Workshop on Integrated Management of Childhood Illness Computerized Adaptation and Training Tool, Seoul, Republic of Korea, 24-26 June 2008 : report

WPRJ200S/DHP/04/CHD(l )/200S Report series number: RS/200SIGE/25(KOR)

English only

REPORT

WORKSHOP ON THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS COMPUTERIZED ADAPTATION AND TRAINING TOOL

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Seoul, Republic of Korea 24-26 June 200S

Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines

March 2009 WHO/WPRO LmRA RY

MANILA. PHILIPPINES

o3 JIJN 2009

NOTE The views expressed in this report are those of the participants in the, Works~~p on the Integrated Management of Childhood Illness Computerized Adap~ah~n Trammg Tool and do not necessarily reflect the policies of the World Health Orgaruzatton,

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for the governments of Member States in the Region and for those who participated in the Workshop on the Integrated Management of Childhood Illness Computerized Adaptation Training Tool, which was held in the Republic of Korea from 24 to 26 June 2008.

CONTENTS Page SUMMARY 1. INTRODUCTION ............................................................................................................ ~ 1.1 Background .............................................................................................................. 1 1.2 Objectives ................................................................................................................ 1 1.3 Participants ............................................................................................................... 1 PROCEEDINGS .............................................................................................................. 2 2.1 Opening session ....................................................................................................... 2 2.2 Overview ofIMCI adaptation, implementation, training approaches and pre-service education ......................................................................................... 2 2.3 IMCI Computerized Adaptation and Training Tool: history, rationale, overview of functions and components ..................................................................... 3 2.4 Keeping IMCI up to date .......................................................................................... 3 2.5 IMCI training challenges and opportunities ............................................................... 4 2.6 Use ofICATT in the Western Pacific Region ........................................................... 6 CONCLUSIONS .............................................................................................................. 8 ANNEXES: ANNEX 1 LIST OF PARTICIPANTS, TEMPORARY ADVISER, RESOURCE PERSONS, REPRESENTATIVES/OBSERVERS AND SECRETARIAT AGENDA OVERVIEW OF IMCI IMPLEMENTATION IN THE WESTERN PACIFIC REGION ICATT - INNOVATIVE SOFTWARE IMCI TECHNICAL UPDATES ICATT -HOWTO START? INTERNATIONAL CYBER UNIVERSITY OF HEALTH (ICUR) IMCI VIDEO ADAPTATION IN PAPUA NEW GUINEA IMCI ICATT-BASED TRAINING COURSE ICATT - EARLY IMPLEMENTATION STEPS

2.

3.

ANNEX 2 ANNEX 3

ANNEX 4 ANNEX 5 ANNEX 6 ANNEX 7 ANNEX 8 ANNEX 9 ANNEX 10 Keywords:

Child health services - education / Delivery of health care, Integrated - education / Integrated management of childhood illness

SUMMARY

In the Western Pacific Region, an estimated 766 000 children die every year before they reach their 5th birthday from common preventable and treatable conditions which could have been avoided if timely and appropriate care were available for those children. The WHOfUNICEF Regional Child Survival Strategy identifies integrated management of sick children as one of the key components of the Essential Package for Child SurvivaL Integrated management of childhood illness (IMCI) is implemented in over 100 countries worldwide including 14 countries in the Western Pacific Region. While the coverage and scope ofIMCI has been steadily expanding. the pace has been slow in some settings. Among the common challenges have been: (I) the periodic updating of the IMCI guidelines with new recommendations and the reproduction of new materials; (2) the overall large number of health workers that still await training and the cost of covering their training needs; (3) the need to ensure that knowledge and skills of trained health workers are retained and updated throughout the years. The IMCI Computerized Adaptation and Training Tool (ICATI) was developed by WHO in collaboration with Novartis Foundation to partly address the challenges faced by countries in scaling up IMCL The ICATI is a new, innovative computerized software application that provides an opportunity for easy adaptation of the most updated generic guidelines at national and subnationallevels. ICATI can be translated into various languages and used in a range of environments and settings with the potential to significantly increase training coverage as it allows computer-, Internet- and satellite-based facilitation that will be useful for in-service/pre-service training and distance learning programmes. The demand for more rapid scaling up of IMCI and greater utilization of new technology makes ICATT application in the Region important, warranting an orientation workshop on ICATI. At the end of the workshop, the participants obtained the latest technical updates on IMCI and familiarized themselves with ICATI to facilitate the periodic IMCI adaptation and updating process; discussed various training approaches being implemented to scale up IMCI and explored ways that ICATI can be used for IMCI training in both pre-service and in-service settings at country level; and outlined a plan for the early application of ICA TI in countries of the Region. The orientation workshop renewed interest in reviewing IMCI implementation in countries. ICATT was regarded as an appropriate alternative tool for scaling up various essential components of IMCI such as: adaptation, updating and dissemination of new technical guidelines; and expanding the coverage of both in-service and pre-service training. Participants agreed that the adaptation and updating of the existing national IMCI guidelines should be completed as a necessary first step. Stakeholders should be oriented on ICA TI as its implementation would require some logistics requirements, like computers, and reorientation of facilitators. It was recommended that the WHO Regional Office for the Western Pacific should continue to coordinate activities to ensure technical support, capacity building and mobilization of resources. Networks among countries with similar characteristics or geographical accessibility should be established to provide support for ICATT implementation: Big network (China, Malaysia, Mongolia, Philippines); "Mekong" network (Cambodia, Lao People's Democratic Republic, Viet Narn); "Pacific" network (Fiji, Papua New Guinea, Solomon Islands). The ICATT website provides a forum for discussion and continued exchange of knowledge. Other agencies which participated in the Workshop were proposed to have a more active role in IMCI and ICATI implementation as follows: Yonsei University for technological support; UNICEF for implementation support; and Menzies School of Health Research for monitoring and evaluation.

I.

INTRODUCTION

1.1

Background

A Workshop on the Integrated Management of Childhood Illness (IMCI) Computerized Adaptation and Training Tool (ICATT) was held at Yonsei University in Seoul, Republic of Korea from 24 to 26 June 2008. The workshop was jointly conducted by the World Health Organization Headquarters, the WHO Regional Office for the Western Pacific and Novartis Foundation. The workshop agenda was developed following the Field test of ICATT held in Basel, Switzerland in May 2007. 1.2

Objectives At the end of the workshop, the participants will have:

(1) obtained the latest IMCl technical updates and familiarized themselves with lCATT as a tool to facilitate the periodic IMCI adaptation and updating process; (2) discussed various training approaches being implemented to scale up !MCl and explored ways that lCATT can be used for IMCI training in both pre-service and in-service settings at country level; and (3) 1.3 outlined a plan for the early application oflCATT in countries of the Region. Participants

The workshop was attended by more than 50 participants, resource persons and observers from 12 countries (Australia, Cambodia, China, Fiji, Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, Philippines, Republic of Korea, Solomon Islands, and Viet Nam), WHO secretariat from all levels (headquarters, regional and country offices); and a UNICEF representative (see Annex 1). The participants from countries included lMCI focal persons from Ministries of Health, key professionals and faculty from universities, and other training institutions involved in lMCl adaptation, in-service and/or pre-service training. The leading contributor to the development of the lMCI generic guidelines and the rCATT software facilitated the workshop as an international expert. Observers represented a variety of institutions including government agencies, academic faculty and nongovernmental organizations from the Republic of Korea. The workshop was conducted from 24 to 26 June 2008 at the Y onsei University in Seoul, Republic of Korea. Professor Chae Young Moon was appointed as Chairperson, Dr Gochoo Soyolgerel as Vice-Chairperson, and Dr Josefina Cardona-Carlos as Rapporteur for the duration of the workshop. The three-day workshop agenda is presented in Annex 2.

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2.

PROCEEDINGS

2.1

Opening session

The Workshop started with the opening remarks of the WHO Regional Director, Dr Shigeru Omi, delivered by the Regional Adviser for Child and Adolescent Health. It was pointed out that the Integrated Management of Childhood U1ness conceptualized in the mid 1990's was the concrete response to several challenges: (1) to reduce childhood morbidity and mortality caused by five common treatable and preventable conditions; (2) to bring together lessons learnt from distinct disease-specific programmes; and (3) to integrate preventive and curative interventions to increase the likelihood of child survival. While IMCI has been embraced by over 100 countries including 14 countries in the Western Pacific Region, the coverage expansion has been slow. The IMCI Computerized Adaptation and Training Tool is a tool for countries to facilitate adaptation and updating process of national {MCI guidelines and to scale up training coverage in pre-service and in-service settings. All participants were welcomed to a productive, exciting and educational three-day workshop and the Government of the Republic of Korea and Yonsei University were thanked for hosting the workshop. Professor Young Moon Chae, Dean of the Graduate School of Public Health, Yonsei University welcomed the participants to Republic of Korea. In his brief welcome remarks he expressed great pleasure and honor in hosting the ICA TT workshop. He also shared optimism that the new computer facilities of Yonsei University would work well for the workshop and extended thanks to WHO for the hard work in the preparation. 2.2 Overview of IMCI adaptation, implementation, training approaches and pre-service education

The first presentation introduced IMCI in the context of the WHOIUNICEF Regional Child Survival Strategy and the Millennium Development Goal 4 to reduce child mortality by two-thirds in 2015 (Annex 3). The pivotal role ofIMCI as one of the seven core interventions in the Essential Package for Child Survival was highlighted. The status of IMCI country implementation was described. The discussion of implementation was along 15 indicators (input, output and outcome indicators) lifted from the Child Survival Monitoring Framework I and the Global Health Atlas. It was evident that IMCI implementation varied among countries at varying paces. Most countries have the organizational structure to implement IMCI as part of the national child health programme but, with differing capacities in conducting key IMCI activities related to training, health care delivery and even updating of guidelines. This presentation provided the background for introducing IMCI Computerized Adaptation and Training Tool as an option in scaling up IMCI adaptation and training in pre-service and in-service settings.

I

Meeting Report: WHO/UNICEF Technical Consultation on Measuring Progress towards Child Survival, 23~25 October 2007,

Siem Reap, Cambodia

-3-

2.3

IMCI Computerized Adaptation and Training Tool: history, rationale, overview of functions and components

The presentation reviewed the history and rationale ofICATT. It described the three key components: the chart booklet builder, the library and the training set, and introduced the two different interfaces (Annex 4). The "Open" interface allows changing and adapting of the guidelines, updating the library of documents and resources and designing the training programme. The "Closed" interface can be used by the trainee for self-learning and/or by the trainer for teaching. The presenter highlighted the fact that ICATT is not intended to replace the standard II-day IMCI case management course in areas where it is sustainable nor is it intended to be a stand alone training. ICATT needs to be supported by clinical practice and the assistance of experienced facilitators. 2.4 Keeping IMCI up to date

2.4.1 Technical updates The presentation focused on the need to update the IMCI guidelines developed in the 1990's owing to new research results from multicentre, randomized controlled trials. Updates were summarized for the following areas: management of neonatal conditions, diarrhoea, fever, acute respiratory infections, HIV/AlDS, ear problem and infant feeding (Annex 5). 2.4.2 Panel discussion: sharing experiences on IMCI adaptation and updating clinical guidelines Five countries (Cambodia, China, Fiji, Papua New Guinea, Viet Nam) participated in the panel discussion. Panel members were asked the following questions: • • • • • • Have you made adaptations in the IMC[ national guidelines? If yes, what portions did you adapt? If not, why? What processes did you undergo to make the changes? What factors facilitated the adaptation? What difficulties did you encounter as you adapted the new updates? How did you disseminate the new guidelines and what repercussions did it have on pre-service and in-service trainings? If you knew ICATT before, would it have helped or made the adaptation process easier?

All five countries had made adaptations in their national guidelines. With exception of Fiji, the rest had already included the first week of life in the sick young infant module. China and Fiji had removed malaria from their fever box, but Fiji had retained dengue. Among the countries in the Region, only Papua New Guinea had included HIV. China had included rickets; China and Viet Nam had included care for development; Fiji was pilot testing an algorithm for skin infections for inclusion in national [MCI guidelines. China had also produced a single module for IMCI complemented by an exercise workbook and a chart booklet and shortened the course to five days. The other four countries still did the traditional 11 days with some changes in the methodology, like skipping some exercises, replacing individual feedback with group feedback, assigning readings beforehand to save time in the classroom. Papua New Guinea had started to develop its own IMCI training DVD which is perceived by many as reflecting their unique training needs and IMCI approach. Cambodia had

-4started to do basic IMCI II-day course for medical students but was reviewing the methodology as it seemed not to be sustainable. The most important facilitating factor had been government support, without which the process could have not been possible. The staunch support and involvement of the professional societies which is best exemplified in the case of Papua New Guinea was also considered crucial. Fiji said that maybe size made a difference. Fiji is a small country and thus less people were needed to convene and convince. One of the difficulties in updating IMCI national guidelines had been the lack of local evidence to back up the proposed revisions. Most of the researches were done in countries outside the Region. New guidelines implied some policy changes, for example, the need to procure low osmolarity oral rehydration salts (ORS) and zinc to implement the new diarrhoea guidelines. Cambodia has tested the marketing of ORS/Zinc as an Drasel kit in the provinces of Siem Reap and Pursat, but further refinement was needed for nationwide application. On the other hand, China had no problem with supply of zinc. Most countries, with exception of Fiji, seemed to find it difficult to assemble a group of local experts to study and endorse the proposed changes for inclusion in the national guidelines with the consequence that overall, the adaptation process had been taking so much time. The printing of new modules and chart booklets to reflect these changes and the revision of accompanying training materials like the wall charts; the dissemination of new guidelines and the reorientation of facilitators had been challenges that had also required time and additional logistical resources. The discussion ended with the consensus that updating national guidelines to include the results of new research was inevitable and is a top task which all countries are conunitted to accomplish. The general perception was that ICATT could be useful for hastening the process of adaptation and improving training coverage. 2.4.3 Guided tour of lCATT chart booklet builder, library and ICATT adaptation guide All participants, including members of the secretariat and observers were provided with individual computers where the lCATT software had been installed. The guided tour of the ICATT chart booklet builder allowed everyone to navigate through a set of charts containing key management decisions to be taken when confronted with a sick child (Annex 6). Moving through the library allowed access to technical documents and visual materials which can be used to supplement training. The tool allowed participants to modify the guidelines in the chart booklet and add resources to the library. The results of the individual work were checked by the facilitator individually and discussed in plenary. 2.5 1M C I training challenges and opportunities

2.5.1 Experience with e-learning: potential and limitations The presentation introduced Yonsei University as an International Cyber University for Health (lCUH) that has explored and applied the advantages of Internet technology since its establishment in 2003 (Annex 7). It has made possible the increase in market share of e-learning in the Asia Pacific to lessen the disparity in academic resources among countries. In the future, lCUH anticipates the expansion of the e-book to include more courses in various languages. The

-5-

ICUH, with its technology and resources, was seen as a highly capable partner in supporting ICATT implementation in the Region. 2.5.2 Video showing of the IMCI training DVD developed in Papua New Guinea At the country level, it was Papua New Guinea that made the first bold attempt to transform IMCI standard materials into a computer-based format for the following reasons: to facilitate teaching and support adult learning, to promote self learning, to facilitate refresher training, to develop good teaching aids, and to improve the quality of IMCI trainings (Annex 8). The IMCI video in Papua New Guinea was locally adapted based on the 10-step checklist for aU sick children. It captured the country profile and culture which enhanced the video's acceptability to the local health workers. This work is still in progress and initial users see it as an effective tool for improving the quality and coverage of IMCI trainings. 2.5.3 ICATT potential to strengthen and widen training options This presentation described ICATT's potential to support IMCI trammgs in both pre-service and in-service settings (Annex 9). There are various teaching and training models to choose from but the fact remains that any model, including ICATT would require an organization of good clinical practice and the assistance of a good facilitator. In general, ICATT can be used in pre-service training as a teaching instrument for formal IMCI training courses allowing for group presentations and group exercises; as a self-learning tool; as a reference tool; an instrument for distance learning and Internet-based learning. ICATT can be used as a tool for in-service training of health care providers at different levels either on the job, or during formal IMCI courses. 2.5.4 Demonstration and introduction to individual practice with the ICATT training player All participants, members of the Secretariat and observers were introduced into the ICA TT training player. With the guidance of the facilitator, each one logged in as a new student and clicked the button "Start Training". The training set includes a generic IMCI training course and all the components needed to use the training materials. The generic IMCI training course has three components: introduction, care of your infant aged up to two months, and care of child aged two months to five years. Each component may include several parts, and each part consists of one or more training units. The key building block of the training course is the ICATT training unit which has four main elements: READ, SEE, PRACTISE, and TEST. The READ section includes the key steps, further reading and a case recording form. The SEE section contains pictures, videos, and sounds for the respective training unit. The PRACTISE section includes clinical practice instructions and exercises to practice what has been learnt. The TEST section offers trainees the opportunity to test their knowledge through exercises. At the end of each training unit, progress is coded through color coded bars: white - not began; yellow - in progress; green - done; red - failed that is, less than 80% of questions were answered correctly. Those who have been previously trained in IMCI found this training tool a good way to refresh learning while those who were new to IMCI found this an interesting way to obtain new information and skills. At the end of the session, the facilitator gathered the insights and experiences of all who navigated through the training player.

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2.6

Use ofICATT in the Western Pacific Region

2.6.1 Planning for ICATT implementation This presentation outlined the key steps to undertake for ICAIT implementation in countries (Annex 10). (I) Make available the nationally adapted IMCI guidelines which reflect local priorities, realities and needs. (2) Reach consensus on the most appropriate training approach to be used: • • • • • • (3) Group teaching vs. individual learning or combination of both Length of training and amount oflearning materials Balance between theoretical and clinical training Training schedule (uninterrupted course, several training sessions, other approaches) Role and functions of facilitators Method of monitoring and evaluation of test results

Review the generic materials included into ICATT.

(4) Ensure availability of hard copies of nationally adapted IMCI clinical guidelines and clear structure of the training course, as well as electronic version of resource materials for inclusion in the library. (5) Make changes through the Open interface ofICATT and produce the Closed version.

(6) Select and train facilitators according to the training approach including the clinical component. (7) Decide on ways and means of monitoring and evaluation of training performance and quality. (8) (9) Conduct initial training of health care providers. Evaluate and summarize lessons learnt, feedback on ICATT.

2.6.2 Group Work Participants were divided into two groups to discuss the ways forward in planning for ICATT implementation in Pre-service training and In-service training. Participants were encouraged to join the group to which they felt they could contribute more. The two groups had almost equal representation from the participating countries and were facilitated by members of the WHO secretariat.

- 72.6.2.1 Pre-service training Countries are at different stages of updating their national guidelines. Inclusion of certain diseases depends on local prevalence of diseases and its impact on child mortality. Some countries, like the Philippines have developed IMCI pre-service resource materials for nursing students. Several stakeholders are involved in pre-service trammg including non-governmental organizations, professional societies, regulatory bodies, and teaching institutions. ICATT implementation may necessitate the need to add new partners such as information technology experts and donors willing to share in providing the additional logistic requirements to set up computer laboratories. In China, closer collaboration between the Ministry of Health and the Ministry of Education which directly oversees pre-service education should be established. In the Philippines, pre-service education is governed by the Commission on Higher Education but the licensure examination is under the jurisdiction of the Professional Regulatory Commission. The roles and responsibilities of the different stakeholders need to be defined carefully at the country level prior to ICATT implementation. ICATT will require some refinement of teaching methods and skills. Expertise in developing and incorporating training materials in the ICATT player should be developed. The development of an IMCI agenda that allow for a combination of IMCI teaching through the ICATT DVD player and actual clinical practice is important. The capacity of existing training institutions and facilitators to implement computer-based IMCI teaching should be carefully assessed. An inventory of existing resources in the countries should be made to see the gaps that need to be addressed for ICATT implementation. For example, Mongolia could enhance the existing collaboration on information technology and elearning with Y onsei University. An approach could be to draft a multi country proposal to fund ICA TT implementation and submit it to a partner agency such as Australian Agency for International Development (AusAID) for consideration. Countries could embark on a phased approach before launching ICATT nationwide. Performance indicators to gauge the success of ICATT implementation should be discussed with the various stakeholders. For practical purposes, this could be linked to the implementation steps and assessing how far each step had been accomplished. The basic ICATT implementation steps as outlined in the presentation will be followed by most countries, with some modifications depending on respective organizational structures. For example in Cambodia, since the adaptation and updating of the guidelines has been completed, ICATT has to be discussed in the National IMCI Committee. then the present curriculum should be reviewed. In China, the discussions should involve both the Ministries of Health and Education, prior to the preparation of the training materials and training of facilitators. In Fiji, adaptation needs to be undertaken of the current guidelines, and revised/updated guidelines in the ICATT DVD inputted before being used in schools. In Mongolia, the adaptation has been done so the concept of ICATT should be approved by the IMCI Task Force and then introduced to the Ministry of Health and the Health Sciences University. In the Philippines, ICATT should be discussed with the National IMCI committee and Pre-service task force and a subcommittee created to complete the adaptation process. In Viet Nam, the Ministry of Health should complete the adaptation, conduct orientation workshop with stakeholders, conduct facilitators' training, hold a planning workshop, and conduct training at the Ho Chi Minh University as a pilot site.

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The main challenges include translating the materials to the local language; convincing the management of universities and schools to use ICATT for pre-service training; improving the computer skills of the teaching and the training staff; and mobilizing resources and finding seed money to start the pilot implementation. 2.6.2.2 In-service training Most of the countries have updated their national IMCI guidelines but there is interest and need to review them again to see if the new research evidence has been reflected. Since the ICATT is an innovative tool that includes updated information, it is perceived to hasten the process of IMCI adaptation. The adaptation of IMCI guidelines is the responsibility of the Ministry of Health but the process should involve consensus meetings with all key stakeholders especially from the professional and academic groups. Many countries still conduct the II-day case management trammg, with exception of China which had reduced it to five days. Supervisory and refresher training courses also exist. The advantage of using ICATT for in-service training is the potential for shortening the duration of the course and for reaching a wider group of trainees which could not be possible with standard courses because of the long duration and the high cost. The challenges likely to be faced in ICATT implementation are the lack of computer facilities in remote areas whose health workers need training; lack of computer skills among some IMCI facilitators and hence the need to conduct some re-orientation courses; and the lack of clinical institutions that could be used as practicum sites for skills training of the increased number of trainees. The logistic investments for setting up computer facilities will need fresh funds. While the Ministry of Health in most countries is mainly responsible for in-service training, closer collaboration with institutions with information technology expertise needs to be formed.

3.

CONCLUSIONS

3.1

General

ICATT was welcomed as a highly appreciated tool to facilitate keeping IMCI up-to-date through periodic adaptations that can be made more easily in a more user-friendly electronic environment. It was also considered as an excellent instrument to scale up IMCI implementation in pre-service and in-service settings and expand the options how IMCI training is carried out. While some initial investments to build capacity in training programmes and institutions to use ICATT are evident, there was a great extent of enthusiasm about the full potential of ICATT, its long-term cost-effectiveness and other benefits for expediting IMCI scaling-up efforts. 3.2 Early implementation steps for ICATT

It was agreed that the adaptation and updating of the IMCI national guidelines should be completed as a necessary first step. Stakeholders should be oriented on ICATT as this would require some logistics requirements and reorientation of facilitators. Initial experiences in capacity building and training itself should be documented and shared within interested parties to learn from the successes and help solving possible problems.

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3.3

Consolidating partnerships for ICATI implementation

(l) Networks among countries with similar characteristics or geographical accessibility could be useful to support ICATT implementation by regular sharing of experiences and mutual support. The three following networks were suggested to be established:

• • •

"Big" Network (China, Malaysia, Mongolia, Philippines) "Mekong" Network (Cambodia, Lao People's Democratic Republic, Viet Nam) "Pacific Network (Fiji, Papua New Guinea, Solomon Islands)

(2) A forum for discussion on progress in ICATT in the Region should be created in the global ICA TT website to facilitate communication and maintain close contact with the experts. (3) The WHO WPRO should continue to coordinate activities to ensure technical support, capacity building and mobilization of resources. (4) Other agencies which participated in the Workshop were proposed to have a more active role in IMCIIICATT implementation as follows: Yonsei University for technological support; UNICEF for implementation support; and Menzies School of Health Research for monitoring and evaluation.

ANNEX 1

LIST OF PARTICIPANTS, TEMPORARY ADVISER, RESOURCE PERSONS, REPRESENTATIVES/OBSERVERS AND SECRETARIAT

1.

PARTICIPANTS

CAMBODIA

Dr Bun Sreng, Head, Disease Control and Prevention Bureau, Communicable Disease Control Department, Ministry of Health, No. 151153 Avenue, Kampuchea Krom, Phnom Penh; Tel. No.: (85512) 852 824; Fax No.: (855-23) 880 532; E-mail: bun_sreng@online.com.kh Dr Hong Rathmony, Vice Director, Communicable Disease Control Department, Ministry of Health, No. 151-153 Avenue, Kampuchea Krom, Phnom Penh; Tel. No.: (855-16) 885 886; Fax No.: (855-23) 880 532; E-mail: rathmony_hong@online.com.kh Professor Ka Sunbaunat, Dean, Faculty of Medicine, University of Health Sciences clo Ministry of Health, No. 151-153 Avenue, Kampuchea Krom, Phnom Penh; Tel. No.: (855-23) 355 090; Fax No.: (855-23) 430 634; E-mail: kasunbaunat@yahoo.com

CHINA

Dr Dai Yaohua, Director, WHO Collaborating Centre for Child Health, Capital Institute of Pediatrics, No.2 Ya Bao Road, Beijing 100020; Tel. No.: (86-10) 85636169; Fax No.: (86-10) 85622025; E-mail: yh.dai@263.net Dr Zhang Shuyi, Assistant Professor, Capital Institute of Paediatrics, No.2 Ya Bao Road, Beijing 100020; Tel. No.: (86-10) 85695579; Fax No.: (8610) 85695579; E-mail: shuyi_zhang@lbz.com

FIJI

Dr Rigamoto Seforsa Taito, Consultant Paediatrician, Department of Paediatrics, Lautoka Hospital, P.O. Box 65, Lautoka; Tel. No.: (679) 666 0399; Fax No.: (679) 666 5423; E-mail: rigamoto.taito@health.gov.fj Dr Elizabeth Rodgers, Associate Professor, Paediatrics, Fiji School of Medicine, Private Mail Bag, Suva; Tel. No.: (679) 3233515; Fax No.: (679) 3233524; E-mail: e.rodgers@fsm.ac.fj

LAO PEOPLE'S DEMOCRATIC REPUBLIC

Dr Bounleua Oudavong, Deputy Director, Mother and Child Hospital Ministry of Health, Vientiane; Tel. No.: (856-21) 216410; Fax No.: (856-20) 7829797 Dr Latsada Phar.1euang, Technical Officer, Mother and Child Division, Department ufHygiene and Prevention, Ministry of Health, Vientiane; Tel. No.: (856-21) 214010/217607; Fax No.: (856-21) 241924

MALAYSIA

Dr Hii King Ching, General Paediatrician, Paediatric Department, Sawarak General Hospital, 93586 Kuching Sarawak; Tel. No.: (60-82) 276666; Fax No.: (60-82) 341033; E-mail: hiikingching@gmail.com

Annex 1

MONGOLIA

Dr Soyolgerel Gochoo, Officer, Department of Medical Service Division, IMCI National Focal Point, Ministry of Health, Government Building-8 Olympic Street-2, Ulaanbaatar; Tel No.: (976) 51263757; Fax No.: (976) 11320916; Email: Soyolgerel@moh.mn Dr Galbadrakh Rentsendorj, Chief, Training and Cooperation Division Maternal and Child Health Research Center, Ulaanbaatar; Tel. No.: (976) 88110095; Fax No.: (976) 11362633; E-mail: galeaI05@yahoo.com Dr Oyukhuu Shagdar, Lecturer, Department of Family Medicine, Health Science University, Ulaanbaatar; Tel. No.: (976-11) 453660; Fax No.: (976-99) 127075; E-mail: oyukhuu_S2@yahoo.com

PAPUA NEW GUINEA

Dr David Mokela, Chief Paediatrician, Port Moresby General Hospital Private Mail Bag, No. 1, Boroko, N.C.D.; Tel. No.: (675) 3248200 Fax No.: (675) 3250342; E-mail: dkmokela@daltron.com.pg Dr Gilchrist Oswyn, Paediatrician, National IMCl Coordinator, Alotau Hospital, P.O. Box 402, Alotau, M.B.P.; Tel. No.: (675) 6411200; Fax No.: (675) 6410040

PHILIPPINES

Ms Ma. Lucila Agripa, Nurse VI, Department of Health, Centre for Health Development - Bicol, Legaspi City; Tel. No.: (054) 4830840 Fax No.: (054) 483 0840; Email: mlsagripa@yahoo.com.ph Dr losefma Carlos, Paediatrician, UERMMC, Member, National IMCI Preservice Task Force for Medical Schools, Rm. 105, R. Magsaysay Blvd., Ouezon City; Tel. No.: 715-0796; E-mail: jccarlosmd@yahoo.com Ms Elizabeth Roxas, Dean, College of Nursing, Baliuag University, Gil Carlos Street, Baliuag, Bulacan; Tel. No.: (044) 766-0398; Fax No.: (044) 766-3345; Email: erroxas2@yahoo.com

SOLOMON ISLANDS

Dr lames Auto, Chief Consultant Paediatrician, National Referral Hospital P.O. Box 349, Honiara; Tel. No.: (677) 38246; Fax No.: (677 24243 Email: jauto@nrh.gov.sb;jmsktrina@yahoo.com Dr Doan Thi Ngoc Diep, Instructor of Department of Pediatrics UMP 217 Hong Bang, Q5, Ho Chi Minh City; Tel. No.: (84-8) 989 II 05 Fax No.: (84-4) 943 3740; Email: diepkhanh93@vnn.vn Dr Nguyen Huu Ninh, Manager and Lecturer, Quangtri Medical School Dongha Town, Quangtri Province; Tel. No.: 0982079255 Fax No.: (84-53) 566187; Email: dminh255@yahoo.com Dr Nguyen Thi Thi Tho, Researcher, National Institute of Hygiene and Epidemiology, No 1 Yersin Street, Ha Noi; Tel. No.: (84-4) 9710791; Fax No.: (84-4) 9718490; Email: poemhnvn@yahoo.com

VIETNAM, SOCIALIST REPUBLIC OF

Annex 1

2. TEMPORARY ADVISER

Dr Juanita A. Basilio, Division Chief, Child Health and Development, National Center for Disease Prevention and Control (NCDPC), Department of Health, Bldg. 13, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1000 Manila, Philippines; Tel. No.: (632) 732 9956; Fax No.: (632) 711 7846; Email: nitzbasilio@yahoo.com

3. RESOURCE PERSONS

Dr Ivan Lejnev, ICATT Consultant, Novartis Foundation, Chemin de l'Erse, 4a 1218 Grand Saconnex, Switzerland; Fax No.: (41-22) 7914853 Email: lejnev_ivan@bluewin.ch Professor Chae Young Moon, Dean, School of Public Health, Yonsei University, 250, Sungsan-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea, Tel. No.: (82-2) 392 7724; Fax No.: (82-2) 392 7734; Email: ymchae@yuhs.ac Dr Naor Bar-Zeev, Fellow, Menzies School of Health Research P.O. Box 41096, Casuarina 0811, Northern Territory, Australia Tel. No.: (61-8) 8922 8196; Fax No.: (61-8) 8927 5187 E-mail: Naor.Bar-Zeev@menzies.edu.au

4. REPRESENTATIVES/OBSER VERS

KOREAN FOUNDATION FOR INTERNATIONAL HEALTH CARE KOREA INTERNATIONAL COOPERATION AGENCY SEOUL NATIONAL UNIVERSITY CHILDREN'S HOSPITAL

Cho Myong Sun, Research Team Manager, Korean Foundation for International Health care; 16-2 Yeouido-dong, Yeongdeunpo-gu, Seoul, Republic of Korea; Tel. No.: 82-2-6910 9060; Fax No.: 82-2-386-3155; E-mail: mscho@kfih.org Dr Oh Chung Hyeon, Health Research Officer, Health Team, Korea International Cooperation Agency, Seongnam-si, Gyeonggi-do 461-370, Republic of Korea; Tel. No.: 82-31-740-0334; Fax No.: 82-31-740-0668; E-mail: och7512@koica.go.kr Dr Cho Hee Yeon, Department of Paediatrics and Adolescent Medicine Seoul National University Children's Hospital, 28, Yongon-Dong, Chongno-Gu, Seoul, Republic of Korea; Fax No.: (82-2) 2072-3917; E-mail: mbread9@medimail.co.kr Dr Choi Hyun Jin, Department of Paediatrics and Adolescent Medicine Seoul National University Children's Hospital; 28, Yongon-Dong, Chongno-Gu, Seoul, Republic of Korea; Fax No.: (82-2) 2072-3917; Email: ianuri@hanmail.net

Annex I

UNITED NATIONS CHILDREN'S FUND PHILIPPINES

Dr Marisa Ricardo, Health Specialist, Health and Nutrition Section, UNICEF Philippines, Yuchengco Tower, RCBC Plaza, 6819 Ayala Avenue, Makati City; Tel. No.: (632) 901 0145; Fax No.: (632) 729 4525; E-mail: mricardo@unicef.org Dr Lee Byung Hwa, Research Associate Professor, Graduate School of Public Health Yonsei University; 134 Shinchon-dong, Seodamun-gu, Seoul, Republic of Korea; Tel. No.: (82-2) 2228 1520; Fax No.: (82-2) 392 7734; E-mail: leebh@yuhs.ac

YONSEI UNIVERSITY

4. WORKSHOP HOST SECRETARIAT

Mr Chang Dong Seok, Director of Administration, Department of General Affairs Graduate School of Public Health, Yonsei University; 134 Shinchon-dong, Seodamun-gu, Seoul, Republic of Korea; Tel. No.: (822) 2228 1505; Fax No.: (822) 392 7734; E-mail: cds@yuhs.ac Ms Kim Ji Eun; Research Assistant; Graduate School of Public Health; Room No. 321, 3rd Floor; Yonsei University; 134 Shinchon-dong, Seodamun-gu, Seoul, Republic of Korea; Tel. No.: (82-2) 228-1536; Fax No.: (82-3) 92-7734; E-mail: jiekim@yuhs.ac Dr Lee Hoon Sang, Senior Researcher, Division of NIP and VPD control Korea Center for Disease Control, 194 Tongilo, Eupyeong-Gu, Seoul, 122701, Republic of Korea; Tel. No.: (82-2)380-2918; Fax No.: (82-2)3528235; E-mail: hsl810@hotmaiLcom Mr Kim Boram, MD candidate, Yonsei University College of Medicine, Seoul, Republic of Korea; lae-lung Hak-Sa #411, Daeshin dong, Seo-Dae-Moon Gu, Seoul, Republic of Korea; Tel. No.: (82-19)644-1441; Fax No.: (82-35) 2-8235; E-mail: tearfulsky@hanmail.net Ms Oh Sinae, MD candidate, Yonsei University; #215 lejung Haksa, 97 Daeshindong, Seodaemoongu, Seoul, Republic ofKorea~Tel. No.: (82352)8235~Fax No.: (82-11) 9780-8545~E-mail: osinae@hotmaiLcom

5. SECRETARIAT

WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC

Dr Marianna Trias, Regional Adviser in Child and Adolescent Health, WHO Regional Office for the Western Pacific, United Nations Avenue, P.O. Box 2932, 1000 Manila, Philippines; Tel. No.: (63-2) 528 9867; Fax No.: (63-2) 521 1036; Email: triasj@wpro.who.int

Annex 1

Dr Emmalita Maiialac, Medical OfficerfTemporary AppointmentProfessional, Child and Adolescent Health, WHO Regional Office for the Western Pacific, United Nations Avenue, P.O. Box 2932,1000 Manila, Philippines; Tel. No.: (63-2) 528 9871; Fax No.: (63-2) 521 1036; Email: manalace@wpro.who.int Dr Wen Chunmei, Programme Officer, WHO Representative Office in the People's Republic of China, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie, Chaoyang District, Beijing 1000600, People's Republic of China; Tel. No.: (86-10) 6532-7189; Fax No.: (86-10) 65322359; Email: wenc@wpro.who.int Dr Niklas Danielsson, Medical Officer, WHO Representative Office in Cambodia, No. 177-179 comer Pasteur (51) and 254, P.O. Box 1217, Sangkat Chaktomouk, Khan Daun Penh, Phnom Penh, Cambodia; Tel. No.: (855) 23-216610, Fax No.: (855) 23-216211; Email: danielsonn@wpro.who.int Dr OmelIa Lincetto, Medical Officer, WHO Representative Office in the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane, Lao People's Democratic Republic; Tel. No.: (856) 21 413-431; Fax No.: (856) 21 413-432; Email: 1incettoor@wpro.who.int Dr Salik Govind, Medical Officer, WHO Representative Office in Mongolia, Ministry of Health, Government Building-8, Ulaanbaatar, Mongolia; Tel. No.: (976-11) 32 78 70; Fax No.: (976-11) 324683; Email: govinds@wpro.who.int Dr Norbert Rehlis, Maternal Child Health Adviser, WHO Representative Office in Papua New Guinea, 4th Floor, AOPI CENTRE, Waigani Drive, Port Moresby, P.O. Box 5896, Boroko NCD, Papua New Guinea; Tel. No: (675) 325 7827; Fax No: (675) 325 0568; Email: rehIisn@wpro.who.int Dr Howard Sobel, Medical Officer, The WHO Representative Office in the Philippines, 2nd Floor, Bldg. 9, National Tuberculosis Centre Building, Department of Health; San Lazaro Hospital Compound, Sta. Cruz, Manila, Philippines; Tel. No.: (632) 338 7479; Fax No.: (632) 338 8605; E-mail: sobelh@wpro.who.int Dr Hoang Thi Bang, National Programme Officer, WHO Representative Office in the Socialist Republic of Viet Nam, 63 Tran Hung Dao Street, Hoan Kiem District, Ha Noi, Socialist Republic of Viet Nam; Tel. No.: (844) 943 37 14 to 36; Fax No: (844) 943-3740; Email: bangh@wpro.who.int Ms Kim Minkyung, Intern, Child and Adolescent Health, WHO Regional Office for the Western Pacific, United Nations Avenue, P.O. Box 2932, 1000 Manila, Philippines; Tel. No.: (63-2) 528 9329; Fax No.: (63-2) 521 1036; Email: killlm@wpro.who.int

Annex 1

WHO

HEADQUARTERS

Dr Samira Aboubaker, Coordinator, Country Support Team, Child and Adolescent Health and Development, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland; Tel. No.: (41 22) 791 2618/3286; Fax No.: (41 22) 7910746; E-mail: aboubakers@who.int

WORKSHOP ON THE IMCI COMPUTF:RIZEO ADAPTATION AND TRAINING TOOL 24-26 June 2008, Seoul, Republic of Korea AGENDA Time 08:00 - 08:30 08:30 - 09:00 09:00 - 09:45 DayI, TUC5dJll', 24 June Registration (l) Opening (including group photo)

WPRl2008/D HP/04/CHD( 1)/2008.1 3 June 2008 English only

Time

I I

Day 2, Wednesday, 25 June (4) IMCI training challenges and opportunities (a) Experience with e-Iearning: potential and limitations (b) Video showing of the IMCI training DVD developed in Papua New Guinea

Time

D~ Tbursday, 26 June (5) Usc of ICAIT in the Western Pacific Region

08:30 - 9:15

08:30 - 09:30

I

(al Planning for ICATT implementation

I (2) Overview of IMCI adaptation, implementation, training approaches and pre-service education

•

I

09: I 5 - 09:45

General cond itions, requirements and possibilities of ICAIT Practical steps on how to start using ICAIT

09:30 - 09:45 09:45 - 10: I 5

•

I

Coffee/tea break (3) Keeping IMCI up to date

09:45 - 10:15 10:15 -10:45

I Colree/tea break (c) ICAIT potential to strengthen and widen training options (d) Demonstration and introduction to individual practice with the ICAIT training player • Introduction to the navigational tools of the training player Individual practice with selected elements of the leAIT training player 09:45 - 10: 15

I Introduction to the group work: implementing ICAIT in the Western Pacific Region

10: i 5 - 1 I :00 I 1:00 - I I : I 5 11:15- 12:00

<a) Technical updates 10:45 - I I :30 10:15- 12:00 I Coffee/tea break (b) Group work (each group with members from different countries)

I Introduction to the group work (b) Group work: sharing experiences on 1M CI adaptation and updating clinical guidelines 11 :30 - 12:00

Group I: In-service training •

Group 2: Pre-service training

13:00 - 14:00 14:00- 14:45

I Plenary discussion of the group work I (c) IMCI Computerized Adaptation and Training Tool (ICAIT): history, rationale, overview of functions and components (d) Guided tour of ICAIT chart booklet builder

13:00- 15:00 15:00 - 15:30

I

LUNCH BREAK Continuation of individual practice

13:00-15:00

I

(c) Presentations, discussion and general agreement on the way forward

I Coffee/tea break 15:00 - 15:30

I Coffee/tea break I (d) Workshop summary (6) Closing

15:30 - 16:30 I

•

Summary discussion of the results of individual work from day 2

15:30- 16:00

14:45 - 15:15

16:30- 17:15

(e) Different ways to use ICAIT for training of various categories of health professionals

15: 15 - 15 :45 15:45 - 16:45

I Coffee/tea break I (e) Individual work on computer with chart booklet builder, library and ICAIT adaptation guide

17: 15 - 17:30 I Summary of day 2

16:45 - 17: 15 17:15- 17:30 18:00 - 20:00

I

(f) General discussion ofthe results of individual work

~ N

I Summary of day I I Reception

:><

World Health Organization

AK\JEX3

• RCM 2005, Noumea. New Caledonia

Overview of IMel Implementation in the Western Pacific Region 24-26 June 2008 Seoul, Republic of Korea

'RCM 2007, Jeju, Republic of Korea

The Regional Strategy offers a unified direction in saving children's lives.

WHOIUNICEF Regional Child Survival Strategy To reduce inequities in child survival and achieve national targets for [vlDG4 by aCCelerating and sustaining actions to reduce childhood mortality ObjecUves: 1. To improve access to and utilization of the essential package for child survival particularly in areas of greatest need; and

Essential Package for Child Survival • Skilled attendance during pregnancy, delivery and immediate postpartum • Care of the newbom

• Breastfeeding and complementary feeding • Micronut,ient supplementation • Immunization of children and mothers

2. To provide an enabling environment for child survival where political will, financial and human resources match the burden of disease

-i~'"

-IMCI components and intervention areas

-. '

• Cosl;,d plans · """ltIl care f'n.aI1~irg • Avallab;illy of IMGI drugs • Quality imp~oveme:1: and

'--

~

C;C;C::C:;:C",,;;] supervision al health facilities • R"ler~al pathways and ser,.,ces • Hea!m mf.:lrma"j;:Orl $Y!>t!.lm • IMe! "rod health seclDr relDrms

Annex 3

World Health Organization

Status of IMCI Implementation in WPRO YES NO

Status of IMCllmplementation in WPRO YES 5. Supportive supen:ision after IMel training

NO

!I"

IMGI as part of national I poficy or national child i health plan

CAM, CHN, FIJ, LAO

MAA,MOG, PHl, PNG,SOl, VTN VTN, SOL

CAM, CHr{ FlJ, LAO, MOG. VTN, PNG CAM, CHN, FlJ, LAO, MOG, PHL, VTN CAM. CHN, FIJ,

IPHl, SOL. PNG (2008), SOL

2. [MGI national programme CAM, CHN. FIJ, LAO, MAA, MOG,PHL, PNG manager Of coordinator 3. Support from

6. IMCI review meetings

nationalisub-national stakeholders 4. Child health budget

CAM, CHN, FlJ, LAO, MAA, MOG, PHL, VTN, PNG , SOL CAM, CHN, FIJ, MOG,

I

(. Integration into preservice education

MAA, VTN,SOL I

LAO, MOG, PHL, VTN, PNG, SOL

Includes IMCI

PHL, PNG,LAO

Status of IMCllmplementation in WPRO ::0:75% 8. Proportion of ciistricts implementing tMel

Status of IMCI Implementation in WPRO ;;::75% 11. Proportion of i': level HF with all essential

50 - 74%

< 50%

50- 74% CHN

< 50%

MOG CHN, FIJ, VTN, PNG

ICAM, rlJ

jPHL,VTN. ,SOL ICAM,MOG

'CHN

mej)cines 12. Propo:tion of 1st level HF with sick child

CAM,FIJ, LAO, MOG, VTN

PNG. SOL

9. Proportion of planned facility based trainings done in 2007

CHN, MOG, VTN

IFIJ, LAO, PNG. SOL CHN(village), FlJ, VTN, SOL

recording forms FIJ, MOG

10. Proportion of planned community based trainings

ICAM- 0%

VTN

13. Proportion of 1,1 level HF with 60% or more HW with IMel training

CHN (township), MOG

I

Status of IMCllmplementation in WPRO ;:::75% 14. Proportion of medical. CAM, FlJ, nursing schools giVing pre- MOG, VTN (MDs), PNG service IMCI

Adaptation to IMCI content • CAM, CHN, MOG, PNG, \/TN revised the sick young infant module to include the 151 week of life. PHL is in the process; Wheeze and sore throat are included in F1J, MOG, PNG,VTN; CHN, FIJ .MOG removed Malaria fr::>m their national gUidelines; CAM, FIJ, LAO. PHL, VTN included Dengue in the fever box; PNG included H1V;

50-74 % SOL

< 50% I PHl,

CHN, VTN (others)

• •

15. Proportion of com HW who received C-IMCI training 16. Proportion of sick UF given ABfAM correctly 17. Proportion of caretaker.; knowing 2 DS

MOG

I CAM, FI.;'.

LAO,PHL SOL, VTN CAM, CHN, FIJ CHN, FIJ, MOG MOG, \/TN, I PNG

• •

(pilot) VTN, PNG (pilot)

• •

PHL & VTN adapted Care for Development CHN & MOG included Rickets;

• FL' is pilot testing an a,'go,ithm for skin conditions.

World Health Organization

Challenges to IMCI training • [Mel training is complex Extensive set of competencies are integrated; Adaptations require updating and printing of new materials: Theory is supplemented by clinical sessions; Various training methodologies are employed to ensure quality.

Technical Consultation on IMCI training Nov, 2007 Main objecllves: • To review IMel training approaches and make recommendations in relation to new approaches to facilitate increased IMel coverage while preserving its impact on health worker performance

• Training duration

IS

long leading to high cost of training

• Training needs skilled course director, facilitators and clinical instructor and appropriate training sites High proportion of practice sessions ,. Facilitator: participant ratio affects Quality

• T 9 review IMCI pre-service experience and propose ways forward

Major findings from surveys on IMCI training • The results showed that the integrated approa~h of JMer is beneficial and should be continued;

• A survey of [Mel (in-service) training approaches in 26 countries from 6 regions - 3 qU2stionnaires: for programme people, trai'ners, health workers

• IMCr chari booklet is an essential component of any IMCr training package; • Clinical practice is an important and non-negotiable part of IMCI training package; • The main b"miers to rapid acceleration: - InadeQual9 funds for training; - long durafion d training; - shortage of facliltl.lors {clinical instructors; - lack of commitment of national authortlies; - fast lum-over of trained health workors

• A review of published and unpublished studies on [MGI training: standard versus shortened courses - A meta-analysis that compared the effectiveness of the standard (11 day) IMCI in-service training with shortened training «11 days)

- Finding from other studies on training duration • A Zambian study that compared the standard' 1 day with a 6 day IMGI training course concluded that skills of trained health workers were comparable and that the shortened course was 40-50% cheaper.

Meta-analysis • A meta-analysis that compared the effectiveness of the standard (11 day) tMGI in-service training with shortened training «11 days) suggested that the standard in-service IMel training course is more effective than short training; although the magnitude of the difference is'unclear.

• A similar study from Kosovo showed no Significant difference in [MGI care by doctors trained in B-day versus 11-day course. However, the training cost per participant fell from $430 for 11-day standard training to $240 in 8-day course. • 80th studies emphasized the importance of regular monitonng of health workers trained in IMGI for successful implementation of the strategy.

Annex 3

World Health Organization

Cross sectional survey on pre-service IMCI • 83% of 36 countries have incorpJrated Pv1CI ir.to the teaching curriculum. • Early involvement of academic staff and commi:me:1t of MOH and stakeholders have facilitated Implerrematioi.. • The main challenges for pre-ser\llce IMCI Implementation included - lack of sustainable commit.'TlemJ,eadersnip Jf na:io~a: autho,ities. - complexity and diversity of cUrriculum across the different teaching institutions: - limited availabili:y of reS::lurC<;JS and - large number of students making logistics and organization of b:",.""Ci.inical , __, and supervision difficult. • il1tr:du:ed I.~CI

\/a'iab!2

Yes

%

Percent of countries with pre-service IMCI:

:ntc- med.cal schOJls {NolJ) s:hcols (~3~ >.-~

25 26 26 12

~~:a .!~CI .~tc ~ara·medl:a.

: 79 I

7.

• Inci\;jec 1),1: .;..

~LestJ.:;r.s

i1 S:Jde,l\ exa'T)S

76 I

35

' . . . c-

'/';~i"lild~.kI~Haaith .

:. ~:.:::.;:

Conclusions from technical consultation • Many countries globally, and all 26 coun,ries included in the survey of in-service lMCI training apprc2ches, a~e cu~~ently conducting IMCI courses shorter than 11 days: Some ::;:)unt~ies are only conducting sh::.rtened IMCI tourses. whilst others are offering both the 11 dc') course and shortened courses • Many C:Juntries have also introducec:i and Implemented pre service IMCI i:l r.ledical and pai8r7ledic3. s:;hools

Conclusions from technical consultation • Adaptations to IMCI training are made and these include' -- red:.Jcing \he amount of ~eading, ~ eiir:,j;-,ating rec",nca.nt text, reducing the number of exercises and Individual feedback an:; increasing group w'Jrk I group feedback

• However, measuring quality of training and health

worker skill post-training remains a challenge particularly in the context of pre-service training

Recommendations • IMCI should focus on a measurable set of core c:Jmpetencies that have maximum impact on under-five mortality. • IMCI training should stimulate life-long learning: a shortened repackaged core course based on core comp:21encies shoul·j lay the foundation for ongoing clinical mentoring

Recommendations • Develop a broad strategy and plan for increasing IMCI coverage • Explore feasible ways of strengthening monitoring and evaluation of in-service and pre-service IMCI training. This will facilitate advocacy for II,,\CI at national, regional and global levels • Strengthen linkages with and seize opportunities posed by other well-funded strategic object;ves relevant to child health at district, national and global levels e.g. EPI, HIV, malaria to accelerate coverage oflMCI

• Ongoing clinical mentoring should maintain and reinforce health worker skills, and intmduce J te2ch additional skills to Improve child survival. Such ongoing clin.ca.1 rr,entonng should ideally be conducted as on-t~e-job training

~i1ifl~~~~;~~

World Health Organization

Options for IMClln service Training • •

"NEW" Training Methodologies In addition, experts who convened in Ababa, Ethiopia in March 2008 identified methods which could potentially accelerate training such as: • Skills stations

Standard course

11 Days

Shortened standard course that only addresses core competencies agreed upon during the 2007 technical consultation on !MCI training HDrizontaJ modular course with final inlegralive/ synthesis module One training course. tnat addresses all modules in an off-site training facility TrOlning IS divided 11'1 2 par~s; part 1: s&lf troll'lin9 for the horizontal modules and part 2; synthe.sls workshop in a

I

•

• Case books • Clinical mentoring • New & improved audio visuals e.g. video demonstrating counselling

training facility or done by 0 qualified supervisor on site of "fhe trainee Self learning: paper-based, multi-media computer· based

ANNEX 4

Speeding-up adaptation of generic guidelines for country use. Currently it is a long and cumbersome process ....

ICAD - innovative software To support WHO/UNICEF strategy for Integrated Management of Childhood Illness

Ensuring periodical updates of national and sub-national

IMO guidelines to respond to local health needs. DJrrently rarefy donI! at country level_. Increasing the number of available training options and

IIMel)

hopefully as a result tralnlng.covt:ragt:. Currently It Is still low to give significant impact...

Production requires considerable flnanciallnvestmen

and In most cases quality production at coontry levells not affordable_. In most cases developed for individual use with individual computer... Impossible to change after Initial production ...

There is common agrt:ement amons educators that computers will never complt:teiy eliminate human InstructOf"S and other forms of educational delivery ... However e-Iearning gfves many advantages among them: 2S pare.nt _r tndltJon.1 mIItho.b Conslrtency In deJlverv ofth"llIChn!c11 tontent S.1f·paclfll tor slow or qulek IAmen; redUCIIS rtt." .nd Incr.asas Atishetiotl Expert know'-<lee is eommunlalted, but mor.lmporunlty upt\lted, with ,oocI ,·lAmlnl Proof ot eompJ.tion and c.rtftlcatlan, .,santlal ,J.m.nts of traln;nl InltJ.tlv"l, un 1M ao.rtomat"d Rltduc:ed overaU con Is the11ncle most Intlullntilll tKtor in adoptinc" "'.mlne .nd _. IMOY othet"s __ t...mln, time, re<:iuc:e4,.n ........'" CJf40 to 60 pere.nt Inaeand retllntion and applutlan to th"job awrac" lIn Incl"llu, of

~

May net covertopiuwhidl.re prioritytodly_.

Often does not reflect locil needs and priorities...

Tralningshould not refyentirt:ly on ust: of a computer on!yit needs to be supported by dinical practice ... Combination of learning and teaching tools implies free navigation Quality control Is entirely responsibility of national or Institutionallevt:1 Assistance of an experienced facilitator Is highly recommended ICATTwiJl be good In GOOD HANDSIII

Annex 4

To allow users (countries) to change the ICAn content practically at any time when it Is need~ ...

To combine In one product individual training tool, and

Computerized software application allows

Combines development and teaching tool in one application Allows technical and pedagogical adaptation of the Instructional materials

effective teaching tool, e.g. be simultaneously useful for learning and teaching ,..

Does not require any speciallzed

To allow change not only technical content by also entire structure and sequence of the training programme ...

computer training for developmental phase lanlUage and commercial software

To be flexible In accommodating local needs and ambitions... Se user friendly for non-computer wizards...

independent can be used fo( teaching and for

individual or group leamtns

The builder permlU the usy .diIPQtion iilnd IOQlI update of WHO e1inlClli ,u1deliroe5 developed Ind summarbe them in iii

"Open" lnteriace· allows to do vlrt1.illly everythin& o.,nle/,<:bpt Ivldtlmu .nd u..ta ma~c_nt flow ch.rttto:.. Updlte Il!nry of

ch.rt booklet according to onion.1 or sub-nnion.1 ,ulde[jne5. Ubrary InduOes r.fere~ Ind edUQtion.Il rNlterials on IMO and rel.ted child he.lth issues developed by WHO and other International agencies. Trainlngs~

documenu, and other ,...;oursu Oesen tn.nlnC

• Contains generic tl'1lloiol course, Ind allows eny adaptation of the leneric m ini", mlterials. • The mini", apj)/'oach an be: chosen to suit loal needs and i!!J ~he tralnlnl courses adapted accordinitv·

pt"OI"'' '.... CTraining Player ~ ·00s1!Cf" tn::l~ Intar1ata. wh let. eln be lISe<! by. uainM fM setf4elrni"l • by.tni" ..... fottucn.,..

....,

~~

Chlnies immediitely visible In preview uea Res.ources an be added or deleted In the content tree All components Ichart buUder, ribnry, traini", set) on one tree No speclat computer skills needed

Suluble fOf ind'vidu.1 tra ining. Indlldlnc setf-le.rnini usln, IUUened order of t~inirl' ... MJy be Jsed by. trainer for dau-n:x>m teachln, (free Nlviption throu,h uainln,ls possible) ._

Iteep.!: track of procre» for every indlvidual student... Provides Immediate feedbadt on practice exercises...

~~::I~~~~e

Contains teachil'll lids for I tramer_.

Annex 4

READ Includes Infonnatlon and mklilOthe

""--

rel8reflCe materlebi (&CXitionai reaellng)

~...,.

I •

PRACTISE includes VariOus exerds8s

with mmedla1e

TEST lrocIucles Test Questions. wI1h

feedback \0 trainee and guidance for clinical practice

""'"-~ available only from fac:l~tator

~~: !:r ~:

Time for classroom ~Inlnt: uslne ICATT-

based approach Is 2.5 times less than elurini S3ndard fI"IOItl\odoloev

La" tuchar Il"Itel"lslveICATT provides immadiata feedback al"lel 1IM1 possibility to rev~w quleldy naw il"lformatiol"l No tima ••vlne for tlil"liCllll pl"lIctice, but better flel(ibility 'l"Id mora Inchil"lll optio"",

Annex 4

aen .. wwraCI • Mor.hNIthWOlbn~bt",~t1IiIMG In,,,,,"-pWIod Dfm.. • c-dd~'-used_Mrof~opt/oIt< ~lutnIro&.poup tudtin&. cRNIQ ......... ~ 81ttltl' QuaDty TaiIored~ .... pp"....t.as".,

InIiMduol PI:IUP' ofhuIUI ~

Use 01 quic/dv .. pelon:" local auldeinH 1ftsU1II:~"""N~1nWrw

ICATT Is designed to support IMel training programs both In P~seMoe settinas- Medial unlverntles, mediQllnd ~t1Imedla' schoob In-service - 10 train he.lth care providers of different levels either on-;ob, or durlne formal courses Any type of IMO tCATT-bued training should Indudl!: solid

"Nt . "k bI1ween h-...w;. ... d~. . . . tnobIirc

Benlr lise of rMnpo_r • 1N:r•• sedpoalblityfol'·~·~ ......... _au-limeof ........... IbHfIU fI'oI'II tt.ir diftIcI

dinical practice - to ensure clinical skills acquisition.

• L...... ..... lnd .... pto~ . . . . . . Cost .ffK!lYet\H1 SlIoft_OloInIn&tIm. IlitcruMd IlWllbef .., printMI fNtaWillHoClK .... tniooq ktt.. ratio ullI>er-lnoIne,

however comprehensive IMa tralnin, win r~uire assistance of a good facilitator I

Many different teachlng/learnirll programs can be used.

ANNEX 5

IM CI Technical Updates -=IQ/~<;f,.. ~on....,~~

century New research results are emerginl- more emphasis on

_d"*",,,

Improving Management of

Childhood Illness

- --~ o - "'= a--roo{i.';QJ

emphasis has been on research findings from muttlc~e, randomized, controlled trials

Three types of updates: Essenti,r Adcfrtloral

Situation.1

MANAGEMENT OF DIARRHOEA

Treatment of dehydration with ORS solution (or wtth an

Intravenous electrolyte solution In cases of severe dehydration)

Continue feeding or increase breastfeeding durinl . and Increase feeding aher the diarrhoeal episode Use antibiotics only when appropriate (I.e. bloody diarrhoea )

and abstain from administering anti..cfi arrhoeal drugs

0-5m

6-1 1m

1 )'Iii"

Age group

____ --_..__ ._L_ .------2 )'IM 3 )'H1S 4 YNtS

Advlse mothers of the need to Increase fluids and continue feeding during future episodes Provide children with 20mg per day of zinc for 11H4 diJYS

----....._ 01 _ _ _

Annex 5

NaCI NaHC03

'CI

3.58 2.5 g 1.5 g 20g

,.

Na+ 90 mEq/I

20 mEq/I 30 mEq/I

He03 CI· Glucose

Sodium mEQ/l

Glucose

Osmol

mmol/l

mOsmol/i

Glucose

SO mEqfI 111 mmol/l 90

111

331

• Osmolarity 331 mmol/l 90

111

311

... ---,_ - .. -- ~

.... _c.Mr1oI ~,

~lR101~

.... ,!!SQ.. ~ltJ1;o·

,"""-

!a'P:

-.,_:W'"

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WHOl~"

1/aI(~SClI

i~~ ..uI)

.

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•

lUS(O.ll'Io1lll

~U3\o' ... ,.Gr:1! UI!\I.,4laU5) Il:11(O)oIIa~llU

-

_ _ _ _'1M

.. _l1li III _I'D!

lW!oa~

-- " U

~.ll(V.QIIIO''l1)

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:u u U

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OZlQ:l06lalJf}

.. 'I101/4.2:N:_UIIII

O.:2(O.t11'Ia".cs) OJ! (!I.cal"')

~-

'Cl 4lllloU".11e4t 1.4 ...1l7(...,"'100AU! U ..., . ,........ o.lII1)

t • .ul1t..... iUIlII

14",0111

...

~----

-'" "

"" " "" ,--

Q.lI{O.47lall.ll)

-• ,-

21.1 ~1.u.t'.-4.IJ.1

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•

1111 _ _ c.1IQI

Odft ..... t~ CUo.'J

lIM

Q/H

1~1~~ ... "" '" "" . m.~. f~~

.... • ... "...

(115% CI S""j

....... ra~ II

Stool output, the volume of liquid stool lost during diarrhoea, is reduced bv 25 to 30%; Vomiting. a frequent associate of diarrhoea, is reduced bV 30%, and The need for unscheduled iv fluids is reduced by more than 30%.

.... " '" ... 'U

Q.7. (025. 2.11) us iO,r: IaUIi} 0,41 fU1 IIUll U4f1.'I11.~

U15(O.lDIt2.t2) G.lIlOlIIIOHS}

0.;1

O$2}

Q..OI

'"'

1

f_CCIIbaI

"

,~

Annex 5

The global group of experts recommended that: I sin,Je ORS solution be used Ind thlt this ORS solution contain 75 mEq/I of sodium Ind 75 mmolll of .Iucase. Ind hive. total osmolarity of 245 mOsmol/l; this reduced osmolarity ORS be used In pilce of mndard ORS fCf treltment of adults wlth chole~,

15% reduction In duration of acute diarrhoea 24% reduction In duration of persistent diarrhoea 42% reduction in treatment failure or death In persistent diarrhoea

,

-----

"india, n .. ·a.ngl.clKh.1119 ·In~. 200 'india, 2OO

• , ....",,'" ,

l~ + I.>--+-< >--+-<

I

Indonesl.. 1", Indla,1n Senllla<lul\,1n India, 20D India, 2DO NepaCZOO • .,glad.sh,2OO

• , , , , ,

r '~ ~ ~ 'T' i-' ."

Pooled

,

Brazil

Zinc supplementation for lO-~4 has longer term effects on childhood Illnesses in the 2-3 months after treatment 34% reduction In prevalence of diarrhoea • 26% reduction In incidence of pneumonia

MANAGEMENT OF ARI

-

--'---

Annex 5

• Duration of therapy 3 VS. 5 days amoxidllin-

• Twice daily amoxici llin Twice vs. thrice daily Pharmacokinetic study-

Pakistan 3 vs. 5 days amoxicillinIndia

,.""

lO.,.

50l.YS

n;893

-, 1793

Brazil Twice daily ammddllin vs.

f 7381"'" L 162 (18%)

7l9(81"J 174(~1

1457(81"1

3 vs. 5 days

cotrimoxazole - Pakistan • Wheezing studies • Very severe pneumonia

cotrimoxazole Bangladesh & Indonesia

I .."'"

r

132 (15")

H6{15%) 38 {;!%}

, 258 (lS"J 6S14'Wij

33611",)

!.1nrlfodnh anlllndanel1l, 2001·2003 (n -1193)

Oral amoxiciliin OR cotrimolGuoie 3-day therapy Is as effective

Higher risk of treatment failure With radiological positive pneumonia With age < 1 year With duration of illness )0 48 hours

Impact of duration of treatment on susceptibility of

clinically as S-day th~apyln the treatment of children 2-59 months old categorized as WHO defin~ pn~monia

nasopharyngAI isolates to ~rimoxaml.

non-s~ere

._. . -. 11 .... -

S·day therapy results in higher proportiofl of antimicrobial r~irtance as compared to 3·daytherapy Higher risk of treatment failun!: with radiological pnaJmonia; age < 1 year and duration of illness> 48 hours

...... -

Longer duration therapy leads to higher preva.lence of reslstilnt orvankml

Twice daily amoxicillin studies Twice vs. thrice daily Pharmacokinet ic study - Brazil Twice daily amoxiciJlin

Amoxidilin twice dally is a feasible alternative for the treatment of non·severe pneumonia Where antimicrobial resistance to cotrimoxazole is high, oral amoxiciliin Is the better choice Injectable ampicillin plus injection gentamicin is a better choice than Injectable chloramphenicol for very severe pneumonia in children 2-59 months of age

vs. cotrimoxazole -

Pakistan

Annex 5

A significant proportion of chHdren with wheeze and fast breathing and low chest indrawlng can be managed by bronchodilator therapy alone A third cycle of bronchodilator therapy at screenln& Is beneficial Audible wheeze Is present is a relatively smaller proportion of children with wheeze Oral bronchodilator works as well

as inhaled bronchodilator in

children sent home for management A home made bottle spacer Is as effective as a commerdal spacer for bronchodilator therapy In young children with wheeze

For children with non-severe pneumonia, 3 days In place of 5 days of antibiotic therlpv with either oral ImoJCiciliin or cotrimolUllole lhould be used In children 2 months up to S years in low HIV prevalence erns OBI.moxicilDn should be used twlol diltv in plillte of three times dally Children with wheeze and fan breathing and/or lower chest Indrlwlng should be ,iven a trlilll of rapid actina Inllaled btonchodilator, befolll they are dasslfaed IS pneumoniill and Ptescribed antibkltks Where antimlaobial resistance to co-trimoxalOIe Is hilh. ~I amoKlciliin is the better choice Injectable ampicillin plus Injection ,entamldn Is a better ""'~, th,," 1 Injectable chloramphenicol for very severe pneumonia 59 months ohi_

"''''"'''''-1

Topical antibiotics were found to be better than aural tOilet alone The addition of topical antibiotics to aural toilet Won associated with a 57% rate of otorrhoea resolution, compared to 27% with aural toilet alone Topical antibiotics used were cJprofloxadn, chloramphenicol, framycetin, gramlddin, gentamldn and tobramydn

MANAGEMENT OF EAR PROBLEM

Additionally topical antibiotics were found to be better than systemic antibiotics Topical antibiotics were mOfe effective than systemic antibiotics In resolving otorrhoea & eradicating middle ear bacteria (OR =0.46, 95% Cl 0.30, 0.68) AntibIotics provide a small benefit for aC\Jte otitis media In children Antibiotic treatment may play an Important ,ole In reducing the risk of mastoiditis In populations where it is more common Oral amoxidllln Is a better choice for the management of suppurative otltis media in countrles where antimicrobial resistance to cotrlmoxazole is high

=

Combined topical and systemic antibiotics are no better than topical antibiotics alone Topical quinolones were found to be better than topical nonquinolones Topical quinolones in children are safe without good evidence of a risk of ototo)(iclty

Annex 5

Chronic ear Infection should be treated with topical quinolone ear drops for at least 2 weeks in addition to dry ear wicking Oral amoxicillin Is a beneT choice for the management of

acute ear infection in countries where antimicrobial resistance to cotrimoxazole is high

MANAGEMENT OF NEONATAL CONDITIONS

Single algorithm for 0-2 months, Including the first week Very Severe Disease - Replaces "possible serious bacterial

Infection" JaundIce - new assessment and classification Diarrhoea and persistent diarm0f!3' clinical sign "blood in

stools" was dropped Feeding problems and low weight - guidance on additional support for feeding and skin-to-skin care

• Fot .. aoons otl'>tt

"*' Jovr>dlot

History or difficulty feeding (OR 10) History of convulsions (OR 15.4) Movement only when stimulated (OR 6.9)

Generic (1995) IMel: Anyone of16 signs in ~pink~ hoKes Weber et al (PIDJ 2003): Arrv one of the set of9 best predictor Signs Bang et OIl (PHll 2005): Any two of 7 signs New IMC! (Lancet 2008): Anyone of 7 signs on the previous slide

Respiratory rate >60 per minute (OR 2.7) Severe ch6t Indrawing (OR 8.9)

Temperature >37.5C (OR 3.4) Temperature <35.5C (OR 9.2)

The following sIs;m hlJd IIIgh OR 1M wtJl'l\! ~ I6'IC(IjM)OI'I Md made no IhDo!I flO tiffetence to seMilMty and spedfdty d the 0Vf1nII ~ gt'WI6ng. ~ ~rtIiI. $lilfimbs

Annex 5

'""

Algorithm

~

-I "'

SensltlvitY-87.7% .. :1:

·"'--Speclflclty-

GenericlMC (199S)

,

66.1" 753% 965%

WE!beret'al (fllOJ 20031' BangelalIP'OJ200S)

m:''' - 793.i'-~'

t~EWIMO

L36.~_ i , 84_6%

!laneet2008)

75.1%

NEW IMCf(t.anc2!l2008}

~--uong.-....,...--

The new IMel algorithm Is more spl!!dfic than the genl!:rlc IMel

Essential interventions for all newborns Assessment of newborn wellbeln, • Support for early Inlti.tion of breutfeedinc .nd exclusive

with almost the same sensitivity. The new fMO would be simpler to teac:h and learn as It has onlV 7 signs of severe illness (compilredto 1610 !enerlc IMel).

breastfet!dina • Support for therrml F;ilre Support for hvcienlc ~rd F;ilre Advice on dancer $I,nl and prompt a,....seeldna: Immunization ldentifioltion of newborns who IlHd .ddition.1care-

The algorithm is the same for the first week of life and 7-59 days, adding to the simplicity of Implementation

Additional care for low-birth-weight babies ManaRement of newborn illness

Mll'Ullement of local infections Man'Iement of feeding problems

Mln.lement of severe illness Situational HIV interventions • Use of Insecticide Treated Bedneu

ANNEX 6

ICATT - How to start? Working with ICATT training player

'. f1! ~

~ r~ I ~

.

-,.-__

'='a<!=-

-

=--

=-,

-~ ' -'

Annex 6

1 --'-=- 1 --~

"

------~~

Annex 6

- - - - -..

";;-

Annex 6

POCKET BOOK

.f

Hospital care for chil"·~

....... -- ....-...... " .. -Nat"'

_wt..u .. "

"" ........

..... .......

~-~

--~.~

... _ m q

Annex 6

-

....

_-_.......... --...... _--_..-

Annex 6

.

'='==:::'-::' .. .. .. .--.-----

. ._ ___. ___ ._, ' ~ -----

•••

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._----. -_! ... _-

: ;.:::.=.::•• 5

--------.-

_ _.--­ _ ' _ _ _' _ ~--

P '17

5

7

- - - 7

-~--J I

ANNEX 7

Table of Contents

International Cyber University of Health (ICUH) Young Moon Chae, Ph.D. Byung Hwa Lee, Ph.D. Graduate School of Public Health Yonsei University. Korea

~ Background • History of ICUH • Organization of ICUH • MOU for credit exchange

• Curriculum

• Enrollment ·Teaching methods

-PBl -CBl • e-Leaming system

- web-based online e-Iearning system ~ e-Book • Course evaluation • Future direction for ICUH

Why do we need a Cyber University? Rapid increase of internet technology Increasing market share of e-Iearning There are great deal of disparity in academic resources among AP ACPH member institutes Increasing need for sharing lecrure materials and infonnation in public health through e-Ieaming for the AP ACPH member universities International Cyber University for Health (lCUR) was established at the 35th AP ACPH meeting in Shanghai in October 2003

Organization Dean: Dr. Young Moon University) Cha~

(Dean, Grllduale Sebool of Public Health, Yonsei

L Board of Governors Chair: Dr. Young Moon Chae (Vice President, APACPH, Dean oflCUH) Dr. Hun Sang Chi (CEQ ofYonsei University Health Systems) Dr. Wen Ta Chiu (President ofAPACPH) Dr. Walter Patrick (Secmary Genc:ra1. APACPH) Dr. Tomiko Hokama (Vice President, APACPH) Dr. Jong Wba Hong (Director ofYSCBC) Mr. Young Tack Lee (CEO, CMF MediCI.) 2. Steerilll Committee: Chair: Dr. Walter Patrick (Secretary General of APACPH)

3. Curdculum Conmlittee: Dr. Colill Binns (Curtin University) 4. Management Committee Chair: Dr. Young MOOJl Cue (Graduate School oiPloIblic Health, YOIlSei Uai~ity) Administrative Scvices: Dr. Samg Hee Ho. SooJiD Yoon..ByunaHwa ~ Bernard Tan, DaJ LaeIm. Ii Eun Kim (Graduate School ofPubhchealth, YomCi University) 4

Goals of ICUH Who should take the courses at ICUH? To meet the health infonnation needs of the public in key areas of relevancy and urgency To upgrade the competence of professionals and allied health workers in APACPH countries To enhance educational opportunities to individuals who otherwise would not be able to advance their careers in health. The University has developed programs for the following target groups:: (1) the public and allied health workers; (2) professionals and qualified individuals to complete their continuing education; (3) graduate students who seek the complementary courses for their Master's degree.

Annex 7

Enrollment Current Status - Since its official inauguration on May 3 2004, ICUH has evolved rapidly to offer onlina PBUCBL courses in several languages - MOU for Credit exchange program with 5 member universities (Yonsei University, RyukyU University, Taiwan National University, Health SCIence University of Mongolia, Yanbian University in China) - Grant fOT the joint study of developin~ PBUC8L online courses by Ryukyu University and Yonsei Umversity - e-Book for four courses (Health infonnatics and International Maternal and Child Health. Systems analysts and design, Injury Prevention) 140

l~------------"::"~-------

120 100

~~--------u;-;;;,--II--'''l!'------

}---------Ihrll--I----·-

~ t------Tr-,-5~-IHI~·' rol~--------~~Br~fr-

"

.. Korean

""Others "!'Total 20

i Foon 20M sprinv F.H spring

Fan 21)06

Spring

FtdI 2007

Sptiftg

2005

2005

2006

20C7

200'

Enrollment 2007 Spring registration" by courses and countries Courses System Analysill and Design in Healthcare InlJociuction to Health

Enrollment 2007 Fall Registration: by courses and countries

Total

""_ 7

Mongolia

eou"""

19 47 30

,

China

J_, 1

7

..........

IRtroalldiontatt_

Eocnornics lfllemational Child Health

44

2 3 3

21

Oc:cupational Health

, 13

• 1

-_ .... _c_ ......d. .. _

co.....

T",

11(1Z)

........ '""'" >om 1(1)

I

. '

c....,.

Ja,.. 2111

, "..... '01

,H11

13(10)

• i

Epidemiology

NOW:

.eIla.--

T..., 34 103 I on UMI ponom row _ not &qUIIIl<> U10 sumo.

..

12

,.........

........ T_

In*",_~...t

_ ......

".

.",

....,.~

...

11,'D)

um

.. _

"" "OI "(111 ~(

,

... "" 8(1)

'01

'01 '0'

=umn

"

•

MDt.: • NIInlbw gf c:ndlt ~ • WI tIw parenthasls .. "tot." .... h botlmn ~ doe, not equal 10 !he _ beause ~Nlenn>1IIId Ia mlllllpJe " , - -

..

<., no.

". 1(1)

4111

DO.

of ....h co ..... n

"" ""

".

1(11

1t11

'01

"

Enrollment 2008 Spring registration: by courses and countries COlJI'sea

Tota' 23 24 22

,7 10

Sy8tem Analyaie and Design i'I HeIIIthcare

- - - - ....... Countl'y

11

2

2 2

1 1

International Child Health Injury Prevenmn

10

1

7

, 25

• , 1 13

1 1 1 1

O<aJH_

3

Total

n

2'

5

•

Note:: ~I· an the boUDm taN doeIo nat eqlAl to the tIIJIII d each ooIo,en because studenta enrolled i'I multiple cIassea

"

Annex 7

Course Title & Professor

Course Title & Professor

Course List for 2008 Fall Semester • • • • Researdi methods in HeaHh (Prof. YM Chae, Prof. Colin Binns) Disaster management (Prof. Walter Patrick - U. of Hawaii) Introduction to Nutrition (Prof. MK Lee, Prof. Colin Binns - Curtin U.) Knowledge management system In healtl1 (Prof. YM Chae, Prof. SH He)

Curriculum Toward Degree Program • Core Courses at Yonsel UniversUy

- Blo-statistics - Epidemiology - Research methods - IntrodycOOn to pyblic health - Major Courses for Health Informatics - Introduction to health informatics - Systems analysIs and desJgn - Database and data mining - Knowledge management system - Consumer health informatics • Major Courses for Public Health, Nursing - Public health nursing - Human resource management in nursing - ReSE!arch in wQlTI&n's health

"

"

Curriculum Toward Degree Program (cont) • Major Courses for Health Promotion and Epidemiology • International chile! health

Difficulties with Running ICUH • Recruiting lecl1lrers

• Intemational matemal and child hea1tll - Health nutrition

- Lecture fee - Academic competency - Willingness to conbibute their time • Recruiting students

- Geneb'c epidemiology - Oral health • Major Courses for Occupational Health

- Introduction to occupational health - Injury prevention • Major Courses for Health Ethics and Law - Health ethics

- Students from Jbroad - Students from Yo;lOsei (for credits) • Running onlina courses - Difficulty with language

- DiffICUlty with monitoring students' participation - Difficulty with organizing group discussion - Difficulty with grading • Administration - Difficulty with financing

-Health law

• Major Courses for Health Policy - Health economics

- Health insurance system In selected countries - Health and pea.ce

- Difficulty with recruiting administrative staffs - Difficulty with Charging tuition to foreign students

- Leadership in ensis communication for disaster

"

Annex 7

PBl and online PBl tools have helped education shift

PBL approach to e-Iearning

Before

After

Sequentialleaming Constructive leaming

VVho1e class leaming Memorizing Single subject learning Unit assignments

Hypermedia learning (assimilation) OiscoveryJinquiry learning Customized. dil!e!wntiated, self-paced leaming

Learning how to leam, synthesizing data Integrated learning Project/problem based learning Authentic assessment learner centered dassrooms (guide on rhe side) Collaborative, interactive learning

SLrnmative evaluation Tsacher centered classrooms

Passive learning

"

PBl Module in Master's-. Goal --~

~'"

Online PBl

;7

• Learning by doing'

Activity?

"wde aM folclltalll : to original

Strengths Economy of non-restrictions

Weaknesses

-:'~Z1

- Time. space - Lecture materiaf Leamer centered education : Multi-way communication for Interaction

.

Different kind of IT systems Difficult to use questions to stimulate higher thinking Lack of interaction with other students

forPBL - Situation - Question

ifl I

"

Core Function of online PBl Tools

Seminar activity for Presentation - Seeing evidence anei reason - Showing evidence and reason

CBL approach to e- learning

Ballot window Show visual ranking for decision making BUlletin board - Show reasoning

- See ranking of other students - See rank from different perspectives a&A,NoteB - Designing Effective Project - Assessing Data and Literature - Online and Collaborative 23

Annex 7

Competency-based learning (CBl) Competency-based learning (CBL) is an individual and systematic. but flexible learning process in technical education and training.

Competency-based learning (CBL)- cont. Leamers define the required knowledge, skills and attitudes to become successful In the envisagea field of work. Teachers design and facili tate flexible learning processes to provide the right opportunities for students to develop these competencies. Students continuously assess their own competencies and pla.n the~r individualleaming.trails to achieve full competency, while belOg coached and gUided by their teachers.

CBl focuses on what you should learn in addition to your existing knowledge. skills and attitudes to become successful in the envisaged field of 'NOr1<.

trclinsfer of knowledge, skills and attitudes. Instead it focuses on the integral development of competencies in a flexible learning process.

eBl deviates from the traditional pre-programmed

"

.

Process & M ethod to apply In the Cyber Subj ects Step 1 Step 2 Step J SIlDIDWY 01 subjcr;u and II,Ibjoas keyword Analysis ofmadc:lll'. &II.rtibo6cJ, kDowIcdac ad lkills ~

Qu es tionna ire on Co mpetency for Intro du ctio n to Health Informatics

Start poitIl evahWion Provid£~(~

'

....

<NooI

~

ofLearuiD& wb

MO<" abilit)'o boachinl> ;(eedback

',::"

'

'

-.,';;;,;", ~"

: ,1

s'oOo!,~

(aW:c schecIulc U=PP IUId £eedbad<)

1 . ~0<I_tthlnt_b

,... ,

Step 5 Step ,

MoaitorillJ Pro&relli. Evaluation of l.cImi ... Wb r=:,i!1I To mcaswe!he muwicll ollcmUnj: ~ili!yl end poW ~

A. Wr.I are !he diff_ _ ..

TPS arid OSS?

......

a. WI\II ~!he kto\I """"ept/ll OCS Of CPOE1 l...c... WhM it b diIhrwoc:e ~ [MR

..w aIR?

• ,,, ••, ,, • ,,, , 4 3 2. 1

0. Whet • ..n.Ith?

· ·

"

..

Questionnaire on Competency(conl ) 2. lnlorm.!ion tM:hnology A..

Questionnaire o n Co rnpetency(c onl) :S. Problem .oIYinll

/IQ.,.... ..... MIll DB "-IDn?

I 4

~

2. 1

A. WhIt KInd of ~1IconoI

PtoIMmo \hal IS can ....... ,

1l ..... )IUU~MtI'I_?

• 4 3 •

a

Il. wt-._ ~ IMIM In '-III ..............., 1 C. HDw"'·.oMIus. prObIOIIN? Ce.g. rtNM 10 ..... ~.bouI. .... *ysIMn)

c. Do )IOU Iomw.r( Progr."",q ~? O. Whet it ubiquMu. CompuIk"og1

4 3 2 1

O. ...... )'OUd ........ pMI~III'IIII..wIarI'*>rrnll1ion ')'!IIIm?

• 4

:s

2 t

...

, ,,, , ,,, ,,, , ,,,

. .

"

..

Annex 7

Questionnaire on Competency(cont.) 4. Pla"","8 capability I'. HJ,ve)'CU ~ WcrmItion I"p\eI!w (otnolegyj pi., B. W~d<I_nMdl<>~ISP?

Guidelines for Introspect Diary

''''"

C. What .... I". key ~ lor IS?? O. How-Oo)lOU ClIny OU! Cos\obanofg .")'1111

• • • •

· ,,, · ,,, , · ,, , , ·, "

1. TitI, page: 2. Format Typed and. half pag... 1M aiu)ln '-ngth (1.250 wonlsj poW_ dialY_ t..ngua~: english, Koraan (ChooM ..... ) 1ot.,.,1.,..: .... tn. following unifonn marghwthrou"hoUC tIM .mIre document ; LeI\. right, bottom, top: lIlmm Font type and ,Ino: H..dIro1, "p~bold .... _alii ......m H...... z:12pC,1>o1d Text: l Dp!

P"'ll ....IlDn:...,.,bIo .......... ~iMIrIQ_',1,l,IKCJ_IIf\erIlMt _ _

3. Introspect Diary is due Nov 23, 2007 (5PM). Send the fila to YSCEC (report menu)

Web-based e-Ieamlng System atYSCEC (Vonsel Cyber Education Center)

1=---::::I-~~:-"

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. _ . . _. . ·. . __ ·. . . ...... --__·..... . ~_4_

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. •. -

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__

"

Annex 7

PBl sessIon for Korean Students

_......-... ... -.... _-_

_ __

-

.§.-", ------..;,.,

;~,;,.

.E:--

"

Annex 7

ICUH Web site (http://icuh.yonsei.ac.kr)

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Annex 7

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Annex 7

Future Dir ecti on Expanding e-Book for more courses in various languages Expanding MOU for credit exchanges with member institutions

Expanding lecturer pool Planning for short Intensive offline courses for those who 'NOrk toward degree program Organizing international seminars on cyber education Charging tuition to MOU institutions Raising funds to strengthen curriculum and provide

scholarship

"

ANNEX 8

WOttshop on IMe l Computerized Adaptation and Tr1Ilnlng Too 24-26 June 2008, Seoul, Republic of Korea

Rationale (1) PNG IMel clinical guideline

fMCf Video Adaptation in Papua New Guinea Dr Norbert Rehlis 1, Dr Gilchrist Oswyn Dr David Makela J 1,

(10 Step Check List for ALL Sick Children)

differs from Generic IMel Guideline

>>-

>-

different classifications different algorithms needs to avoid inconsistencies during teach ing process

f MCH Advisor; WHO Counl1y Off/ee In PNG 1 PNG {MCI Coordinator, J PNG Ch/.' P,Ied/lIulellIn

Rationale (2) Low quality of trainings at provincial and district levels

Rationale (3) some IMel areas not covered by Generic IMel video needs for addressing country profile and " culture" in IMel video materials • IMel Generic Video was difficult for management during teaching process

>>>-

not all IMel tra iners were profession al teachers lack of good t eaching aids strong need to improve quality of IMel trainings

iNk

Rationale (4) I:

Process of creating DVDs • The film were cut into small pieces II The interactive menus were added

Lack of adequate number of cases at some facilities to ensure good understanding of IMel algorithm during the training.

Annex 8

Results • DVD structure supported learning process }>

Results • IMCI DVD can be used for different purposes: Teach ing aid Introduction for (Mel training Refresher training Selfalearning materials Evaluation (Tests) Materials for advocacy for (MGI

short films maintain attention required

for learning • Easy to use

Support adult learning (free naVigation)

Comments: CO: .., work ~ healtil centre In Lote. Out of seven 01 my staff only me end one nurse was trained In /MCI strategy. There were only two fMCI trainings organized In my prD.mca during the last rNe years. 18m not 8 professional teacher to teach IMC/. However I can do it when supported by the IMel 8udio-video training materials that WlIS shown to me. I fund that this DVD can be used as well as a self-learning tool. I played it on the laptop end it was logical and easy. I think that with such DVDs we can push implementation of fMCI forward in Paua New Guinea .• Simon Santor lote Health Centre (SP) 4 5

Comments: • ", work as Famly Hea"h Co-ordinator in Wewak. The quality of IMCI training is reaDy an issue on provincial end district levels. Therefore I found this video mat9l'lals to be useful for improvement of quality and coverage of IMCI trainings. But what is more Important. I am V8I)' proud as a citizen of Papua New Gunes, that WEI wN have our ovm video adaptlon of IMCI, prepared by our doctors, rel/ecting our /MCI approaches and our tranlng needs.· Sr. Ale Llnnah Family Health Services Coordinator in Wewak (East Sepik)

"

.I

Let us experience the PNG IMel video adaptation

ANNEX 9

ICATT Is designed to support IMel training activities

both in Pre-!';\'I'IY!C'! 3e:t:ns;' - Medical u!'liverslties, medical and

IMCIICATI-based training course Potential to strengthen and widen training options

paflllmediall 5ChooIs i.,.SM\IQ _ \0 train health

care prOloiOers 01 di1fcfent lel'eb

either 0t>-j0b. (I( clumg fotmaI courses

My type of IMGI training with ICAn win require organlzalloo of good clinical practice -10 ensure dinlcal skills acquisition. Many different teachlng!leaming models can be used, however comprehensive IMCltrainlng will require assistance of a good facilitator!

y t"aching Inslrumtlrlt for group PllWlenlHflooll, grouPi 6.>.lIrc.... S

o r~'lIr.nca \001 ior indlllldual WOIk by alllClents In Itl. IlbrSl'Yas 8 pritparollcn 1::1 cIa8. ~rk , I00I for r;ombined {n:tivIduaiI;roup 'oOOrk)\n eo....,ulllf ela6SI:lS

ICAn In pre-semce training as: "~imtrumlH1\

tor IarmaIIMCICralrlng ~s

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Individual learning .. Group clinical practic:e

Group pr6entatioM & e)(ercice:s + Group clinical practice

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Annex 9

~o" <om"m '".0'" ,Gm" (>

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Advanced Individu.1 tr1llnlnil IndiVIdual dlnlell p~ctlce + facilitator's fee-dback

C~ room group wort <MtI'I help of 100 faci(tallr-It\eoly. pr.aioI

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. ICATT iJS a reference tool for on-Job skills reinforcement

o on job ca.nIcaI practICe wI~ I'IeIp of LMC! InIined 5IriJt ODIeagues o PeriodiC feedback on dlnic;al palt$ by IL1ClladUtalDrS

o ThIS approecn II

o Final cenlbtion

-", """""'*'_ ..... already at:lended • eotne,

but woukI like 10

leam mo... about fMC!

IMlifnlft biRd tra lnl"&, I!1divldual Of croup dlni". prac tle •• r.~hlltcr'~ f..dbilck

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Periodic feecIbKIt on difliclil pans by fMel f,clitlltors

o Final certtlcllfion

ANNEX 10

IMCI strategy Is adopted for use in a country Strong national or sub national adaptation learn Clear decision on and experience with training needs and approaches for IMCI Clinical training Strong leadership of a good training institution Experience with large scale lraining programmes for first Jevel health worl<.ers Good links with first level c~nics and front line health workers Experience In monitoring and evaluation of training outcomes Interest In use of innovative training approaches

ICATT - early implementa tion steps Using ICArr at country level

Ensure availabilitv of nationallv iJdilpted IMet guidelines, which reflect local priorities, realities and needs Careful decision and agreement about most appropriate training approaches to be used: a Group teaching vs. individuilileilrning or combinatIOn of

Review of generiC materials Included into ICAn -library, generic training set and identification of the local materials (reference document, illust rations, videos etc) which will be inserted into the tool Ensuflng availability of hard caples of national adapted IMCI dinic4l1 guidelines (chartbookletJ and clear structure of the training course, IS well as elettronic version of identified recourses for Inclusion into ICAn Work with OPEN Interface of ICAn a . M,klnllppropriate ch,nlelln fMC booklet b. updatln&lch'1IJ1nl Ubrary component of the tool c. Adaptation of t"e leneric tralnlnl materials Indooed into ICATT 'ccordin, to the local trlin1nl need$ Ind desiln d. Review of coherence of III ch,nle5 made In the tool e. Production of aOSfO version

bolh b. Length of training and amount of learning materials

C.

Balance between theoretiCill and clinical training d . Training schedule (uninterrupted course, several training sessions or anoth~ approach) e. Role and functions of facilitators f. How monitoring and evaluation of training results will be

done

Selection and training of the faCIlitators according to the training approach(s) chosen, including clinical component

7.

DeciSion on ways ;lind means of monitoring and evaluation of training performance and Quality Initial training of health care providers Evaluation and summary of lessons learned, feedback on

8. 9.

'CATT