Operational Guidelines
for
Implementation of Integrated
Management of Neonatal and Childhood Illness (IMNCI)
SECTION-A: The Package
1. Introduction
1
2. What is
IMNCI?
2
3. The
IMNCI Package
2
4. Components
of IMNCI 3
SECTION-B: Institutional Arrangements
1. State
Level
5
2. District
level
8
SECTION-C: Training in IMNCI
1. Focus on
skill development 10
2. Training
at two levels 10
3. Personnel
to be trained 10
4. Training
of trainers 11
5. Number
to be trained 11
6. Training
institutions 12
7. Follow
Up Training 13
8. Pre
Service Training 13
SECTION-D: Funding
arrangements for IMNCI Training
1. National
level training 14
2. State
level training 14
3. District
level training 14
4. Translation,
Printing
and
supply of training material 15
5. Field
level monitoring support,
Follow
up and Coordination 15
Operational Guidelines
for
Implementation of Integrated
Management of Neonatal and Childhood Illness (IMNCI))
SECTION A : The package
1. Introduction
Bringing down Infant and Child Mortality Rates and improving Child Health &
Survival has been an important goal of the Family Welfare Programmes in
India. During the period 1977 to 1992
programmes like universal immunization programme; oral rehydration therapy
(ORT) programme and programme for prevention of deaths due to acute respiratory
infections (ARI) were implemented as vertical programmes. These programmes were integrated in 1992
under the Child Survival and Safe Motherhood Programmes and have continued to
be a part of the Reproductive & Child Health Programme implemented since
1997.
As a
result of these efforts, the Infant Mortality Rate (IMR) has come down
significantly over the years from 114 in 1980 to 58 in 2004. It has, however, been seen that the decline
has not been uniform across all States over the years. The IMR and child mortality in some States
such as MP, Orissa, UP, Rajasthan, Bihar, Gujarat, Assam and Haryana continue
to be unacceptably high. Besides this,
it has been seen that the IMR decline
which during the period 1980 to 1990
was 34 points (114 to 80), an annual decline of 12 (80 to 68) during the period
1990 to 2000, with Rajasthan, Assam and Haryana showing only a negligible
fall. The major reason has been as a
very slow decline in the neonatal mortality rate. A large number of children
continues to die during the first month of life (neonatal period) and efforts
have to be made to tackle this situation in a very focused manner. At the same time efforts have to be
continued to bring down deaths due to diarrhea and acute respiratory infections
by implementing the related interventions.
It has
to be remembered that malnutrition and low birth weight (LBW) are contributors
to the about 50% deaths among infants and children under 5 years of age. It is
obvious that for preventing deaths due to low birth weight, the health and
nutritional status of mothers during pregnancy has to be taken care of. It is well established that care during or
immediately after birth plays an important role in preventing deaths in the
early neonatal period. Visiting the
children at homes has been found to be a critical intervention which helps in
preventing deaths. However, unfortunately post natal care has not received
adequate attention until recently.
According to NFHS-II Survey only 6% women were visited by a health
worker during the first week of life. Efforts have therefore to be made during
the coming years to ensure that the numbers of home visits during the post
natal care are increased significantly.
2. What is Integrated Management of
Newborn and Childhood Illnesses (IMNCI)
WHO/UNICEF
have developed a new approach to tackling the major diseases of early childhood
called the Integrated Management of Childhood Illnesses (IMCI). Studies show that children presenting with
any illness often suffer from more than one disease. For instance, a child presenting with diarrhoea may also be
malnourished and may not have received the immunization as per the National
Immunization schedule. The integrated
approach ensures that all relevant needs of the child are looked at and
attended to during the contact of the child with the health workers.
3. The IMNCI
Package
The IMNCI package has been developed by experts including the Child
Health Researchers, academicians the Indian Academy of Pediatrics (IAP) and the
National Neonatology Forum (NNF) to adapt it for the specific requirements of
children in India. Since newborn care is an important issue for bringing down
the infant mortality rate in India, this aspect has been included in the
package adapted by India. This package includes the following interventions:-
Care of Newborns and Young Infants (infants under 2
months)
o Keeping the child warm.
o Initiation
of breastfeeding immediately after birth and counseling for exclusive
breastfeeding and non-use of pre lacteal feeds.
o Cord,
skin and eye care.
o Recognition
of illness in newborn and management and/or referral).
o Immunization
o Home
visits in the postnatal period.
Home visits are an integral part of this
intervention. Home visits by health workers (ANMs, AWWs, ASHAs and link
volunteers) help mothers and families to understand and provide essential
newborn care at home and detect and manage newborns with special needs due to low
birth weight or sickness.
Three home visits are
to be provided to every newborn starting with first visit on the day of birth
(day 1) followed by visits on day 3 and day 7.
For low birth weight babies, 3 more visits (total of six visits) are to
be undertaken before the baby is one month of age. The details of these visits
are given in the training package.
In
addition the opportunity of home visit is to be used for the care of mothers
during the post-partum period. This will help mothers and families on how to
recognize and manage minor conditions and will ensure timely referral of severe
cases.
Care
of Infants (2 months to 5 years)
o Management of diarrhoea, acute respiratory infections (pneumonia) malaria,
measles, acute ear infection, malnutrition and anemia.
o Recognition
of illness and at risk conditions and management/referral)
o Prevention
and management of Iron and Vitamin A deficiency.
o Counseling
on feeding for all children below 2 years
o Counseling
on feeding for malnourished children between 2 to 5 years.
o Immunization
After
neonatal period, IMNCI package is accessed by the family for their
newborns/children from the health workers in the community (ANM, AWW, ASHA or
link volunteer) or providers at the facility (PHC/CHC/FRU).
□ Training
IMNCI is a
skill based training. The training is based on a participatory approach combining classroom sessions with hands-on
clinical sessions in both facility and community
settings.
Broadly,
two categories of training are included, one for medical officers and a second
for front-line functionaries including ANM’s and Anganwadi Workers (AWW’s).
For ASHA
and link volunteers if any, a separate
package consistent with IMNCI focusing on the home care of newborn and children
is in preparation keeping in mind their educational status.
While training is an important input for
implementation of IMNCI, this is not the only one. Effective implementation of
IMNCI in a district also involves the following components.
□ Improvements to the health system. The essential elements include:
v
Ensuring availability of the essential drugs with
workers and at facilities covered under
IMNCI.
v
Improve referral to identified referral facility.
v
Referral mechanism to ensure that an identified sick
infant or child can be swiftly transferred to a higher level of care when
needed. Every health worker must be aware of where to refer a sick child and
the staff at appropriate health facilities must be in position to identify and
acknowledge the referral slips and give priority care to the sick children.
v
Functioning referral centres, especially where
healthcare systems are weak, referral
institutions need to be reinforced or private/public partnerships
established
v
Ensuring availability of health workers / providers
at all levels
v
Ensuring supervision and monitoring through follow
up visits by trained supervisors as well as on-the-job supportive supervision
□ Improvement of Family and Community Practices Counseling of families and creating awareness
among communities on their role is an important component of IMNCI. This
includes
-
Promoting healthy behaviors such as breastfeeding, illness recognition, early
case seeking etc.
-
IEC campaigns for awareness generation.
-
Counseling
of care givers and families as part of management of the sick child when they
are brought to the health worker/health facility.
-
During Home Visits- Home Visits provide an
opportunity for identification of sickness and focused BCC for improving newborn
and child care practices.
□ Collaboration/coordination with other Departments,
PRIs, Self Help Groups, MSS etc
Implementation of IMNCI in an
effective way in any district would be possible only with the total involvement
of ANM and Anganwadi workers of ICDS, and grassroot functionaries of other
sectors. Community ownerships and participation is of paramount importance.
Therefore active involvement of PRI, self help groups and women’s groups is a
must. Special effort will thus be
required on the part of the district CMOs to involve the concerned
departments.
For training of health staff and
follow-up and supervision of IMNCI activities in the district, the involvement
of pediatrics units/departments of District Hospitals will be necessary. The
involvement of the Departments of Pediatrics and Preventive and Social Medicine
of the local or regional medical colleges should be sought. This may need
decisions at State level.
|
Implementation of IMNCI in the districts
has to be seen as part of the Child Health Strategy under the National rural
health mission/Reproductive and Child Health Programme- PhaseII. “While training of the staff and workers will need
special efforts, the Coordination mechanisms, improvement in the health
systems and improvement in family and community practices is to be undertaken
as part of the ongoing efforts in these areas under the National Rural Health
Mission and RCH Programme-Phase-II”. The referral care for sick
children and newborns is to be
provided at the upgraded PHC’s and FRU’s which are being developed as a part
of the RCH programme phase-II .The guidelines for services at these
facilities have been developed. |
SECTION
B: Institutional Arrangements
|
IMNCI
is a Child Health Intervention to be implemented as part of NRHM/RCH-II.
Training for IMNCI will therefore be part of the overall training plan under
RCH-Phase II.
□
Appoint a nodal
officer for IMNCI. IMNCI is a Child Health
Intervention to be implemented as part of NRHM/RCH-II. Training for IMNCI
will therefore be part of the overall training plan under RCH-Phase II.
However, implementation of IMNCI within the districts will need a lot of
coordination with other Departments of the State Government as workers from
these Departments will not only have to be trained but also involved in the
implementation of the programme. It is therefore suggested that at the State
level there should be a dedicated officer for looking into IMNCI
Implementation. Considering that co-ordination with other Departments is also
part of the overall implementation of RCH-Phase II/NRHM, the State RCH
Programme Director could take up the responsibility himself. The nodal officer
will be responsible for the institutional arrangements listed below.
□
Set up a
co-ordination Group. IMNCI is a major intervention for
bringing down IMR. It is therefore necessary that a coordination mechanism is
built at the State level by including the donor agencies, other Departments like
ICDS, Panchayati Raj, department of medical education are important as medical
colleges will be involved not only in IMNCI implementation but also education
of medical and nursing students. The coordination committee should be linked to
the State Health Mission of the NRHM.
Meeting quarterly, the role of the
coordination group would be to (i) provide any technical support needed for
state and district level implementation, (ii) coordinate financial inputs,
(iii) review logistics and dugs supply
and (iv ) review progress in the implementation of IMNCI training and
implementation activities. Involvement of departments like ICDS, Panchayati
Raj, Medical Education will all have essential and specific contributions to
make in scaling up IMNCI.
□
Arrange translation,
printing and supply of training material. Training
materials have already been developed at the central level. The modules,
charts, booklets, videos and facilitators guides will be made available to
states for facilitating the training under IMNCI. Translations are currently
available in Hindi, Marathi, Oriya, Gujarti, Karnatak, Teluggu, Tamil and
Bengali. Materials would need to be printed depending on the needs of each
state. A thorough review of the quality of the translation by experts in medicine
and IMNCI is strongly advised before moving for printing. Requirement of
funding for these activities may be reflected as part of State PIPs.
□
Create pool of State
level trainers. Depending on the number of
districts selected and the availability of medical colleges/other Regional
Training Centres in the districts, State are to work outs their requirement for
State level trainers. These trainers are required for training of trainers
(TOT) of district trainers as defined earlier and also to monitor quality of
training in the districts. These trainers will be trained at the National
Institutes at Delhi. In case any State feels that they have the capacity to
develop some institutions as National Training Centres, they can approach the
Central Government for assistance in this regard.
□
Select priority
districts for IMNCI implementation[1]. IMNCI will have to be implemented in a well planned manner as it
requires a great deal of time and resources. It is therefore suggested that initially
only in a few districts and then taking up more districts based on the initial
experience. The selection in the first phase may therefore be restricted to 3-4
districts along with regional training centers (preferably medical colleges) in
the first phase. Each state should however, strive to complete implementation
of IMNCI in at least 25-30% of the districts over the next 2-3 years.
A number of states have already
indicated in their RCH – II Project Implementation Plans the number of
districts they are going to take up for IMNCI training. The States may in the light of the
guidelines, rationalize the number to be taken up by them during the subsequent
years. The states which have not
included IMNCI in their earlier PIPs may do so from the next year.
|
There will be 2 kinds of districts in each
state i.e. those implementing IMNCI and those not implementing IMNCI but
continuing with existing interventions. In districts not implementing IMNCI the
existing interventions including immunization, diarrheal disease control, ARI
control, vitamin A supplementation and essential newborn care including
promotion of exclusive breastfeeding for 6 months, and starting optimal
complementary feeding from 6 months of age onwards should be vigorously
implemented to achieve universal coverage. |
□ Monitoring, follow-up and review of implementation of
IMNCI
States will need to carefully plan
the details of monitoring and follow up visits and periodic reviews of the implementation
of IMNCI in the districts. Funds for these activities should be reflected as
part of State PIPs .
□
Identify the
state nodal institute for IMNCI training
The
institute must have an adequate case
load, facilities for training must be present or if not , must be provided
before it is formally declared as the state nodal institute. The institute must have a dedicated trained staff.
Medical colleges may be used for this purpose as they would generally have all
the prerequisites.
□
Improvement in
family and community practices
Improving household behaviors for
newborn and child care is an important objective of IMNCI. This should be
achieved through activities as a part
of RCH/NRHM BCC strategy. The messages should be consistent with IMNCI protocols/guidelines.
Major emphasis should be laid on seeking health worker contact in neonatal
period starting as soon as possible after delivery, and on early care seeking
if the child is not well. Involvement of PRI, women’s groups, NGOs, TBAs and
other self help groups for improving family and community practices will have
to be undertaken.
Many of the institutional arrangements at the State
level need to be developed at district level, though emphasis is less on
overall direction and quality control and more on the day-to-day activities to
make IMNCI successful.
□
Appoint District
Coordinator for IMNCI. The
district level also benefits from a dedicated officer to oversee implementation
of IMNCI. He/She could be the district RCH Officer or the district CMO himself.
He will be responsible for overseeing the planning, coordination and monitoring
of IMNCI implementation in the district.
District
Coordinators may also like to attend the ‘orientation course’ with the State
IMNCI steering committee.
□
Set up an IMNCI
Coordination Group. To foster a
day-to-day working relationship between the ICDS and health functionaries in
particular, a coordination group should be set up under the Chairmanship of the
Chief Medical Officer (CMO), including officers from ICDS, Panchayati Raj, and
other departments, representatives of the Departments of Paediatrics and PSM of
the regional Training Centres and/or local medical colleges, and development
partners involved in implementation such as NGOs, international organization,
and/or private medical practitioners.The purpose of the coordination group is
to (i) coordinate and plan inputs of each of concerned departments /
development partners, (ii) recommend district IMNCI facilitators/trainers,
(iii) organize and schedule IMNCI trainings, (iv) review progress of IMNCI
training and implementation on a bi-monthly basis. The plans and
recommendations of the IMNCI coordination group should be linked to the
District Health Mission of the NRHM.
□
Train District
Trainers. Every district will
require a clearly identified and committed group of trainers. The nodal officer
should identify members of the pool and working with their concerned agency or
department devise a level of commitment from each of the district IMNCI
facilitators and clinical facilitators. An average district will need to have a
pool of about 40-50 facilitators, one third of which being physicians. Identified district facilitators should be
trained by State or National level IMNCI facilitators. This is given in detail
in section C.
□
Develop a
detailed plan for IMNCI Implementation in the District. Each district will need to formulate a detailed plan
and budget for IMNCI implementation for the district. The plan will reflect in
detail overall training workload and phasing of the PHC areas to be taken up.
In addition, selection of training sites, number of trainers and training
materials, training calendar, referral, and monitoring and review arrangements
should be addressed.
IMNCI Training is part of RCH-Phase II Training. The funding will be based on the norms of TA/DA and other
expenses as applicable under the RCH Programme. The requirement of funds on the
basis of the norms will have to be projected as part of budget under the
flexi-pool funding for RCH Programme.
As
with the State IMNCI plan, the District IMNCI plan should be planned and
presented together with the District NRHM / RCH II plan, not in isolation.
Before advancing, this plan will need to be approved by the state IMNCI
coordination group for IMNCI and will form the basis of implementation as also
for monitoring and the periodic reviews to be undertaken at the district level.
□ Ensure timely supplies & logistics, supervision
and follow-up
Uninterrupted timely supply of
drugs is an issue which will have to be addressed if implementation of IMNCI is
to be ensured. Since the workers acquire new skills in the IMNCI training, it
is imperative to provide on-the-job guidance to them. Regular supportive
supervision in the form of skill reinforcement, facility support and record
review has to be ensured. Supervisors will learn these skills in the IMNCI
Follow up Training course. Health and ICDS Supervisors should plan their field
visit in consultation with workers with aim to follow-up all workers at least
twice or thrice. It is not necessary that health worker should be supervised by
health supervisors only. For convenience and quality, supervisors could divide
geographical areas for supervision. After initial support, IMNCI supervision
should be integrated into overall programme supervision. Mobility support can
be provided to strengthen supervision. It should be ensured that during
supervisor visit, supervisor should carry drugs to replenish if required and
support workers in implementation. Supervisors should be asked to give feedback
to higher authority about their monitoring visits using follow-up forms.
Monthly meeting at PHC level provide such opportunity. These information should
be used to take corrective steps.
□ IEC activities for improvement in family and
community practices
This has been detailed earlier
under the section Improvement of Family
and Community Practices
|
SECTION C
: Training in IMNCI |
1.
Focus on Skill
Development
The training under IMNCI is focused on applied skill development. Around 50% of
training time is spent building skills by “hands-on training”
involving actual case management and counselling, the remaining 50% is spent in
classroom sessions, building theoretical understanding of essential health
interventions. The hands-on training is undertaken through clinical training
sessions in hospitals and in the community. Physicians spend 6 days in hospital
and 1 day in community; workers spend 3 days in hospital and 4 days in
community settings.
The hands on practice is to be
undertaken through
-
Visits to hospitals and
-
In the case of Health workers in addition to
hospital based practice, the participants are to be trained through field
visits and visits to the homes of sick children.
Skill development is critical to the implementation of IMNCI.
2.
Training at two levels
o
Inservice training for
the existing staff – The existing staff in the
districts will have to be provided in-service training in a phased manner. The
objective of the training effort would be to ensure that all medical officers
and health worker are trained in IMNCI.
o
Pre-Service Training
–For including IMNCI in the pre-service teaching of doctors, nurses, ANM’s,
LHV’s and others. The State
Governments will need to issue instructions in this regard.
3.
Personnel to be Trained
There
are 2 types of trainings under IMNCI*
|
Type of
Training |
Personnel
to be trained |
Duration |
Package
to be used |
Place of
Training |
|
Clinical
skills training |
Medical
Officer and Pediatricians |
8 days |
Physicians
Package |
Medical
college /District Hospital |
|
Health
Workers, ANMs, LHVs, Mukhya
Sevikas, CDPO’s and AWWs |
8 days |
Health
Workers Package |
District
Hospital |
|
|
Supervisory
Skills Training |
Medical Officers, Pediatricians, CDPO’s LHVs and Mukhiya Sevikas) |
2days# |
Supervisory
Skills package |
Medical
college /District Hospital |
# To be clubbed Preferably with clinical skills training. Where this is
not possible the two days training should be conducted within 4-6 weeks of the
clinical skills training. Experience has shown that it is difficult to call
back people within 6 weeks again for another training.
* An orientation meeting of 1 to 2 days may
be organized in some districts fpr
planners and key personnel such as people from PRI, CDPO’s and other senior
health functionaries and other stake holders to orient them about IMNCI and its
implementation plan.
4. Training
of Trainers
For
training of the district staff it would be essential to have adequate number of
trainers within the districts. The trainers at district level includes all pediatricians in the district, selected medical officers from CHCs
and block PHCs, selected staff nurses and LHVs and CDPO’s and Mukhiya Sevikas
from ICDS. Experience has shown that about 40-50 trainers are required for
undertaking training of the health staff on a continuous basis. This is because
in every district around 200 doctors and 200 supervisors along with 1200- 1600
workers need to be trained. All IMNCI facilitators undergo Clinical skills
training (physician or worker module) plus
specific training in facilitation techniques and training on supportive
supervision. Total training time is 10 days: 8 days (Clinical skills training )
+ 2 days for supportive supervision. The TOT for Physicians is facilitated by
National IMNCI facilitators; the TOT for Health/ICDS workers is facilitated by
State IMNCI facilitators ideally with
participation of national IMNCI facilitators. Candidates for the all TOTs and
ultimately the district training pool would ideally include all paediatricians
in the district, plus selected CHC/Block PHC medical officers, staff nurses,
LHVs, CDPOs, and ICDS supervisors. Additional TOT candidates might include
faculty of HFWTC, ANMTC, GNMTC, MPW(M)TC, junior faculty of medical colleges,
and NGOs. All candidates should have good
communication skills. Districts with limited manpower might also consider
including freelance facilitators.
5.
Number to be trained
Ø
It is estimated that in a district of average size
about 1800 health staff will need to be trained. The exact numbers will however
have to be calculated for each district will be taken up for implementation of
IMNCI.
Ø
Since the staff of other departments like ICDS etc
is also to be trained, their numbers should be carefully included in
consultation with the concerned district officers.
Ø
Since meaningful implementation of IMNCI will need
adequate numbers of trained staff, it will be better if the staff belonging to
a PHC areas may be taken up fully before moving to another PHC area.
6.
Training Institutions
a).
State Level
Each state will need to train adequate number
of trainers for training the district level trainers. Therefore the state will
have to identify a Regional Training Centre. Since training is mainly skill
based, choice of the regional or local medical college is obvious. The Departments of Pediatrics and Preventive & Social Medicine in
each college will have to take up this responsibility. Another benefit of selecting the
medical colleges as regional training centre would be in the pre-service
training of undergraduate students. In addition to medical colleges other
centres including private centres can also be used for training provided they
have the requisite clinical material and facilities for training available.
States may identify one or more medical
colleges in the first year depending on the number of districts they wish to
bring under IMNCI during year one. The staff of these medical colleges will be
trained at the Kalavati Saran Children Hospital, New Delhi and Safdarjang
Hospital New Delhi which have been designated as the National level IMNCI Training
Centres.
b). District
Level
The following issues need consideration
before selecting the institutions for training of district staff
§
As IMNCI training focuses on building skills by
hands on training on cases, the selected institution for training should have
sufficient load of inpatient newborns to provide case material for hands on
training. The selected institution for training should also have sufficient
load of inpatient newborns to provide case material for hands on training. Do
not select facilities that are not busy because it will not be possible to show
enough number of sick children.
§
Health workers have to be given the opportunity for
practice on cases in home situations. Therefore at-least 4 visits have to be organized
to nearby field areas during their training. This will require proper
administrative and logistic arrangements.
§
Class room teaching is also an important component
of the training. Classroom training can be done in a place where there are
adequate number of class rooms (Preferably two) with sitting capacity of 12-15
participants each. In addition other
support facilities liker video etc should be available.
§
Since attention is given to individual skill
building, each batch of training should not have more than 25 participants with
6-7 facilitators. The facilitators should have sufficient clinical skills to
demonstrate signs of illnesses in sick newborns. If necessary, private
pediatricians and supervisor level functionaries from NGOs and private sector
can be involved.
§
HFWTCs/ANM schools can perform this task only
jointly with a hospital/health institutions. District hospital will thus be an
obvious choice for training of medical officers. For training of health workers
CHCs/operational FRUs etc can be considered. Where institutions with enough
case load are not available in public sector – involvement of hospitals/health
centres of local bodies/public sector enterprises or even private sector. In
rare cases even facilities of adjoining districts should be considered
The
Follow-up Training is designed to improve supportive supervision skills such as
methods for skill reinforcement, records review, and assessment of facility
functioning. The intended participants include medical officers/paediatricians
and health/ICDS supervisors who will be involved in supervisory, monitoring,
and follow-up functions of IMNCI implementation. The duration of the training
is 2 days which may either be clubbed with Clinical skills training or conducted
within 6-8 weeks of the initial Clinical skills training.
Following
the initial experiences in implementation IMNCI in several districts, States
should plan early for the expansion to remaining districts. Pre-service
training in medical colleges will need to include training on IMNCI in the
training schedules of undergraduate students and interns, during their postings
in the Departments of Paediatrics and Preventive & Social Medicine. ANM,
AWW, and Staff Nurses’ training schools will need to include training on IMNCI
in their training schedules. State Governments will need to issue instructions
in this regard to be implemented by teaching institutions by respective
directorates.
|
SECTION D: Funding arrangements for IMNCI Trainings |
1.
National
Level training:
For
the national level training of the faculty of Medical Colleges of different
States at Kalawati Saran Children Hospital and Safdarjung Hospital at Delhi, the
States need not provide for budget in their NRHM/RCH-II-Programme
Implementation Plans (PIPs) as the funding for this training will be entirely
provided by the Government of India. This will include all costs such as TA/DA,
stay and other training expenses.
2.
State Level
training (at the Medical Colleges identified as training centres):
The States need to project their funding requirements
for the following in their NRHM/RCH-II-PIPs:
·
Equipments for
imparting training such as:
o One Computer with in-built CD RW/ROM
o One LCD Projector with display screen
o Other miscellaneous training/ teaching accessories.
·
TA/DA and honorarium to
the trainees and trainers as per RCH norms.
·
Vehicle hiring for
field visits for trainees as per State Government norms.
3.
District Level
training:
a). At District Training Cell (in the District Hospital):
The States need to project their funding requirements
for the following in their NRHM/RCH-II-PIPs:
·
Equipments for
imparting training such as:
o One Computer with in-built CD RW/ROM
o One LCD Projector with display screen
o Other miscellaneous training/ teaching accessories.
·
TA/DA and honorarium to
the trainees and trainers as per RCH norms.
·
Vehicle hiring for
field visits for trainees as per State Government norms.
b). At other Training Centres within the District
(Maximum two in identified CHCs/PHCs):
The States need to project their funding requirements
for the following in their NRHM/RCH-II-PIPs:
·
Equipments for
imparting training such as:
o One television (which is CD player compatible)
o One CD player
o Other miscellaneous training/ teaching accessories.
·
TA/DA and honorarium to
the trainees and trainers as per RCH norms.
·
Vehicle hiring for
field visits for trainees as per State Government norms.
4.
Translation, printing and supply of
training material:
The
modules, charts, booklets, videos and facilitators guides will be made
available to the States for facilitating training under IMNCI. These will need
to be translated and printed in local languages depending on the needs of each
State. The funding requirements for the same may be projected in the State
NRHM/RCH-II-PIPs under the flexi-pool funding for NRHM/RCH Programme (Part-A of
programme).
5.
Field-level
Monitoring Support, Follow up and Coordination:
A
reasonable budget may be indicated in NRHM/RCH-II PIPs as institutional charges
for monitoring and follow up visits/meetings, coordination and other related
activities for successful implementation of IMNCI trainings.
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[1] In districts not implementing IMNCI, existing interventions including, diarrhoeal disease control, ARI control, vitamin A supplementation and essential newborn care including infant feeding should be vigorously implemented.