Use of Integrated Management of Childhood Illnesses Adaptation and Training tool

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 WHO/UNICEF 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 of IMCI has been steadily expanding, the pace has been slow in some settings.

Among the common challenges have been:

(1) 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 (ICATT) was developed by WHO in collaboration
with Novartis Foundation to partly address the challenges faced by countries in scaling up IMCI. The
ICATT is a new, innovative computerized software application that provides an opportunity for easy
adaptation of the most updated generic guidelines at national and subnational levels. ICATT 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.

ICATT potential to strengthen and widen training options

This presentation described ICATT's potential to support IMCI trainings in both pre-service and in-
service settings. 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.

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 training 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 Yonsei University. An approach could be to draft a
multicountry proposal to fund ICATT 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, qadaptation 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.
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 11-day case management training, 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.

Conclusion

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 carries 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.

Reference

World Health Organization Western Pacific Region. (2008). Workshop on Integrated Management of
Childhood Illnesses Computerized Adaptation and Training Tool [PDF File] Retrieved from
www.wpro.who.int › docs ›