Shigeru Omi, Regional Director, followed by Dr Azmi Bin Shapie, State Health Director of Penang, who delivered greetings and a warm welcome on behalf of the Ministry of Health of the host country.

The following Chairpersons were selected to chair the sessions at the consultation: Dr Joseph Flear, Fiji School of Medicine; Ms Verzilyn 1som, Solomon Island College of Higher Education; Dr Le Thanh Hoang, Lam Dong Secondary Medical School; Dr Paulus Ripa, University of Papua New Guinea Medical School; and Dr Carmelita Divinagracia, University of the East - Ramon Magsaysay Memorial Medical Centre. Ms Ramlah bt Taha, College of Nursing Hospital Ipoh was selected as Rapporteur. 2. PROCEEDINGS

The agenda of the Consultation can be found in Annex 2. It was divided into eight sessions covering the different phases for planning, implementing and evaluating the integrated teaching of public health approaches in child health in academic institutions. Most of the sessions included presentations, discussions and group activities that ranged from structured group work to brainstorming and role-plays. 2.1 2.1.1 Session 1: Strengthening the teaching of child health Overview of child health in the Western Pacific Region

The large Regional diversity in culture, languages, socio-economic development and health risks warrants an adaptable and flexible strategy on child survival, health and development. Regional briefs were given on the major programme areas, which are linked to each other within the life-cycle approach adopted in the Region. It is estimated that around one million children die in the Region before their fifth birthday, and the highest country-specific infant and under-five mortality rates are as high as 95 and 124 deaths per 1000 live births, respectively. As of July 2002, 12 countries in the Region have

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introduced IMCl as a major strategy in child health, and four countries have moved on to the expansion phase with increased geographical coverage of IMCI and its scope of activities. While encouraging experiences are accumulating on the implementation ofIMCI through its three components (improving skills of health professionals, strengthening health system and improving family and community practices), efforts have also started to introduce IMCI into the curricula of undergraduate health professionals. Rapid progress to this effect has taken place particularly in the medical schools in Viet Narn, Mongolia and Fiji as well as in the nursing and midwifery schools in the Philippines. A global strategy on infant and young child feeding was developed in 2001 and endorsed by the World Health Assembly in May 2002. Currently, countries in the Region are in the process of developing their national strategies on the same. Incorporation of breast feeding counselling training in the pre-service education in the secondary medical schools in Viet Nam is a good example of Regional efforts to institutionalise improved feeding practices. As an emerging priority in child health, a global strategy for neonatal health is also under development. In adolescent health and development, integration of adolescent health concepts in the preservice education curricula is one of the key areas of work. 30 key competencies in four domains have been identified, and the teaching content in 16 nursing and medical schools in 16 countries in the Region have been reviewed. The curricula integration process guidelines continue to be developed. 2.1.2 Strengthening public health approach in the teaching of child health

One of the biggest challenges in providing the best of health to children, is: "Transforming the current knowledge into action." Quantity and quality of information on the essential problems as well as the identified tools and selected interventions that could provide solutions were discussed. Data and information that helped to identify the public health priorities in child health were also presented and discussed: neonatal care, infant and young child feeding, IMCI and adolescent health and development. The key aspects in the major child health interventions were mentioned as they: focus on common serious problems; respond to the needs and demands of populations; positively impact child health and development; contribute to prevention, early diagnosis and treatment of illness at home and the health facility; promote effective use of scarce resources; and increase equity. In this context, the need to strengthen the teaching of child health was brought up as a way to: give priority and emphasis to the most frequent and serious problems in children's health; provide a link to real life situations; emphasize action-oriented and affordable interventions;

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link preventive and curative care; link different disciplines in the health sciences; and ensure sustainability of the whole process. During the discussion that followed the presentation, some comments were raised regarding the need for setting priorities for new teachings, the importance of creating links with health services and the need for students to be trained in contents related to the real life situations they will face upon graduation. It was also mentioned that it is important to ensure that teaching of health sciences should respond to the e,volving needs of children and adolescents. 2.2 2.2.1 Session 2: Review of key competencies for child health. Current status of the teaching of child health in the Region

Two groups from medical schools and two from nursing schools discussed personal and institutional experiences with the introduction of public health approaches into their teaching programmes. The different accomplishments and challenges encountered with the incorporation of control of diarrhoeal diseases, acute respiratory infections, IMCI and breast-feeding were summarized. The usefulness of creating a task force at the national level for the introduction of new teaching was discussed, with the example of IMCI introduction at nursing and midwifery schools in the Philippines where a model draft of new teaching based on the schools' needs was designed. The usefulness of addressing enhancement of child health content rather than curricular change was highlighted. Practical and logistical issues were also discussed, such as ensuring enough patients for clinical sessions, adequate equipment and supplies at the clinics, space in the rooms at the outpatient services, screening of patients for teaching purposes and quality of care at the clinics. Experience has shown that improvement of teaching should include not only training of teachers but clinical trainers as well. 2.2.2 Core learning objectives

Core learning objectives are understood as the essential knowledge, attitudes and skills that students must develop before graduation. These learning objectives should focus on preparing graduates to: provide clinical services but also to understand the distribution and frequency of common health problems, support the development of appropriate health policies and systems and support appropriate health practices among individuals, families and communities. It was proposed to divide the learning objectives by level of difficulty in basic, advanced and specialized learning objectives. After the introductory presentation the participants broke up in four working groups each one to review different core objectives for teaching and learning: newborn care, infant and young child feeding, IMCI and adolescent health and development (see Annex 3, List of Learning Objectives). The task was to assign the proposed learning objectives to the above-mentioned three levels of difficulty: basic, advanced and specialized. The participants were also asked to report on the biggest areas of agreement and disagreement on the objectives.

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At the plenary session that followed, the groups presented their work by areas: (a) Newborn care group (medical schools)

The participants of this group agreed on the classification of basic and advanced for all the following knowledge objectives: Basic: • • • • • • • • public health importance clinical management assessment skills identification of actions needed care of the newborn drugs, supplies and equipment needed national policies to protect, promote and support appropriate infant feeding supporting key practices among individuals, families and communities • Advanced: analysis and integration into daily practice of country trends, statistics and cultural factors policies needed promotion of strategies for improvement perinatal and neonatal health

• •

They also agreed that the content of teaching is directly related to the development of the health services in the country (example: patient-controlled analgesia would be a basic objective in developed countries while it would be considered advanced or specialized in another context). (b) Infant and young child feeding group (nursing and midwifery schools)

The group analysed core learning objectives in the areas of public health and management of infant and young child feeding. All public health knowledge objectives and skills were considered basic with the exception of trends and statistics that for some countries would be considered advanced for midwifery schools. All knowledge and skills learning objectives in "basic management of infant and young child feeding" were considered basic. It was also noted that defining the levels oflearning objectives are influenced by the country's professional practice requirements and the educational system. (c) IMCI group (medical schools)

The participants reviewed the objectives related to public health, basic clinical management of sick children, advanced clinical management of sick children, support of policies and practices, and support of key practices among individuals, families and communities. They agreed that most of the learning objectives were basic with the exception of management of children from high-risk groups, specially when referring to management of children with HNIAIDS which was considered to be advanced. The group disagreed on the classification of the following learning objectives: • • knowledge of causes and epidemiology of common serious conditions; knowledge about policies needed to promote and support integrated prevention and management ofrnajor childhood conditions (some members thought them to be basic because medical students need to know about the existing policies but not the policies needed); and

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•

knowledge about local organizations or persons working on child health at community level. (Some members mentioned that medical students do not need to know local resources but only need to know where to obtain the related information.)

In terms of the skills necessary to analyse and integrate into daily practice country trends and statistics, the group suggested splitting this one into two separate objectives, one for trends and statistics and another for cultural factors. They pOinted out that students need to be aware of trends, statistics and cultural factors (basic), but do not need to analyse them (advanced). The content objectives that shol\ld be added in the group's opinion are evidence-based to public health approach, for example: EPI and clinical signs like chest in-drawing. (d) Adolescent health and development group (nursing/midwifery schools)

The group considered the adolescent health and development competencies (categorized within eight domains) according to general understanding and importance of the problem or issue in countries represented. The participants had difficulties in differentiating advanced from specialized objectives and therefore made the decision to merge those two levels of competencies. The domains considered were: • • • • • • • foundational knowledge - epidemiology, needs assessment and priorities; foundational knowledge - adolescent growth and development; working with adolescents and families/professional values and socialization; psychosocial and mental healt, - adolescent behavioural problems and mental health; assessing and managing common health/medical conditions; adolescent sexuality and reproductive health, promoting adolescent healthy behaviours and lifestyles; and management of serious illness, chronic disease and disability.

The group noted that the majority of competencies were of a basic level and that most were relevant to their schools/countries. Exceptions were counselling and management of serious problems, considered advanced competencies. Participants did not reach consensus about the following competencies: to facilitate participation of adolescents in planning, implementation and evaluation of services; and to provide counselling for family and environmental risks/problems. 2.3 Session 3: Phases for strengthening teaching

(a) Overview of the phases for plarming, implementing and evaluating the teaching of integrated approaches in child health The strengthening of pre-service education is a gradual, phased process which can be divided into four different stages: orient and plan; prepare and conduct teaching; review and re-plan teaching; and evaluate. During the presentation, the objectives and the critical tasks necessary for accomplishing the phases were identified for the national government level and the teaching institution level. It was noted that the process for strengthening teaching is not a one-time activity but an ongoing, long-term process of change. The WHO Plarming Guide for pI arming, implementing and evaluating pre-service education was presented as a detailed guide to the process.

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2.4

Session 4: Phase 1 - Orient and plan

2.4.1 Orientation and planning for teaching integrated approaches in child health at national and teaching institution levels The objectives for this phase are to generate understanding, acceptance and support for strengthening teaching among national authorities, the academic community and professional associations and to create written plans of action for strengthening the teaching. The needed tasks at the two levels, national and institutional were introduced as follows: National level Teaching institutions

• • • •

•

Analyse the situation Orient national opinion leaders and decision-makers'" Create a national coordinating group Develop a national plan Assist teaching institutions to orient and plan'"

• •

Analyse the situation'" Orient decision-makers'" Create a coordinating group'" Train key planners'" Plan for the introduction of teaching'" Request endorsement of the plan

• • •

*critical tasks

•

The different tasks were discussed in detail, illustrating the discussion with the Philippines case study where all the necessary steps had been followed. The lessons learned during the process were: initiate discussions on pre-service education early; allow enough time to build understanding, acceptance and consensus; use a generic approach and materials help guide the orientation process; and building a strong partnership among government, the academic community and major partners is essential to success. Analyse the situation

2.4.2

The objectives for this critical task, situation analysis, were explained as follows according to the implementation level: National level • To identify the major child health problems in the country. To identify programmes that address the major child health problems. To select priority problem(s) that should be addresses during health care provider education. • Teaching institutions To identify opinion leaders and decision-makers who need further orientation. To identify areas where these topics are already taught. To identify persons within different units who need training. To ensure that all relevant persons contribute to and endorse a plan of action.

• •

• • •

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The example of a situation analysis conducted in Argentina from the national level was presented. This analysis was conducted in 1999 in 10 medical schools and compared the time allocated within the paediatrics curricula to teaching knowledge and skills related to the major causes of infant child mortality. After a brief introduction and orientation, the participants worked in four groups, two for medical schools and two for nursing and midwifery schools. One of each was assigned to discuss situation analysis issues from the national level and the teaching institution level perspectives. Herewith are summarized the conclusions from the groups. (a) Why do we need a situation analysis? To facilitate the planning and decision making process. To decide the possibility of new teaching regarding the resources needed. To prioritize contents. To determine goals. (b) Who should participate in the situation analysis? At the national level: Training divisions ofthe Ministry of Health and the Ministry of Education, professional regulatory agencies, members of professional associations, members of scientific societies, members of training institutions. At the institution level: school authorities, related departments' staff, students' associations. (c) What questions should the analysis answer? What are the main problems in child health? How much are we already doing? Do we have all the needed resources? How should the situation analysis be conducted? (d) How can the situation analysis be conducted? Collecting existing information Analysing the results in meeting A task force needs to be appointed 2.4.3 Orient opinion leaders and decision-makers at national and teaching institution levels

It is important to create awareness and understanding of the strategy and approaches to strengthening teaching among opinion leaders and decision makers both at the national and teaching institution levels. The objectives are to gain acceptance, generate commitment and support and to establish partnerships.

By way of a role-play the questions of when, who and how to orient were introduced. At the discussion that followed, the participants spoke about the similarities encountered with their own situation. They also mentioned the need to have some type of promotional materials that would help them when providing orientation to key people.

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2.4.4

Planning for the strengthening the teaching of child health

After a short presentation on the objectives and activities for planning at national and institution levels, the participants had their group work to discuss how to develop an action plan in a teaching institution to strengthen the teaching of adolescent health in the Bachelor of Medicine prograrrune. One group reported at the plenary and the others added on. The conclusions were: Those who will participate in preparing the plan of action depend on the topics to be integrated/strengthened and the critical contribution that the members will make. Including topics related to adolescents in the curriculum/programme often implies strengthening or mainstreaming such topics in the relevant sections/modules of the curricula (e.g. sexually transmitted infections, or care for pregnant adolescents, mental health). To overcome resistance in integrating certain issues considered controversial, such as adolescent reproductive health, into the curricula, it is important to include key policymakers in the planning process. 2.4.5 Discussion

After reviewing Phase 1 and the tasks included, the participants concluded that the process of strengthening teaching is a cycle that it is not a one-time activity but an ongoing, long-term process of change. This means that there is no need to change everything at once. It was also agreed that at the national level, the situation analysis and the creation of a national coordinating group are critical tasks. Participants suggested incorporating a national strategic marketing plan in this phase. As an example of promotional material that could be used when orienting key people, a 20-minute video that presents the experience of the Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam with the introduction ofIMCr in the curricula ofthe medical school was presented. This material was very well received and highly commended. 2.5 Session 5: Phase 2 - Prepare and conduct teaching

2.5.1 Preparation for and conduct ofteaching integrated approaches at national and teaching institution levels At this session, the objectives of this phase and the tasks required to accomplish them were discussed. The objectives are: to clearly defme where and how teaching wiIl be strengthened within the academic programme; to prepare teaching staff, materials and clinical practice sites; and to coordinate, implement and monitor. Two essential issues were noted, the need of synergy between departments to strengthen teaching and also the context of the clinical practice sites where the selected strategy or programme should be normally used. To illustrate this, a presentation on the University of Alexandria (Egypt) case study for the incorporation ofIMCr into paediatric teaching was shown. The presentation highlighted in detail the chaIlenges, achievements and lessons learned in training staff, preparing practice sites, teaching and learning materials, coordinating teaching and monitOring the process.

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During the discussion on existing experience among the forum, the Mongolia delegates expressed that introducing new methodology is easy but reaching consensus is difficult. Young teachers are receptive and easy to come on board. The Papua New Guinea Medical School representative mentioned that in their experience when a new approach is brought in by an outsider to the university it lacks sustainability. Conversely, when members of the teaching staff and members of the Paediatrics Society are involved in introducing new teaching, they have the Dean's endorsement more easily. 2.5.2 Define when, where and how to strengthen teaching

After a short presentation that provided guidelines for the group discussion, two groups were assigned to define when, where and how to strengthen teaching on infant and young child feeding and two other groups worked on the same guidelines for !MCl. When: The groups agreed that !MCl and infant and young child feeding should be incorporated throughout the academic year. In the case of Fiji School of Medicine it was indicated that the subject will be incorporated throughout the curricula of the medical school. Where: All groups found that it should be done in the inpatient wards, the outpatient clinic and as part of community health and outreach activities. The general remark was "wherever children are seen." How: Strengthening teaching should be applied for knowledge learning objectives (in lectures, readings, discussions, case studies, chart booklet and photographs), as well as for skills objectives in demonstrations, supervised clinical practice, videos and role-plays).

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2.5.3

Develop or adapt materials for teaching, learning and student assessment

The different types of materials needed for new teaching include learning objectives, list of competencies, teaching and assessment materials, learning materials and materials to improve teaching skills. The materials are, for example, textbooks, reference materials (articles, reviews), audio/video tapes, computer-based programmes, transparencies, slides, handouts, wall charts, checklists, workbooks and assessment tools. It should be noted that there is a need for consistency with national guidelines for the new topic. Also, the issues of cost and sustainability must be taken into account. The following materials developed by WHO were presented: For teachers For students

• • • • • • • •

•

The generic IMCI training set Reference library of selected IMCI materials IMCl Technical Seminars IMCl Student assessment guidelines IYCF Model Chapter for textbooks Breastfeeding Counseling training course Systematic review on the optimal duration of exclusive breast-feeding Hypoglycemia oftbe newborn: review oftbe literature Complementary feeding of young children in developing countries Complementary feeding: family foods for breastfed children HIV and infant feeding

• • • • • • •

IMCI Model Chapter for textbooks IYCF Model Chapter for textbooks IMCI Model Handbook IMCl Chart booklet IMCI motber's card IMCl case recording form Management of the child witb a serious infection or severe malnutrition

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2.5.4

Training needs for teachers and clinical staff

At national and institutional levels, there are three types of people who need training in at least the selected public health strategy and clinical guidelines: orienters, persons who will orient others to the general concepts; planners, persons who will plan for strengthening teaching; and teachers, clinical instructors and relevant clinical staff. The participants were divided irito three work groups: orienters, planners and teachers. Each of the groups had to answer five questions about the reason for providing training and the type, materials and timing needed for each of the categories. Question Why does your group need training? Orienters Head of academic and clinical departments. * Planners Content knowledge Teachers Updated background knowledge and skiIls. Teaching to be consistent and standardized Information on rationale, content of the subject, teaching, assessment, communication, counseling and interpersonal skills.

What information and skills do you need?

Updated information official endorsement and advocacy skiIls

What types of materials do you need to use after training? Who should organize and conduct training courses for you?

!MCI planning guidelines, promotional package, evidence-based reference materials. WHO Ministry of Health

Children's health statistics, information on available resources, team-building skills, planning, coordination, analytic, negotiation and communication skills. promotional materials

How and when should training courses be conducted?

Use of case studies, evidence-based research, problem-based teaching, interactive learning

Ministry of Health, Ministry of Planning, universities, consultant, NGOs, professional associations When funding is available

Teaching aids, generic package and reference materials, assessment tools. Ministry of Health, consultant

Use of adult learning methods, at the end of the academic year

* This group changed this question to: Who should be selected as an orienter?

2.5.5

Coordinating and monitoring teaching of integrated approaches

Regular interaction among representatives of teaching units, sub-units and clinical sites, as well as the involvement of private institutions, is important in order to reduce gaps or contradictions in IMCI teaching and reinforce the effort needed to implement IMCI teaching. A role-play further illustrated the issue.

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2.5.6

Discussion

After reviewing Phase 2, the participants voiced their comments on their experiences. The need to plan ahead, to establish partnerships, to carefully choose the practice sites in order to have sufficient caseload, the need of sustainability of materials and the constant requirement of adjustments when introducing new teaching were emphasized. 2.6 2.6.1 Session 6: Phase 3 - Review and re-plan teaching Review and re-planning at na~onal and teaching institution levels

After completing Phases 1 and 2, and once teaching has been going for some time, there is a need to review and plan for adjustments and reinforce or change direction. The purpose of this critical task is to identify what elements of the plan of action have been achieved and what actions are needed to sustain or strengthen child health teaching. At this phase the national level could assist teaching institutions. The institution will have the responsibility of reviewing the plan of action, assessing the methods and materials used, measuring the outcome of teaching and revising the plan of action. The institution could decide to conduct these tasks with its own staff, including external resources and/or national level group members. The activities could include individual reviews, meetings and review visits. The materials and methods used should also be assessed and the results of previous assessments/examinations reviewed. One can conduct focus groups interviews with teachers, clinical staff and students (current and former), and observe classroom, in-patient and outpatient teaching. Conducting a wrap-up meeting to communicate the findings is also an important step. Prof Hoang Trong Kim, Head of the Paediatrics Department of the Ho Chi Minh Medical and Pharmaceutical University, Ho Chi Minh City, Viet Nam presented the school's two years of experience with WCI teaching. This presentation provided details of the different phases undergone and the methods and activities conducted. Among the main lessons learnt during this process Prof Kim highlighted the need of monitoring and the fact that strengthening teaching is a task of different units, not only one. 2.6.2 Group work on review and re-plan

Four groups, two for medical and two for nursing schools, discussed on the purpose of reviewing new teaching and its about timing, contents, responsibility and activities for this task. A summary of these discussions follows: Purpose: to determine effectiveness and strengths of the programme -its process and outcome; to identify problems, weaknesses and gaps; to seek improvements, find ways to solve problems; and to facilitate new ideas. Timing: Review and replanning should occur regularly, at the end of the academic year. Along the process, monitoring will identify the need of minor adjustments.

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Reviewers should include planners, implementers (teachers, clinicians), and recipients. It was suggested that the IMCl national officer, chief paediatrician, representatives of the national task force and members of other supporting organizations should be invited as external reviewers. Areas to be reviewed: Completeness of the activities in the plan of action Outcomes, teachers and students performance Quality of care provided at teaching sites Activities and methods: Meetings of the review team Focus groups interviews with teachers, clinical staff, students and caregivers Visits to lecture halls, clinics and wards for direct observation Review of teaching notes, exams, patient satisfaction surveys Suggestion boxes Feedback sessions Circulation of fmal report among interested parties 2.7 2.7.1 Session 7: Phase 4 - Evaluate teaching Evaluating teaching

Phase 4 was introduced as an optional phase, recommended if the information collected during monitoring and review was not sufficient. It was suggested that the same indicators, techniques and tools meant for the monitoring and review could be used. The areas to be evaluated include the teaching-learning process, the outcomes (newly acquired competences) and the effectiveness when the students or graduates use the knowledge, attitudes and skills. The concepts of introduction and recurrent costs as well as sustainability of the process was also discussed by the participants and it was agreed that once the introduction of the new teaching is in place the ongoing cost should be minimal. That is because the teaching institutions have already a structure and staff. 2.7.2 Discussion

Phases 3 and 4 are at the core of the process for introduction new teaching. Because of this they are integrated into the action plan right from the start. During the different activities carried out there was ample consensus on the need to find a moment to stop and look back and then decide to confirm or to change direction. It was also noted that it is important to keep in mind that the process of strengthening teaching is cyclical and that changes might take some time to be accomplished. 2.8 Session 8: How to move forward in strengthening the teaching of child health in the Western Pacific Region

The Chairperson invited the participants to plan and reinforce their commitment with the teaching of child health in a group work to outline the next steps at Regional, country, or institutional levels.

- 16 -

The participants worked in groups divided by country of origin. First, they put forward three or four conclusions which were consolidated into a fmal list that was discussed and approved in a plenary session. After considering that the discussions and topics presented were relevant to their country/institution reality, they prepared the next steps for their teaching institutions or national level for the introduction of teaching of public health approaches to child health. All the comments and discussions presented during the week were included in their plans of actions, which can be found in Annex 4. Informal consultations among participants' country experiences were considered valuable inputs for planning. Nine action plans contemplate the introduction or reinforcement of at least one content area in both medical and nursing schools. The vast majority planned for the introduction ofIMCI and two plans include also adolescent health and development. 2.9 Evaluation of the consultation

Being the first Regional Consultation of this kind, at the end of the consultation evaluation questionnaires were filled out by the participants. Among 30 respondents, 93% found the overall organization and methodology used as good or excellent. For 97%, the time dedicated to the different type of activities was sufficient. However, 17% mentioned that the number of presentations was more than enough and 33.3% felt that the time assigned to group work was insufficient. Overall, 78% of the respondents found the sessions very useful; 63% rated good content and 59% rated excellent methodology. The majority of the participants mentioned that the best aspects of the workshop were: sharing experiences and new ideas; the overall development of the sessions; and the materials introduced. As for suggestions and comments, the participants mentioned that by increasing the number of case studies in presentations and group work, reducing the time dedicated to presentations and using examples from nursing and midwifery schools, the workshop could be further improved.

3. CONCLUSIONS

-. The participants prepared the following set of conclusions that were openly discussed and agreed upon during a plenary session: 1. The steps proposed in the WHO/UNICEF Pre-Service Training Planning Guide for Child Health are a practical, appropriate and meaningful approach for introducing, implementing and evaluating pre-service curricular activities. It can serve as a model for child health (IMCI, newborn care, infant and young child feeding and adolescent health) and also for other primary health care issues and public health priorities. 2. The introduction of new curricular contents is best understood as a cyclical process which begins with a situational assessment and analysis of epidemiological, demographic patterns and health problems of populations or sub-populations, as compared to the existing curricula and related competencies of health professional graduates. 3. Changes in pre-service education have to be linked with changes in health policies at all levels. Strengthening pre-service education in child and adolescent health has to go hand-in-hand with implementation of programmes in health services.

- 17 -

4. Pre-service education is closely linked to quality service performance of health professionals. 5. Incorporation of public health approaches in pre-service education is crucial for the strengthening and the sustainability of health programmes in the country. 6. The consideration of cost is necessary for implementing and sustaining new teaching.

7. The sharing of experiences and lessons learned in other countries through provision of concrete examples facilitate the understanding of the process of introducing new child health concepts into pre-service education curricula. 8. Cooperation among institutions within a country and among countries within a region enhances the process of capacity building in neighbouring or nearby countries. 9. The consultation included methods (small groups, role plays, brainstorming) that provided maximum participation, sharing of experiences and information. This variety of methods can also be applied to future teaching activities to improve training methodologies. 10. The materials and tools introduced contain a substantial body of well-presented information that is easy to use. 11. Support from national and institutional authorities and other stakeholders is necessary to implement changes in pre-service education. To get this support, some advocacy material including success stories may be useful.

ANNEX 1

ACADEMIC CONSULTATION ON PRE-SERVICE TRAINING IN CHILD HEALTH PENANG, MALAYSIA 8-12 July 2002 LIST OF TEMPORARY ADVISERS, CONSULTANT, RESOURCE PERSONS, OBSERVERS AND SECRETARIAT 1.

TEMPORARY ADVISERS Dr Carrnelita Divinagracia Dean College of Nursing University of the East - Ramon Magsaysay Memorial Medical Centre Aurora Blvd., Quezon City Philippines Telefax No: (632) 7133309 Email: carrnelitadivinagracia@hotrnail.com Dr Joseph A. Flear Senior Lecturer Paediatrics MBBS Programme Coordinator Fiji School of Medicine Private Mail Bag Suva, Fiji Tel: (679) 331 1700 Fax: (679) 330-8122 Email: iflear@connect.com.fi Dr Le Thanh Hoang Principal Secondary Medical School 6B Ngo Quyen St. Da Lat - Lam Dong, Viet Nam Tel: (84-63) 822-153 Fax: (84-63) 815-000 Email: Ithoang@hcm.vnn.vn

Dr Amphayvieng Chaleunphon Staff of Academic Affairs Section College of Health Technology P.O. Box 1930 Vientiane, Laos Tel: (856)212-17213 Fax: (856) 212-14032 Email: arnphayvieng@yahoo.com Dr Dai Yaohua Head WHO Collaborating Centre for Child Health Capital Institute of Paediatrics No 2 Ya Bao Road Beijing 100020 China Tel: (86-10) 652-70833 Fax: (86-10) 651-28367 Email: yh.dai@263.net

Professor Danzan Malchinkhuu Lecturer Paediatric Department National Medical University Ulaanbaatar, Mongolia E-mail: drnalchinkhuu@yahoo.com Dr Lester Deniega Vice-Chair ofIMCI Committee Philippine Paediatric Society and Associate Associate Professor Department of Paediatrics, Faculty of Medicine and Surgery University of Santo Tomas Sarnpaloc, Manila Philippines Fax: (632) 743 6330

Ms Verzilyn Isom Senior Lecturer School of Nursing and Health Studies Solomon Island College of Higher Education P.O. Box RI13 Honiara, Solomon Islands Tel: (677) 30-111 ext. 240 Fax: (677) 30-390 Email: verzilynisorn@hotmail.com

Ms Terenga Itibita Principal Nursing Officer Kiribati School of Nursing c/o Ministry of Health P.O. Box 268 Bikenibeu, Tarawa, Kiribati Tel: (686) 28-100 ext. 265 Fax: (686) 28-152 Email: mhfp@tskl.net.ki Ms Nola M. Marita Nursing Education Officer Department of Health, Human Resource Management Branch P.O. Box 807, Waigani, N.C.D. Papua New Guinea Tel: (675) 301 3683,301 3662 Fax: (675) 325 7494 Email: mroroi@health.gov.pg Ms Filomena McKay Nurse Practitioner Coordinator Fiji School of Nursing Private Mail Bag Suva, Fiji Tel: (675) 3321-499 Fax: (679) 3321-013 Email: fna@is.com Professor Chhour Y Meng Director National Paediatric Hospital No. 100 Federation of Russia Blvd. Phnom Penh, Cambodia Tel: (855) 11 813-899 Fax: (855) 23 880-475 Email: cymeng.nph@bigpond.com.kh Dr Nyamjav Sumberzul Lecturer Medical Education Unit National Medical University of Mongolia Ulaanbaatar, Mongolia Tel: (976) 11-323-052 Email: sumberzul@yahoo.com

DrChhimPum Technical Bureau Chief Technical School for Medical Care Phnom Penh Cambodia Tel: (855) 12-855-331, (855) 238-83148 Email: chhimpum@hotmail.com Dr Paulus Ripa Lecturer Child Health School of Medicine University of Papua New Guinea Medical School P.O. Box 5623 Boroko, N.C.D. Papua New Guinea Tel: (675) 311 2626 Fax: (675) 325 0809 Dr Manivanh Souphanthong Head Medical Department Faculty of Medical Sciences P.O. Box 7444 Vientiane, Laos Tel: (856)-21-222881 Fax: (356)-21-214055 Email: fms@laonet.net Mr Marco Sto. Tomas Dean Institute of Health Sciences St. Joseph College San Roque, Cavite City 4100 Philippines Tel: (046) 431-3820 (Home); (046) 431-1937 (Office) Fax: (046) 431 0682 Email: tsidkenu2002@hotmail.com Dr Suvd Bekhkhuyag Lecturer Paediatric Department Medical College Ulaanbaatar, Mongolia Fax: (976) 11-687-633 Email: mediccolleg@megic.mn

2. CONSULTANT

Ms Ramlah bt Taha Head College of Nursing Hospital Ipoh 30450, Ipoh, Perak Malaysia Tel: (605) 253 3333 Fax: (605) 241 8694

Dr Maria Angelica Flores-V erschoor Pirovano 270 (1640) Buenos Aires Argentina Tel: (5411) 47925576 Fax: (54 11) 4 7334377 Email: verschoor@fibertel.com.ar

Ms Rosaria Taissets Nurse Practitioner Vila Central Hospital PMB 013 Port Vila, Vanuatu Tel: (678) 22100 Fax: (678) 26721 Email: ltarivonda@vanuatu.gov.vu Sr Haemarie Taito Tutor Paediatrics Fiji School of Nursing Private Mail Bag Suva, Fiji Tel: (679) 332 1499 Fax: (679) 332 1013 Dr Tan Truong Thi Expert of Training Health Worker Science and Training Department Ministry of Health 138A Giang Vo Street Ha Noi, Viet Nam Tel: (846) 4 416/409 Fax: (844) 843 0015 Email: tac@moh.gov.vn

RESOURCE PERSONS

Ms Nancy Brisa Fuentes Marlboro Drive Tahimik Avenue MatinaKm.6 Davao City 8000 Philippines Tel: (63-82) 296 2159 Fax: (63-82) 299 0424 Email: fbmaris@skyinet.net Professor Hoang Trong Kim Head of Paediatrics Department Ho Chi Minh Medical and Pharmaceutical University 217 An Duong Vuong Street District 5 Ho Chi Minh City, Viet Nam Tel: (848) 8346152 Fax: (848) 855 2304 Email: kimht@hcm.vnn.vn Professor Nguyen Gia Khanh Deputy Head, Paediatrics Department Ha Noi Medical College National Institute of Paediatrics La Thanh Road Ha Noi, Viet Nam Tel: (844) 828 9702 (Home); (844) 7752571 (Office); (844) 835 7482 (pediatric Department) (844) -7752571 Fax: (844) 775 4448 Email: nip-vn@hn.vnn.vn

Professor Wei Min Director and Professor Department of Paediatrics Peking Union Medical College Hospital Beijing 100730. China Tel: (86-10) 652 96271 Fax: (86-10) 65124875

Dr Elizabeth Rodgers Senior Lecturer (paediatrics) Fiji School of Medicine Private Mail Box Suva, Fiji Tel: (679) 3311700 ext. 1917 Fax: (679) 3308 122 Email: e.rodgers@fsm.ac.fi Dr Wong Swee Lan Institute of Paediatrics Kuala Lumpur Hospital lalan Pahang 50586 50586 Kuala Lumpur, Malaysia Tel: (03) 26948352 Fax: (03) 269 48187 Email: wongsl@hk1.gov.my

SECRETARIAT

Dr Marianna V. Trias Medical Officer Child and Adolescent Health and Development World Health Organization Western Pacific Regional Office United Nations Avenue Manila, Philippines (Responsible Officer) Tel: (632) 528 9868 Fax: (632) 521 1036 Email: triasm@wpro.who.int Ms Kathleen Fritsch Regional Adviser in Nursing World Health Organization Western Pacific Regional Office United Nations Avenue Manila, Philippines (Co-Responsible Officer) Tel: (632) 528 9804 Fax: (632) 521 1036 Email: fritschk@wpro.who.int Dr Rafael Lopez Short-term Professional Child and Adolescent Health and Development World Health Organization Western Pacific Regional Office United Nations Avenue Manila, Philippines Tel: (632) 528 9870 Fax: (632) 521 1036 E-mail: lopeza@wpro.who.int Dr Tran Minh Nhu Nguyen Associate Professional Officer Child and Adolescent Health and Development World Health Organization Western Pacific Regional Office United Nations Avenue Manila, Philippines Tel: (632) 528 9866 Fax: (632) 521 1036 Email: tranminhn@wpro.who.int

4. OBSERVERS Dr May S.M. Fox Assistant Professor School of Nursing The Hong Kong Polytechnic University Hung Hom, Kowloon Hong Kong Tel: (852) 276 66542 Fax: (852) 236 49663 Email: hsmfox@inet.polyu.edu.hk Ms Lee Sok Yee Nursing Tutor College of Nursing Hospital Ipoh 30990 Ipoh, Perak, Malaysia Tel: (60S) 522 2708 Fax: (60S) 241 8694 Email: ilcheong@hotrnail.com Professor Kun Sun Xinhua Hospital Shanghai Second Medical University 1665, Kongjiang Road Shanghai, 200092 China Tel: (086) 2165-79000 ext. 3020 Fax: (086) 2165-795173 Email: sunkun@public4.sta.net.cn

Ms Sharifah Tahir Technical Officer Child and Adolescent Health and Development World Health Organization Western Pacific Regional Office United Nations Avenue Manila, Philippines Tel: (632) 528 9871 Fax: (632) 521 1036 Email: tahirs@wpro,who.int

Dr D.H. Susantha de Silva WHO Representative in Malaysia World Health Organization P,O. Box 12550 50782 Kuala Lumpur, Malaysia Tel: (603) 209 39908; (603) 209 21184 Fax: (603) 209 37446 Email: who@maa.wpro.who.int

Dr Severin von Xylander Medical Officer c/o WHO Representative, Cambodia World Health Organization P.O, Box 1217 Phnom Penh, Cambodia Tel. No,: (855) 23216610; (855) 23216942 Fax: (855) 23216211 Email: xylanders@cam.wpro.int Dr Helene Lefevre-Cholay Short-term Professional c/o WHO Representative, China World Health Organization 401 Dongwai Diplomatic Office Bldg. 23, Dongzhimenwai Daijie Chaoyang District 100600 Beijing. China Tel: (8610) 6532 7189; (8610) 6532 7190 Fax: (8610) 6532 2359 Email: who@chn.wpro.who.int Personal email account: cholay@chn.wpro.who.int

Dr Ivan Lejnev Team Coordinator Child and Adolescent Health and Development World Health Organization Avenue Appia 20 1211 Geneva 27, Switzerland Tel: (4122) 7912122 Fax: (4122) 791 3286 Email: lejnevi@who.int

Dr Maria del Carmen Casanovas Medical Officer Child and Adolescent Health and Development World Health Organization Avenue Appia 20 1211 Geneva 27, Switzerland Tel: (41 22) 791 4225 Fax: (4122) 791 32 86 Email: casanovasm@who.int

ANNEX 2 PROG~EOFACTnnTlliS

Monday. 8 July 2002 08.00-09.00 09.00-09.30 09.30-09.45 a.m. Registration Opening Consultation objectives and agenda Session 1: Strengthening the teaching of child health 09.45-10.15 10.15-10.45 10.45-12.00 Overview of child health in the Western Pacific Region GROUP PHOTO AND COFFEErrEA Strengthening public health approach in the teaching of child health • IMCl • Infant feeding • Newborn care • Adolescent health Discussion p.m. LUNCH Session 2: Review of key competencies for child health 13.30-15.00 Discussion: Current status of the teaching of child health in the Region COFFEE/TEA Core learning objectives Discussion Day 1 concluding session

12.00-12.30 12.30-13.30

15.00-15.15

15.15-16.15 16.15-16.45 16.45-17.00

Tuesday, 9 July 2002 Session 3: Phases for strengthening teaching 08,00-09.00 a.m. Overview of the phases for planning, implementing and evaluating the teaching of integrated approaches in child health Session 4: Phase 1 - Orient and plan 09,00-10.00 Orientation and planning for teaching integrated approaches in child health at national and teaching institution levels COFFEErrEA

10.00-10.15

10.15-11.30

Activity: Analyse the situation at national and teaching institution levels Activity: Orient opinion leaders and decision-makers at national and teaching institution levels p.m. LUNCH Activity: Strengthening the teaching of child health COFFEEfTEA Discussion of Phase 1 Day 2 concluding session

11.30-12.30

12.30-13.30 13.30-15.00 15.00-15.15 15.15-16.45 16.45-17.00

-. Wednesday, 10 July 2002 Session 5: Phase 2 - Prepare and conduct teaching 08.00-09.00 a.m. Preparation for and conduct of teaching integrated approaches at national and teaching institution levels Discussion Activity: Define when, where and how to strengthen teaching COFFEE/TEA Activity: Defme when, where and how to strengthen Presentation: Develop or adapt materials for teaching, learning and student assessment p.m. LUNCH Activity: Train teachers and clinical staff COFFEEfTEA Coordinating and monitoring teaching of integrated approaches Discussion Day 3 concluding session

09:00-09: 15 09: 15-10:00 10:00-10.15 10.15-11.00 11.00-12.30

12,30-13.30 13.30-15.00 15.00-15.15 15.15-16.00 16.00-16.45 16.45-17.00

Thursday, 11 July 2002 Session 6: Phase 3 - Review and re-plan teaching 08.00-09.00 09.00-10.00 a.m. Review and re-planning at national and teaching institution levels Activity: Review and re-plan

10.00-10.15

COFFEErrEA Session 7: Phase 4 - Evaluate teaching

10.15-11.00 11.00-11.45 11.45-12.30 12.30-13.30 p.m.

Evaluating teaching Activity: Evaluate teaching Discussion LUNCH. Session 8: How to move forward in strengthening the teaching of child health in the Western Pacific Region

13.30-14.00 14.00-15.00 15.00-15.15 15.15-16.45 16.45-17.00

Introduction to preparing an outline of the next steps in the Region Group work to outline the next steps at regional/country/institutional levels COFFEEffEA Continue group work Day 4 concluding session

Friday. 12 July 2002 08.00-10.00 10.00-10.15 10.15-10.45 10.45-12.00 a.m. Presentation and discussion on the next steps COFFEErrEA Evaluation of the consultation Summary and closing

ANNEX 3

LIST OF POSSIDLE CORE LEARNING OBJECTNES: NEWBORN CARE The main learning objective for essential newborn care is: To prepare health professionals to provide essential care to normal and sick newborn infants during the first week of life. I The following is a list of specific learning objectives related to essential newborn care: A.

The Public Health Importance of Newborn Care2 l.

Students should learn and demonstrate knowledge of the following topics as a basis for a public health approach to newborn care within the context of the country: (a) The causes and epidemiology of common serious newborn conditions: asphyxia, low birth weight (LBW) and very low birth weight (VLBW), birth trauma, birth defects, infections, jaundice. Trends and statistics related to perinatal and neonatal morbidity and mortality (e.g. infant mortality rate, etc.). Objectives, scope and implementation of strategies for improving perinatal and neonatal health: i) ii) ii) iv) (d) Women's education and health status Organisation oflevels of care Antenatal and delivery care Neonatal care

(b) (c)

General benefits of breastfeeding i) ii) ii) Benefits for the infant: nutritional, protection against illnesses, developmental Benefits for the mother: physical, psychosocial, convenience, child spacing Benefits for the family and community: economic, social, child spacing, environmental protection, food security

""' . 2.

Based on the knowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the following skills necessary for the effective promotion of essential newborn care in the country: (a) (b) Analyse and integrate into daily practice country data, and cultural factors that may affect perinatal and neonatal care. Promote strategies for improved perinatal and neonatal health.

Appendix I contains a glossary of important terms related to newborn care Leaming objectives related to 'perinatal' care are included in this section because events occurring in the perinatal period (especially before and during labour) are often responsible for diseases and deaths during the first week of life. The learning objectives in the other sections of this document refer only to the 'early neonatal' aspects of newborn care. However, a public health approach to decreasing neonatel morbidity and mortality should encompass interventions that address pregnancy, labour and the neonatal period.

B. Clinical Management of Newborn Infants. 1. Students should learn and demonstrate lmowledge of the following topics as a basis for effective clinical practice at referral services: (a) Assessment of the newborn infant for signs and symptoms of common serious conditions: asphyxia, low birth weight (LBW) and very low birth weight (VLBW), birth trauma, birth defects, infections, jaundice. Identification of management interventions that are appropriate for the newborn infant's conditions. Identification of newborn infants who need referral. Administration of important pre-referral treatments. Essential care for healthy newborn infants. Essential treatment and care for newborn infants with: i) ii) iii) iv) v) (g) Asphyxia Minor birth trauma Minor birth defects Local infection Jaundice

(b) (c) (d) (e) (f)

How breastfeeding works: i) ii) iii) Anatomy of the breast Physiology of milk secretion Breast milk composition

(h)

The signs of correct breastfeeding positioning and attachment, and steps for assessing and improving them if needed. Prevention, identification, management and follow-up of breastfeeding difficulties. Management and feeding recommendations for selected maternal and newborn infant's problems: i) ii) iii) Newborn infant with HN p+ositive mother Sick newborn infant Pre-term newborn infant

(i) (j)

(k) (I)

Methods of counselling the mother about breastfeeding her newborn infant. In areas with high prevalence ofHIV/AIDS, counselling of the confirmed HN positive mother about feeding options, helping her to take an informed decision.3 Methods of advising mothers about the care of both healthy and sick newborn infants, and when to seek medical care. Reassessment of the problem and provision of appropriate care for newborn infants during a scheduled follow-up visit.

(m) (n)

An HN positive mother is a mother who is already diagnosed as positive and has gone through the full HN counselling/testing process.

2. Based on the knowledge of the topics listed above and after appropriate clinical practice, students should be able to demonstrate the following skills necessary for effective newborn care management at referral-level services: (a) Assess the newborn infant: i) ii) iii) iv) Check spontaneous breathing and heart rate Assess birth weight/gestational age Check for birth defects and birth trauma Assess the newborn infant's breastfeeding • take a breastfeeding history (if seen not at the first day of life) • identify breastfeeding difficulties or problems • conduct a breast exam (b) Identify actions needed for essential newborn care

i) ii)

iii)

Determine if urgent referral is needed For newborn infants who need urgent referral, identify urgent pre-referral treatment(s) needed, explain the need for referral to the mother or care taker, write a referral note For newborn infants who do NOT need urgent referral, identify treatment(s) needed

Asphyxia Minor birth trauma Minor birth defects Local infection Jaundice

(e) Assist, advise and counsel the mother or caretaker of a newborn infant advise the mother about care of healthy newborn infant advise the mother about care of sick newborn infant assist the mother to obtain or maintain correct positioning and attachment for breastfeeding iv) assist the mother to maintain lactation during separation from her infant v) assist the mother to prevent or overcome breastfeeding difficulties vi) advise the mother about recommended newborn infant breastfeeding behaviours (for either a healthy or sick newborn) vii) in high prevalence areas, counsel the HIV positive mother about feeding options helping her to take an informed decision viii) advise the mother/care taker when to return (t)

i) ii) iii)

Conduct a follow-up visit, reassessing the problem and providing appropriate care

Supporting the Development and Implementation of Policies and Practices for Effective Newborn Care 1. Students should learn and demonstrate knowledge of the following topics to advocate for and implement essential newborn care at health services:

(a) Policies needed to promote and support essential newborn care. (b) Drugs, supplies and equipment needed to support essential newborn care.

(c) Processes and systems (e.g. record keeping, referral systems, supervision, etc.) needed to ensure effective newborn care. (d) National policies that protect, promote and support appropriate infant feeding, such as the Baby Friendly Hospital Initiative. 2. Based on the knowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the following skills to advocate for and implement essential newborn care: (a) Promote the implementation of policies relevant to essential newborn care. (b) Apply relevant policies to their own clinical practice.

(c) Assist to identify and maintain a continuous supply of essential drugs, supplies and equipment. (d) Promote and support processes and systems (e.g. record keeping, referral systems, supervision) needed for essential newborn care. (e) Promote the implementation of policies that protect and promote appropriate infant feeding, such as the Baby Friendly Hospital Initiative (BFHI). (t)

Apply the elements of policies that are within the responsibilities of health professionals.

(g) Establish linkages with community services. D. Supporting Key Practices Among Individuals, Families and Communities for Newborn Care 1. Students should learn and demonstrate knowledge of the following topics to advocate for and implement appropriate newborn care at family and community level: (a) Traditional newborn care practices, both harmful and harmless. (b) Family and community practices that influence the care of newborn infants.

(c) Early recognition of signs that indicate that clinical care is needed, and early care seeking. (d) Information, education and communication activities that could be promoted or facilitated by health professionals. 2. Based on the knowledge ofthe topics listed above students should demonstrate the following skills to advocate for and implement essential newborn care practices at family and community level: (a) Assist training and educational activities targeted at mothers, families and community health workers. (b) Promote and support the implementation of a referral system between communities and health facilities.

(c) Promote appropriate newborn care practices and early care seeking for high-risk pregnancies and sick newborn infants during community outreach activities. (d) Promote appropriate infant feeding practices during community outreach activities.

Appendix 1 GLOSSARY OF TERMS RELATED TO NEWBORN CARE Birth weight: Birth weight is the fIrst weight of the newborn infant obtained as soon as possible after birth (within \-2 hours) before signifIcant postnatal weight loss has occurred. Low birth weight (LBW) - less than 2500 grams (up to and including 2499 g). Very low birth weight (VLBW) -less than 1500 grams (up to and including 1499 g). Extremely low birth weight - less than \ 000 grams (up to and including 999 g). Essential newborn care - the minimum set of interventions that should be made available for newborn infant(s) at every birth. Gestational age is expressed in completed weeks or days; the duration of gestation is measured from the fIrst day of the last normal menstrual period (e.g. events occurring 280 to 286 completed days after the onset of the last normal menstrual period are considered to have occurred at 40 weeks of gestation). Natal period: Natal period refers to labour. Perinatal period (around birth) commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Prenatal period refers to the events occurring before onset oflabour. Intranatal period refers to the events occurring during labour. Postnatal period refers to events occurring after labour. Neonatal period: Neonatal period (newborn period) oflife commences at birth and ends 28 completed days after birth. Early neonatal period - commences at birth and ends 7 completed days after birth. Late neonatal period - starts at day 7 and ends 28 completed days after birth. Referral-level services corresponds to a package of services available for essential newborn care irrespectively to the physical site where the childbirth takes place (it might be home, or medical point, or small rural hospital). This package of services contains a set of basic tools and technologies for diagnosis, resuscitation and treatment. Term period: Term period - from 37 completed weeks to less than 42 completed weeks (259 to 293 days) of gestation. Pre-term period refers to 'fewer than 37 completed weeks' (less than 259 days) of gestation. Post-term period refers to a pregnancy length of more than 42 completed weeks (294 days or more) of gestation.

'\.

/'<... '

LIST OF POSSIDLE CORE LEARNING OBJECTIVES: INFANT AND YOUNG ClllLD FEEDING

The main learning objective for infant and young child feeding is: To prepare health professionals to protect, promote and support recommended infant and young child feeding practices in the context of the country. The following is a list of supporting learning objectives related to essential actions in infant and young child feeding. . A.

The Public Health Importance of Infant and Young Child Feeding 1. Students should learn and demonstrate knowledge of the following topics as a basis for a public health approach to infant and young child feeding within the context of the country: (a) (b) The Impact of appropriate infant nutrition on human development. General benefits ofbreastfeeding: i) ii) iii)

Benefits for the infant: nutritional, protection against illnesses, developmental (physical, cognitive, psychosocial) Benefits for the mother: physical, psychosocial, convenience, child spacing Benefits for the family and the community: economic, child spacing

The cultural and psychosocial factors that affect breast feeding and complementary feeding. The rationale for recommended and timely infant and young child feeding practices: i) ii) Breastfeeding (early initiation, exclusive breastfeeding and sustained breastfeeding) Complementary feeding (timely, adequate, safe, properly fed)

(e)

Trends and statistics related to breast feeding and complementary feeding in the country. i) ii) iii) iv) Breastfeeding rates Complementary feeding rates Common breastfeeding problems or difficulties (infant, maternal and breastlbreastfeeding problems) Common complementary feeding problems or difficulties (food access, food safety, inappropriate frequency, amount or consistency of foods)

(f) (g)

Policies that support the working mother. Effective interventions implemented (health system support, community support, legislation, information-education-communication, status of commercial promotion of breast milk substitutes).

Based on the lmowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the fonowing abilities or skins necessary for effective promotion of recommended infant and young child feeding practices within the context of the country: (a) (b) (c) Integrate into daily practice country or local data, and cultural factors that may affect infant and young child feeding practices. Provide advice about appropriate infant and young child feeding practices. Support activities to help lactating working women.

Basic Management of Infant and Young Child Feeding I.

AlI students should learn and demonstrate lmowledge of the following basic topics as a basis for effective basic management of infant and young child feeding. (a) (b) How breastfeeding works (effective suckling, milk flow, milk sufficiency). Signs of correct attachment. How to assess breastfeeding and complementary feeding. i) ii) iii) iv) (c) (d) The signs of correct breastfeeding positioning Steps for assessing and improving positioning and attachment Criteria to assess complementary feeding (what, when, how, who) Components of a history and physical exam related to infant and young child feeding, including growth monitoring

How to express and store breast milk. Prevention, identification, management and follow-up of simple feeding problems. i) ii)

Simple breastfeeding problems (nipple trauma, breast engorgement, Candida infection, perceived low milk supply) Simple complementary feeding problems (late initiation, inappropriate consistency, lack of variety, inappropriate amount, absence of responsive feeding, hygiene problems) Maternal medications and breastfeeding Maternal nutrition

(e)

Maternal health and nutrition. i) ii)

(f)

Principles of inter-personal communication and advice. Criteria for reassessment and follow-up. i) ii) ii) Of pregnant women During the neonatal period During infancy and early childhood

(g)

Based on the lmowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the fonowing abilities or skills necessary for effective basic management of infant and young child feeding. (a) Assess the infant and young child's feeding. i) ii) iii) iv) Take an infant and young child feeding history Recognise appropriate infant and young child's feeding (breastfeeding and complementary feeding) Assess the growth of infants and young children (measurement, evaluation of the growth, relating age/weight and height) Identify feeding difficulties or problems

(b)

Advise the mother or caregiver: i) Advise the mother or caregiver about appropriate infant and young child feeding behaviours, for either sick or healthy infant

Assist the mother or caregiver: Assist the mother to obtain or maintain correct positioning and attachment for breast-feeding. Assist the mother on milk expression and feeding her baby expressed breast milk. Assist the mother or caregiver to prevent or overcome common feeding problems, according to the age of the infant or young child.

Advanced Management of Infant and Young Child Feeding 1. In addition to what is included in basic knowledge, students that need further training should learn and demonstrate knowledge of the following topics for effective advanced management of infant and young child feeding: (a) (b)

Detailed review of the anatomic characteristics of the breast and physiological mechanism of lactation. Breast milk composition, the properties of the breast milk components. Particularities in the growth and development ofbreastfed infants. Maternal health and nutrition. i) ii) iii) Mechanism why drugs and contaminants affect the breastfeeding infant Principles of an appropriate diet for the pregnant or lactating woman Family planning methods and breastfeeding

(e)

(f)

Identification, management and follow-up of more complicated infant and young child feeding problems. i) More complicated breastfeeding problems and breast conditions: inverted/flat/long nipples, obstructed duct, mastitis, breast abscess, low milk supply, infant crying, refusal to breastfeed, More complicated complementary feeding problems: refusal to receive complementary foods

ii)

Identification, management and feeding recommendations for selected maternal and infant problems: i) ii) iii) iv) v) vi) Infant with HlV positive mother - How to counsel the HlV positive mother about the feeding of her infane Maternal infections: tuberculosis, hepatitis B, cholera Infant with physical problems (cleft lip-palate, neurologically impaired) Preterm newborn infant Breastmilkjaundice Hypoglycaemia

(g)

Principles of recommendations for appropriate complementary feeding (responsive feeding, amount, consistency of foods, and frequency of feeds according to age). Principles and practice ofrelactation. Recommended management of hospitalised mothers and infants to promote and maintain appropriate infant and young child feeding. Principles of counselling for infant and young child feeding.

(h)

(i) (j)

Based on the knowledge of the topics listed above, in addition to basic skills, and after appropriate practice, students should be able to demonstrate the following abilities or skills necessary for effective advanced management of infant and young child feeding: (a) Assess the infant and young child's feeding and maternal conditions associated with it: i) ii) iii) (b)

Identify more complicated feeding problems Ask about maternal diet and family planning methods Identify maternal or infant problems that may interfere with appropriate IYCF

Counsel the mother or caregiver about: i) ii) iii) iv)

v) vi) vii)

Appropriate IYCF practices Her diet during pregnancy and lactation, according to the local situation Family planning methods compatible with breastfeeding How to maintain milk production and feed her infant when she or her infant are hospitalised Relactation and help her to succeed Infant and young child feeding options when she or her infant have problems In areas with high prevalence of HlV/AIDS, counsel the confIrmed HlV positive mother about feeding options, helping her to take an informed decision4 , and provide on-going support for her to carry-on her decision.

(c)

Assist the mother or caregiver: i) ii) iii) To use alternative feeding options when breastfeeding is not possible With the management of more complicated infant and young child feeding problems With the treatment of maternal or infant problems that may interfere with appropriate IYCF

Supporting the Development and Implementation of Policies and Practices for Effective Protection, Promotion and Support of Infant and Young Child Feeding Practices. 1. Students should learn and demonstrate knowledge of the following topics to advocate for and implement appropriate infant and young child feeding practices at health facilities: (a) (b)

Practices in health facilities that protect, promote and support appropriate infant and young child feeding such as the Baby Friendly Hospital Initiative (BFHI) The rationale for the Ten Steps for a successful breastfeeding i) Application of the International Code of Marketing of Breast milk Substitutes in health facilities

An HIV positive mother is a mother who is already diagnosed as positive and has gone through the full HIV counselling/testing process.

Practices in health facilities that protect, promote and support appropriate infant and young child feeding such as the Baby Friendly Hospital Initiative (BFHD. The rationale for the Ten Steps for a successful breastfeeding. i) Application of the International Code of Marketing of Breast milk Substitutes.in health facilities.

Based on the knowledge of the topics listed above and after appropriate practice, students should demonstrate the following abilities or skills to advocate for and implement appropriate infant and young child feeding practices at health facilities: (a) (b)

Promote the implementation of policies that protect and promote appropriate infant and young child feeding, such as the BFHI. Apply the elements of policies, such as the BFHl, that are within the responsibilities of health professionals. Promote elements of the International Code of Breast milk Substitutes that are within the responsibilities of health professionals, and demonstrate application of the code in his/her daily practice.

(c)

Supporting Key Practices Among Individuals, Families and Communities for Appropriate Infant and Young Child Feeding. 1. Students should learn and demonstrate knowledge of the following topics to advocate for and implement appropriate infant and young child feeding practices at community level: (a) (b)

Ways to link communities and health facilities. How to assess infant and young child feeding practices, growth and nutritional status of infant and young children in a community. Information, education and communication activities that could be either promoted or facilitated by health care providers. Organizations or persons working on infant and young child feeding promotion at community level.

Assist training/educational activities on infant and young child feeding, targeted at mothers, families or community health workers. Apply simple techniques for assessment of infant and young child feeding practices, growth and nutrition of infants and young children in a community. Promote and support the implementation of a referral system between communities and health facilities. Promote appropriate infant and young child feeding practices during community outreach activities. Support community-based organizations by providing up-to-date information.

(e)

LIST OF POSSIBLE CORE LEARNING OBJECTIVES: INTEGRATED MANAGEMENT OF CHILD HOOD ILLNESS (IMCn

The main learning objective for child health is: To prepare health professionals to prevent and manage major childhood illnesses and malnutrition in an effective and integrated manner. The following is a list of supporting learning objectives related to child health: A.

The Public Health Importance of Preventing and Managing Major Childhood lllnesses 1. Students should learn and demonstrate knowledge of the following topics as a basis for a public health approach to preventing and managing major childhood illnesses and malnutrition within the context of the country: (a) The causes and epidemiology of common serious childhood conditions such as ARI (including pneumonia), diarrhoea, malaria, measles, ear infections, and malnutrition. Trends and statistics related to child morbidity and mortality in the country. The objectives, scope and implementation of strategies for the integrated prevention and management of major childhood illnesses and malnutrition (e.g. IMCI).

(b)

(c)

Based on the knowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the following skills necessary for supporting a public health approach to preventing and managing major childhood illnesses and malnutrition within the context of the country. (a) Analyse and integrate into daily practice country trends and statistics related to childhood morbidity and mortality, and cultural factors that affect child health and development. Promote and support strategies for the integrated prevention and management of major childhood illnesses and malnutrition

(b)

Basic Clinical Management of Sick Children 1.

Students should learn and demonstrate knowledge of the following topics as a basis for good clinical practice in first-level health services: (a) (b)

Assessment, in an integrated manner, of the signs and symptoms of common serious illnesses, and of nutrition and immunization status Classification of the child's illnesses according to the IMCI case management charts Identification of treatments for the child's classifications, and of children in need of referral based on the IMeI case management charts Administration of important pre-referral treatments (such as a first dose of an antibiotic, vitamin A, quinine injection, and treatment to prevent low blood sugar) Treatment in the clinic, including oral rehydration therapy, oral antibiotics, oral antimalarial, vitamin A, and immunization Principles of inter-personal communication

(g) (h) (i)

The signs of correct breastfeeding positioning and attachment, and steps for assessing and improving them if needed Methods for advising the mother about treatment, feeding (including age-appropriate feeding recommendations), and when to return For children who return for a scheduled follow-up, reassessment of the problem and provision of appropriate care.

Based on the knowledge of the topics listed above and after appropriate clinical practice, students should be able to demonstrate the following skills necessary for effective case management in first-level health services: (a) Assess and classify the sick child age 2 months up to 5 years according to the IMCI clinical guidelines: Ask the mother about the child's problem Check for general danger signs Ask the mother about the four main symptoms (cough or difficult breathing, diarrhoea, fever, ear problem) iv) When a main symptom is present, assess the child further for signs related to that symptom v) Classify the illness according to the signs that are present or absent vi) Check for signs of malnutrition and anaemia and classify the child's nutritional status vii) Check the child's immunization status and decide if the child needs any immunizations today viii) Assess the child's feeding and identify feeding problems ix) Assess any other problems (b)

i) ii) iii)

.-..

Identify actions needed for case management according to the IMCI clinical guidelines: i) ii) Determine if urgent referral is needed For children who need urgent referral, identify urgent pre-referral treatments needed, explain the need for referral to the child's caretaker, write a referral note For children who do NOT need urgent referral, identify the treatment(s) needed

iii) (c)

Treat the sick child according to IMCI clinical guidelines: i)

ii)

iii)

iv) v)

Determine oral drugs needed and their appropriate dosage and schedule for a sick child Give the first dose of oral drugs (including antibiotics, antimalarials, paracetamol, vitamin A, iron and mebendazole), and teach the child's caretaker how and when to give oral drugs at home Treat local infections (such as eye infections, ear drainage, mouth ulcers, sore throat and cough), and teach the child's caretaker how and when to give the treatments at home Give pre-referral drugs administered in the clinic only (intramuscular injections of chloramphenicol and/or quinine) Prevent low blood sugar

vi) vii) (d) i)

Treat different classifications of dehydration, and teach the child's caretaker about giving extra fluids at home Immunize children

Advise the mother or caretaker of a child according to the IMCI guidelines: Assist the child's mother or caretaker to prevent or overcome common feeding problems ii) Advise the mother or caretaker about recommended feeding behaviours, for both sick and healthy children iii) Advise the child's'caretaker to increase fluid during illness iv) Advise the child's caretaker on when to return for foHow-up visits, when to return immediately for further care, and when to return for immunizations v) Give relevant advice to each caretaker using good communication skiHs and using a Mother's Card as a communication tool vi) Ask open-ended questions of a child's caretaker to check hislher understanding Assess, classify and treat the sick young infant up to 2 months of age according to the IMCI clinical guidelines: i) ii) iii) iv) v) vi) vii) viii) Assess and classify a young infant for possible bacterial infection Assess and classify a young infant with diarrhoea Check for feeding problem or low weight, assess breastfeeding and classify feeding Treat a young infant with oral or intramuscular antibiotics Give fluid for treatment of diarrhoea Teach the young infant's caretaker to treat local infections at home Teach correct positioning and attachment for breastfeeding Advise the child's caretaker on how to care for the young infant at home

.(e)

(f)

Conduct a follow-up visit according to the IMCI clinical guidelines: i)

Decide if a young infant or child has been brought for a first visit or a followup visit for the illness ii) If the young infant or child has been brought for follow-up, assess the signs specified in the follow-up box for the child's previous classification iii) Select further treatment based on the child's signs iv) If the young infant or child has any new problems, reassess and classify the child's illnesses as in an initial visit Advanced Clinical Management of Sick Children 1. Students should learn and demonstrate knowledge of the following topics as a basis for good clinical practice at first-level referral services: (a) Steps ofthe triage process at the referral level based on IMCI classifications at firstlevel health services i) ii) iii) Triage assessment for all sick children to detect emergency conditions Emergency treatment for emergency conditions Assessment for further treatment

(b) (c) (d) (e) (f)

Steps of problem-based assessment and diagnosis of children with lethargy, unconsciousness, convulsions, diarrhoea, cough or difficult breathing, and fever Hospital management of children with diarrhoea, including dysentery and persistent diarrhoea Hospital management of children with respiratory problems Hospital management of children with fever Management of children from high risk groups (young infants, severe malnutrition, children with HN/AIDS) Items to monitor the progress of the child Criteria and procedures for discharge from the facility when improved

(g) (h) 2.

Perform triage at referral level based on !MCl classifications at first-level health services Give treatment(s) for emergency conditions Assess for further treatment Make problem-based assessment and diagnosis of children with lethargy, unconsciousness, convulsions, diarrhoea, cough or difficult breathing, and fever Treat sick children at the first-level referral hospital using !MCl principles of: i) ii) iii) iv) v) vi) vii) Fluid management Antibiotic/antimalarial therapy Oxygen therapy Management of wheezing Management of fever Nutritional management Management of high risk groups (young infant, severe malnutrition, children withHNIAIDS)

(f)

Counsel mothers about breastfeeding Provide emotional and psychological support to sick children and their families Ensure that essential practical clinical procedures are available and safe: blood transfusion, N administration, intraosseous infusion, insertion of a nasogastric tube, lumbar puncture, insertion of a chest drain.

(g) (h)

Supporting the Development and Implementation of Policies and Practices for the Integrated Prevention and Management of Major Childhood lllnesses 1. Students should learn and demonstrate knowledge of the following topics needed to advocate for and implement integrated prevention and management ofmajor childhood conditions: (a) (b)

Policies needed to promote and support integrated prevention and management of major childhood conditions Drugs, supplies and equipment needed to support the effective prevention and management of major childhood conditions Processes and systems (e.g. record keeping, referral systems, supervision) needed to ensure the effective prevention and management of major childhood conditions

(c)

Based on the knowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the following skills needed to advocate for and implement integrated prevention and management of major childhood conditions: (a) (b) (c) (d) Promote the implementation of relevant policies. Apply relevant policies to their own clinical practice. Assist to identify and maintain a continuous supply of essential drugs, supplies and equipment. Promote and support processes and systems (e.g. record keeping, referral systems, supervision) needed for the effective prevention and management of major childhood conditions.

E. Supporting Key Practices Among Individuals, Families and Communities to Prevent and Manage Major Childhood Illnesses! 1.

Students should learn and demonstrate knowledge of the following topics needed to advocate for and implement effective prevention and management of major childhood conditions at community level: (a) (b) (c) Local organizations or persons working on child health issues at community level within the country Methods for linking communities and health services Key family practices needed to prevent and manage major childhood conditions (e.g. breastfeeding, complimentary feeding, careseeking, hygeine, sanitation, etc.)5

Based on the knowledge of the topics listed above and after appropriate practice, students should be able to demonstrate the following skills needed to advocate for and implement effective prevention and management of major childhood conditions at community level: (a) (b) Assist training/educational activities on child health, targeted at families or community health workers Promote and support the implementation of a referral system between communities and health services Promote appropriate family practices during community outreach activities.!

(c)

5 Improving/amily and community practices: A component o/the IMCI strategy. Geneva, World Health Organization, 1998 (unpublished document WHO/CAHl98.3; available on request from the Department of Child and Adolescent Health and Development, WHO, 1211 Geneva 27, Switzerland, e-mail: CAH@who.int, fax 41227914853)

LIST OF POSSIBLE CORE LEARNING OBJECTIVES: ADOLESCENT HEALTH AND DEVELOPMENT

Sample competency and objective domains (categories) and learners' objectives Foundational knowledge: Epidemiotogy,.needs assessmentlUld priorities Assess and analyse available epidemiological data at national and local levels regarding adolescent mortality, morbidity, self-reported health status and needs and access to care. Demonstrate proficiency in selecting crucial epidemiological data, choosing priorities for interventions, and disseminating it among various target ~ou'ps.

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Foundational knowledge: . , Adolescent growth lUld develClBment . Demonstrates understanding of normal anatomy and phys associated with puberty and adolescence, including: Growth and development Tanner stages Pre-puberty; early and mid-adolescence Psychologic growth and development in each stage, including: Life aspirations Preoccupation with body image Sexuality and physical changes Moodlbehaviour changes Peer pressure and support Feelings of invulnerability Accidents Family/parental relationships; attitudes Concrete versus abstract thinki~ Working with adolescents and families! Professional values and socialization Understands and appropriately describes personal values and attitudes about providing health services/care to adolescents. Be able to explain principles andlor theoretical frameworks which support adolescent health and development

--'-

Develop knowledge and attitudes that reflect an understanding of the effects of the following factors on adolescent health and development: The preoccupation of adolescents with their bodies; The effects of peer pressure and peer support; Family problems; School problems; The effects of gender; The effects of socio-economic status, ethnicity; urban/rural residence; environment; employment status; marital status; Media influence; Poverty; Violence/safety; Adolescents' inquisitive and confrontational attitudes toward society, parents and others; Adolescent sexuality, including physical, psychosocial, moral and sex and gender identity issues; Adolescents' sense of invulnerability and the tendency toward high-risk behaviour; Issues of confidentiality in the provideradolescent/patient interaction; Spirituality; and the promotion of adolescent health, wellness and prevention habits. Demonstrates the ability to create a conducive environment for free expression of opinions and ideas by adolescents Demonstrate an understanding of the medico-legal issues of adolescents, including consent/confidentiality and legislative/regulatory policies and laws. Demonstrate an understanding of appropriate service delivery models for adolescents, particularly those marginalized. Facilitates the participation of adolescents and other stakeholders in planning, implementation and evaluation of services rendered in practice settings Collaborates with families, adolescents', peers and other professionals (health, social, education and justice) when appropriate. Demonstrates good communication and observation skills, including reflective listening; asking open-ended questions; encouraging; positive body image; observing and monitoring nonverbal communication, demeanour and behaviour.

Assessing and managing common health/medical conditions Demonstrate the ability to utilize interviewing techniques specific to adolescents to elicit a comprehensive adolescent health history, including: Presenting problem Health habits and health risks Family functioning Social and school situation Socio-economic, cultural and spiritual factors Assess adolescent stressors, vulnerabilities, addictive behaviours, coping mechanisms, personal strengths, and use of available support and community resources.

IdentitY major threats to life and health in adolescence: Violence Malignancies Cardiovascular diseases Congenital anomalies Communicable diseases Perform physical examination and screening tests, tailored to adolescent health risks, including: Visionlhearing screening; Blood pressure screening; Anaemia screening; Assessment of physical development; Assessment of nutritional status; Assessment of sexual maturity; Screening for and identification of abnormal findings IdentitY variations in growth and development, including: Short and tall stature Precocious puberty Delayed puberty Delayed menarche Menstrual irregularities Male gynecomastia Non-descended testicles IdentitY illnesses, including: Nutritional, eating disorders Upper and lower respiratory tract disorders, including asthma, tuberculosis, pneumonia; Cardiovascular diseases/conditions, including elevated blood pressure or hypertension; cardiac diseases; Other diseases, including diabetes; and Communicable disease, including malaria, STIsIHIV/AIDs

Provide counselling focused on the prevention of common illnesses and health promotion. Recognize the range of essential and effective treatment options for common disorders in adolescence Manage common disorders/illnesses in adolescents, including: The development of management plan with the adolescent and hisiber family when appropriate, which includes: Self-care in regard to minor illnesses/injuries; The prevention and management of common health problems; Referral when necessary. Management of serious illness; chronic diseases; disability Demonstrate awareness of the impact of chronic illness in adolescents and man~ementj)rinciJJles involved. Manage serious and chronic illnesses of adolescents. Provide rehabilitation services. Psychosocial and mental health: Adolescent behavioural problems and mental health Using relevant and appropriate interviewing skills, elicit a psychosocial history, investigate sensitive topics and assess: Psychosocial development Cognitive development Moral/ethical develQ1Jment Identify mental health/psychiatric issues or disorders, including: Depression Suicide risk Schizophrenia Eating disorders Learning disorders (including attention deficithyperactivity disorder and dyslexia) Epilepsy Identify body image issues, including: Acne obesity Identify substance abuse, including: Drugs Nicotine Alcohol Performance-enhancing agents Provide adolescent-specific counselling for: The management of stress, emotions, depression, self-injury potential

Manage mental health/psychiatric issues/disorders, including: Altered mental status/mental illness Severe depression; suicide potentiality Schizophrenia Eating disorders Learning disorders Substance abuse Epilepsy Pt6fu'otiug'ad&ll:lscentnelllthy llena'Vl«}1.lrs'andtifesttlc' . . •.•. Promotes adolescents' development of healthy lifestyles Develops tools to promote provider recognition and screening of adolescent health risks. Demonstrates an ability to undertake basic counselling, specific for adolescents, including anticipatory counselling and guided decision-making. Identifies and provides counselling for lifestyle practices and health risks, including: Behaviour risks, e.g. substance abuse, sexual behaviours and activities Amount and type of physical activity Nutritional habits; Immunization status/needs; Injury prevention and safety precautions; Provides counselling for family and environmental risks/problems, including: physical abuse sexual abuse violence Selects relevant and appropriate interventions and strategies related to: enhancing self-worth (self-esteem); and building life-skills and self-care skills (decision-making; negotiating; refusal; self-management; coping strategies; risk identification skills; protective factors). Works in partnership with adolescents, families, groups and communities to promote healthy adolescent behaviour and lifestyles. Understands and appropriately describes the reproductive health risks (unintended pregnancy, STIs, unsafe abortion, gender-based violence, sexual abuse) and consequences (medical, psychological, social, economic) for adolescents. ..",.

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Develops appropriate attitudes and counselling skills to address adolescent sexual concerns, including: identity; orientation; body image; masturbation; contraception; sexually transmitted infections, including HNIAIDs; and pregnancy (prevention, health risks, psychologic and educational issues, family and parenting issues). Works with adolescents to build their knowledge, understanding, informed decision-making and selfresponsibility, in relation to sexuality, the range of sexual expression, the risks and consequences of sexual activity, contraception, fertility and gender issues. Adapts sexual and reproductive health services, including antenatal, labour and postnatal programmes, to make provision for adolescent boys and girls.

ANNEX 4

PLANS OF ACTION r -________________________C~AMBODr~~----------------------~ Ccunbodlan Action Plan for Pre-Service Troining in Child Health 2002 - 2()().4 Cambodian Action Plan for Pre-Service Training in

Child Health 2002 - 2()().4

...... 2004 bet ,r;,.,VDOC -Jiiji [FobMarApr~·Juoi·:.iJIAu.gS.PdCi

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CHINA

Situation analysis: 1. 2. Infant mortality is high Causes leading to high mortality rate Pneumonia Diarrhoea Malnutrition Lack of understanding (public & health care professional) of appropriate complementary feeding

The current situation of child health teaching: Newborn care, Adolescent care and Nutrition are not covered in the curricula There is lack ofteaching materials The teachers are not equipped -Resources: Human: available for !MCI but not for other Public Health approaches Comment: to expand teachers training Materials: available from international agencies Comment: translate the materials to Chinese Financial: available for in-service training not for pre-service Comment: expand to pre-service training Key planners: Some of the staff from MOH are trained in !MCI but not the MOE staff Comment: conduct orientation for the planners China Action Plan Activities Situation analysis Orient national opinion leaders/decision makers Planning meeting Prepare teaching materials Teaching methodology workshop Train teachers & coordinate teaching Request endorsement Conduct and monitor teaching

Time Sept 2002 Oct 2002 Nov-Dec 2002 Jan-March 2003 April 2003 May- July 2003 Aug 2003 Sept 2003 onwards

Place Bejiin~

Materials

Beijing Bejiing Beijing Beijing Beijing Beijil!K Shangai

IMCI materials

Budget U$S dollars 10 000 10000 5000 5000 7000

IMCI materials

7000

IMCI materials

FIJI

Plan of action for Fiji: Strengthen the implementation of the Fiji National Plan of Action. -Step 1: Review the National Plan of Action -Step 2: See where the activities have behind the timetable in the Plan lagg~d

Pre-service: Fiji School of Medicine: -Orientation of relevant new staff at the FSM, specifically, Head of School of Public Health and Primary Care, the Senior Lecturer (Health Services Management), Senior Lecturer (primary Care): End-August 2002

-Step 3: Mobilize the Steering Coinmittee to catch up on these activities .

..-..

Pre-service: Fiji School of Medicine (cont'd): -Look into the possibility of Fiji medical registration for several current PBL tutors (with medical degrees from foreign countries), in order to have them assist in clinical supervision ofMBBS 1 to 3 students in health centres: End-August.

Pre-service: Fiji School of Medicine (cont'd): -Train the PBL tutors (I clinical supervisors): September / October 2002

Pre-service: Fiji School of Medicine (cont'd): -At the end of the year, review the curriculum with a view to strengthening teaching of these areas: Infant and Young Child Feeding, Care of the Newborn, and Adolescent Health and Development: End-November 2002 -This should be preceded by review of statistics /surveys / studies on adolescent health problems in Fiji.

Pre-service: Fill School of Nursing: -Curriculum review already scheduled: Incorporate strengthening ofIMCI-related areas of the curriculum into this review: EndJuly 2002. -Orientation of faculty staff of the FSN (can be done together with orientation of the senior staff of FSM): End-August 2002

Pre-service: Fill School of Nursing (cont'd): oTrain four basic tutors, four post-basic tutors, and two clinical tutors in the five-day IMCI training programme (adapted and spread over a six-week period): September / October 2002

In-service: oThe Fiji National Plan of Action scheduled an II-day in-service training workshop for sub-divisional heads, divisional heads, both medical and nursing, for mid-May 2002. This has not been done. Reschedule for midSeptember 2002 . • Clinical site supervisors to be nominated for inclusion in this in-service training: End-July 2002.

LAO PEOPLE'S DEMOCRATIC REPUBLIC

Lao plan for Sep-Dec 02 ~~"'~"'i~'0':;<-~-""'__';~;"uw.'_~;:

1$'

I Brief the Dean of the medical school, Director of the college and the curriculum committee I Meeting with the national IMCI WG to propose setting a subgroup for IMCI pre-service training. The subgroup will be appointed by MOH and . MOE I Key persons from teaching institutions will be trained In standard !MCI course

I Orientation on IMCI pre-service training for the teaching institutions I Regular meeting of subgroup for IMCI preservice training to set a pian of action for 9 and 24 months • Project proposal first to IMCI working group, then to dean of medical school an director of college, curriculum committee, National University of Laos and MOH

----

Lao plan for Jan-Mar 03 ';'~i<'~'~'~;~'''!:::'';''+~$l~'''Jt

Lao plan for Apr-Jun 03 , '·''':·~'"''''"t't.iC''?''~''''-<''i~::rr;@1,ii:~.1

III

I Plan of action for the next 9 months finalized I Project proposal to supporting bodies and partners for financial/technical support to introduce phase I of IMCI pre-service training

I Initial activities of phase I to incorporate IMCI into pre-service training carried out

MALAYSIA

HOW -1 HOW TO MOVE FORWARD STRENGHTENING TIIE TEACHING OF ClllLD HEALTH IN MALAYSIA • CREATE A SMALL WORKING GROUP • Prepare a paper • "analyze child health situation at national level I regional level • "review current situation of child health teaching in the current basic and post basic curriculums • ·analyze resources I budget

WHO? • • • • • Ms Ramlah Taha Ms Lee Sok Yee Local MCH Officer Local Paedaetrician Person Responsible: Ms Ramlah Taha

TIME 1152 (201712002)

WHAT -2 • Brief authorities on this consultation, working papers done, and • Get endorsement

WHO TO BRIEF? • Personnel from the Training and Man Power Department (MOH) • Curriculum committee • BY : Ms Ramlah Taha

WHAT-3 Prepare first round of IMCI teaching 'Identify key person to go for the training course 'Place to conduct it 'Experiences available for students Locations for clinical experiences Materials Budget required

WHO TO BE INVOLVED-2 Working Group • Tutors in charge of running the following courses / curriculum planners • Basic Schools 'Post basic Schools - Midwifery -Paedaetrie - Neonate - Public Health

WHEN -2 BASIC SCHOOLS - VERY SOON (8/8/2002) • POST BASIC SCHOOLS - next meeting when called by MOH

WHAT-4 • TRAINED TUTORS IDENTIFIED DURATION ~ I I DAYS • BY: Dr. Wong Swee Lan and her facilitators • When: October 2002

-WHAT- 5 Facilitator course • For same persons (4) • By same persons (4)

WHAT-6 • Trained the student nurses identified as in the present curriculum (by modified learning objectives-agreed by curriculum planners when teaching child health components according to IMCI approach) - Basic Courses - Post Basic Courses

When - To start for JULY 2003 Intake

MONGOLIA

Action Plan Mongolia Academic Consultation Malaysia - July 2002

Demographic pyramid by age group and sex, 1989 and 2000

Country Situation Mongolia is a landlocked country in northeast Asia and has a relatively small number of people who live over a large geographical territory of 1.56 million sq. km, which is half the size ofthe India or three times the size of France. The country is one of the most sparsely populated countries in the world with a population density is 1.4 persons per sq. km. The climate of Mongolia is defmed as semi-arid continental with long severe winters and short summers

:. ::::

.... (919

....

... ... 2000

Health Indicators Indicator Population growth

Disease Burden 2000 1.4 65 5.99 158 31.2 42.4 .'

In 2000, 23 562 cases of infectious diseases registered. - 41'.2% were STI' 5 - 25% was viral hepatitis, - 2.5% was measles, 4.19% was rubella,. 8 % was tuberculosis. and 4.4% was shigeU05is and others .

Life expectancy al birth Mortality rate (per 1000 population) MMR (per 100,000 live birtlts) IMR (per 1000 live births) Uadu 5 mortality nt. (per 1000 live births)

The incidence ofvaccioe preventahle diseases has heen reduced as a result of the high priority given \0 the Expanded Program for Immunization which achieved over 92% inlmonization coverage for the under 1 year age group in 2000

Rationale for introducing IMel into pre-service training Graduates from Medical College work as General Practitioners in Primary Health Care level right after graduation There is limited time for teaching IMCI in pre-service training medical students Medical training/paediatric more focused in in-patient diagnosis and treatment rather than outpatient and community activities Main causes of child mortality and morbidity are diseases covered by IMCI (pneumonia, diarrhoeal diseases, perinatal disorders, etc.)

IMel pre-service training at the National Medical University of Mongolia Department of Paediatrics and department of General Practice are responsible for planning and implementing IMCI or BF counselling teaching The teaching staff members are 11 in the Department of Pediatrics and 7 in the Department of General Practice. Medical course has 6 years curriculum and leads to bachelor degree. Over 1416 students are studying in the Medical Faculty and 250 students enroll every year.

IMel pre-service training at the National Medical University of Mongolia The IMCI introduced initially in April 2000 All teaching staff from department of Pediatrics participated in shortened 5-day course • Faculty of Department of Pediatrics developed learning objectives for its teaching

IMel pre-service training at the National Medical University of Mongolia PAEDIATRICS is taught from the third year to the sixth year. Paediatric rotation lasts 2 weeks in the third year, including child respiratory diseases. The fourth year includes diseases of digestive system, malnutrition, anaemia, rickets and is covered during the 2 weeks rotation. In the fifth and sixth years students study neonatology, paediatric nephrology, cardiology, haematology and emergency care

IMel pre-service training at the National Medical University of Mongolia Since 2001-2002 academic year the IMCI has been taught. In the third year 2 hours lecture for IMCI introduction and parts ofiMCI for respiratory disorders, breast feeding counseling are taught In 4'" year management of sick child according to IMCI is taught In the fifth year of study management of sick young infant age I week up to 2 months In the sixth year 16 hours practice dedicated for the IMCI

Planned activities at institutional level Orientation for decision-makers Task force formation Coordinating meetings - Task force Planning/coordinating integration of IMCI into teaching Preparation of teaching materials Preparation ofteaching sites Monitoring of planned activities Evaluation of planned activities

Mongolia - Plan of Action Wh•• Who

Mongolia - Plan of Action Who. orIMeI into teeehiDe:

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Who

When SopIcmbcr-Oecombcr 200' October 2002 - March 20t])

OricIatation o("DcciJiOlt-makCl1

ur ...

Daaa (or DCQaaic

Septembor 2002

Planniug/coordinatin& inteJl'"otiOD

IbdIcC~l

eo..... PreparatiOD Dfaaaehina malOrials

Hucb: of Dcpar\DIcIIt Dira;tars ofNuniill

Pireclon of Medicol Colleics

Tuk CCI'CC orpai.ltioa

Same III previous

After orioalllioa 5qJtcmber lOO1

Hudl ofDqw1menli IMCINatio.w Coordinatoc Schook admUUicraCors

Coordinatina mecri......Tuk (CWCCl Head ofTask Force Dcaa.'1 Offilll:l for

December 2002

Teathers Preparatiga of tachinl sita HadJofDepill1lDCl\b Soptc:mbcr 2002 _ May &:hoolJ adminil&nlDn '003

Juno 2003

AClidcmic AtTain

Mongolia - Plan of Action Wb8l Who Heads ofOepartDtenu nc..·.OfliGofOl' Acadomio AII'ain IL:ad ofTuk Porco Head ofTuk Force

Wh•• September 2002-July 2003

Manitori.., ofplllnned activities

EvaluaLioaofpianacd ldi.vjtiet;

JulylOOJ

NationaIlMCI _bold« Headt of OcpatmeaU

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PHILIPPINES

Philippine Plan Accomplishments

t. introduction 1. t Introduction to Academic Leaders (Medicine, Nursing & Midwifery). 1.2 Organization of Coordinating Committees 1.3 IMCI Expanded Orientation 1.4 Planning Workshops

2. Early Implementation 2.1 Training of Faculty (ll-<lays & Facilitators) 2.2 Implementation Plan 2.3 Draft !MC!-PS Curriculum 2.6 Pilot Implementation of the !MCI PreService Curriculum. 2.7 Undertake Review & Re-planning 2.8 Conduct Consultative Workshops with key organiZAtions e.g. ADPCN, APSOM, PPS, ANSAP, etc. on the National Implementation of !MCI with the revised !MCI Curriculum

3. Expanded Implementation ... 3.1 More Faculty & Health Facility Staff _ Training nationwide. 3.2 Continue Implementation of "Refined" !MC! Curriculum 3.3 Monitor & Evaluate 3.4 Conduct a formal scientific evaluation (OPTIONAL, depending upon the availability of funds). Note: Funds for faculty training programs, review

-&5..

4. Other Related Preparations for future expansion of IMCI - Institutional coverage. 4. t Begin briefing other academic heads (Deans, School Administrators, Significant Others) about the IMCI Pre-Service Curriculum Strengthening. 4.2 Start coordination work with local health facilities. 4.3 Do progressive updating of country plan.

and evaluation can be assumed by the National Organization in collaboration with the National Task Force.

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PHILIPPINES Accomplished/ongoing: • Creation of a national task force • Involvement of strong Philippine Paediatric Society - lMCI Committee • Approval and recommendations made by APMC • Parallel work on IMCI by Department of Health F National --- I Time frame ",,,r..U,", .Iu.I..1

-- ,,_

...

Activity

Resources National task force for IMCI National task force for lMCI National task force for lMCI

Locus of responsibility NTFmedical working group

Expected outcomes

6-12 months

•

Restructuring medical education towards a public health approach

• •

Form medical working group Train members ofNTF - MWG

Integration lMCI on the medical curriculum or suggest inclusion oflMCI . to new curriculum Trained knowledgeable members Seminar(s) on restructuring medical curriculum towards a public health approach Media campaigns Support and endorsement of DOH for NTF projects Encourage APMC to put into action previous IMCI recommendations Include lMCI topics in Medical Board Examination Continued awareness/action of Postgraduate MD's on lMCI and adolescent health

•

Create an awareness of Public Health concern in Medical Community

NTFIDOHfPPS and sponsoring company

NTF-MWG

• •

•

Establish linkage with DOWAPMCfPhil. Board for medicine to strengthen IMCI teaching in medical institutions Continued PPS IMCI activities including adolescent health

NTF

NTF-MWG

•

PPS and sponsoring company

PPS lMCI committee and adolescent health committee

• •

•

Future plan - Institutional level Accomplished: • Orientation of Dean and Department of Paediatrics. • Teaching ofIMCI in year 3, 4 and post-graduate inters and residents. Time frame Activity Resources NTF-MWG Locus of responsibility IMCI institutional MWG Institutional MWG Expected outcomes

6-12 months

•

Orient/reorient administrationlDepartment ofPaediatricslDepartment of Family Medicine on IMCI (pre-service training) Meetings with Department of Medical Education on integrating IMCI on new curriculum Coordinate with DOHIWHO(?) for training of teachers Coordination with Department of CommunitylFamily medicine for integration of IMCI into their department

•

Continued awareness of institutions and involved departments on IMCI Integration ofIMCI into new curriculum Trained teachers on IMCI Integration ofIMCI in Department of CommunitylFamily medicine

• •

IMCI - MWG (Inst.)

• • •

Institutional MWG Institutional MWG

•

)

PAPUA NEW GUINEA 12 MONTH PLAN (No pre-service yet)

Briefings of authorities (next weeks) two groups: Health Dept. University Head of Training Unit Head of Paeds Dean

Working groups from related departments to carry out activities Again 2 groups: Cross representatives Health Department Training unit Curricula team Nursing school reps.

University Dean/delegate Heads - Paeds Paed teachers Education committee rep

!MCI Task force Paediatrics Society Donora enc Focus grOUps?

May appoint sub-committees to look at specific tasks Timeline for !MCI plan of action Pre-service programme PNG HEALTH DEPT INSTITUTIONAL Activity Orientation of senior staff Formation working group/situation analysis Training of teachers/clinical staff Identification & preparation of clinical sites Preaparation of teacbJng, learning & assessment materials Coordination of teaching theory + clinical Other Months 1-3 I

Months 4-6 J-

Months 7-9

Months 10-12

~ Phase 2 - Jan 2003 hi Begin teaching

l l

=> I

Mid-term review

VIETNAM

FUTURE PLAN IN VIET NAM CHILD HEALTH PRE-SERVICE TRAINING 2 from medical school 1 from nursing school 1 from Ministry of Health

STEPS NEEDED TO STRENGTHEN IMCI PRE SERVICE TRAINING IN HCM MED. SCHOOL • Review plan: • Identify achieves & difficulties - verify that methods and materials cover the learning objectives • Revise the plan of action accordingly • Identify actions and resources need ed to sustain and strengthen teaching • Assess outcomes

7.2002

• Revise plan • ... Second teaching cyde

STEPS NEEDED TO STRENGTHEN IMCI PRE SERVICE TRAINING IN HANOI MED. SCHOOL

LAM DONG NURSING SCHOOL

* Prepare and conduct IMCI teaching: - Train teachers & dinical staff - Prepare clinical prad:ice sites - Prepare T, L , A materials - Conduct teaching - Review & Replan after 1 academic year * Incorporation Adolescent health teaching

* Prepare practice sites * Prepare material * Conduct teaching: In - service training Pre - service training

* Orientation workshop * Train teachers

* Review and Replan

NATIONAL LEVEL • Analyze situation of child health teaching and IMCI pre-service training • Revise pediatric curriculum / Medical and Nursing schools • Orientation workshop/ Med,Nursing schools • Meeting/ IMCI coordinating group • AssIst Teaching( teacher, materials. •• ) • Monitoring IMCI teaching/ pilot schools • Review. Replan

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 2002

Source World Health Organization