CB-IMNCI is an integration of CB-IMCI and CB-NCP Programs as per the decision of MoH on 2071/6/28
(October 14, 2014). This integrated package of child‐survival intervention addresses the major problems of sick newborn such as birth asphyxia, bacterial infection, jaundice, hypothermia, low birth- weight, counseling of breastfeeding. It also maintains its aim to address major childhood illnesses like Pneumonia, Diarrhoea, Malaria, Measles and Malnutrition among under 5 year’s children in a holistic way.
CBIMNCI TREATMENT CHART BOOKLET
Community Based-Integrated Management of Childhood Illness (CB-IMCI)
In Nepal, Child survival intervention began when Control of Diarrhoeal Disease (CDD) Program was initiated in 1983. Further, Acute Respiratory Infection (ARI) Control Program was initiated in 1987. To maximize the ARI related services at the household level, referral model and treatment model at the community level were piloted. An evaluation of this intervention in 1997 revealed that treatment model was more effective and popular in the community than referral model. In 1997/98, ARI intervention was combined with CDD and named as CB-AC program. One year later two more components, nutrition and immunization, were also incorporated in the CBAC program. IMCI program was piloted in Mahottari district and was extended to the community level as well. Finally, the government decided to merge the CBAC into IMCI in 1999 and named it as Community-Based Integrated Management of Childhood Illness (CB-IMCI). CB-IMCI included the major childhood killer diseases like pneumonia, diarrhoea, malaria, measles, and malnutrition. The strategies adopted in IMCI were improving knowledge and case management skills of health service providers, overall health systems strengthening and improving community and household level care practices. After piloting of low osmolar ORS and Zinc supplementation, it was incorporated in CB-IMCI program in 2005. Nationwide implementation of CB- IMCI was completed in 2009 and revised in 2012 incorporating important new interventions.
Community-BasedNew Born Care Program
Up to 2005, Nepal had made a huge progress in reduction of under-five and infant mortality, however,
the reduction of neonatal mortality was observed to bevery sluggish because the country had no
targeted interventions for newborns especially at community level. State of world report, WHO
showed that major causes of mortality were infections, asphyxia, low birth weight and hypothermia.
The Government of Nepal formulated the National Neonatal Health Strategy 2004. Based on this
‘Community-Based New Born Care Program (CB-NCP)’ was designed in 2007, and piloted in 2009.
CB-NCP incorporated seven strategic interventions: behaviour change communication, promotion
of institutional delivery, postnatal care, management of neonatal sepsis, care of low birth weight
newborns, prevention and management of hypothermia and recognition and resuscitation of birth
asphyxia. Furthermore, in September 2011, Ministry of Health and Population decided to implement
the Chlorhexidine (CHX) Digluconate (7.1% w/v) aiming to prevent umbilical infection of the newborn.
The government decided to scale up CB-NCP and simultaneously, the program was evaluated in 10
piloted districts. Upto 2014, CB-NCP was implemented in 41 districts covering 70% population.
Free Newborn Care Services
The Government of Nepal (GoN) has made provisions on treating sick newborn free of cost through all
tiers of its health care delivery outlets. The aim of this program is to prevent any sorts of deprivation
to health care services of the newborn due to poverty. Based on the treatment services offered to the
sick-newborn, the services are classified into 3 packages: A, B and C. The new born corners in heal
posts and PHCs offer Package ‘A’, district hospitals with Special Newborn Care Unit (SNCU) offer Package
‘B’ and zonal hospitals and other tertiary hospitals offering Neonatal Intensive Care Unit (NICU) provide
services for Package ‘C’. The government has made provisions of required budget and issued directives
to implement the free newborn care packages in Nepal. The goal of the Free Newborn Care Service
Package is to achieve the sustainable development goal through increasing access of the newborn care
services to reduce newborn mortality. The program makes the provision of disbursing Cost of Care to
respective health institutions required for providing free care to inpatient sick newborns.
Goals, targets, objectives, strategies, interventions and activities of CBIMNCI
- Goal
Improve newborn and child survival and healthy growth and development.
Targets of Nepal Health Sector Strategy (2015-2020)
Reduction of Under-five mortality rate (per 1,000 live births) to 28 by 2020
Reduction of Neonatal mortality rate (per 1,000 live births) to 17.5 by 2020
Objectives:
o To reduce neonatal morbidity and mortality by promoting essential newborn care services
o To reduce neonatal morbidity and mortality by managing major cause so fillness
o To reduce morbidity and mortality by managing major causes of illness among under 5 years
children
Strategies
o Quality of care through system strengthening and referral services for specialized care
o Ensure universal access to health care services for new born and young infant
o Capacity building of frontline health workers and volunteers
o Increase service utilization through demand generation activities
o Promote decentralized and evidence-based planning and programming
4.2.3 Major interventions
1. Newborn SpecificInterventions
o Promotion of birth preparedness plan
o Promotion of essential new born care practices and postnatal care to mothers and newborns
o Identification and management of non‐breathing babies at birth
o Identification and management of pre termand low birth weight babies
o Management of sepsis among young infants (0‐59days) including diarrhoea
2. Child SpecificInterventions
o Case management of children aged between2 ‐59 months for 5 major childhood killer
diseases (Pneumonia,Diarrhoea,Malnutrition,MeaslesandMalaria)
3. Cross-CuttingInterventions
o Behaviour change communications for healthy pregnancy, safe delivery and promote personal hygiene and sanitation
o Improved knowledge related to Immunization and Nutrition and care of sick children
o Improved interpersonal communication skills of HWs and FCHVs