National orientation and capacity building |
Clear leadership of the MOH and an understanding of partners about their roles and responsibilities |
Demonstration course for district and national managers to create awareness among relevant stakeholders |
National planning and adaptation workshop to reach consensus moving forward |
Minimal adaptation to the generic WHO/UNICEF guidelines |
Orientation of DHMTs, mapping of hard-to-reach areas, and joint planning |
Engagement of the national IMCI technical working group in the process |
Proper coordination of available support and collaboration of partners to roll out activities in assigned districts |
Community ownership and participation |
Community dialogue before introduction of the services |
Formation of village health committees under each functional VHC |
Engagement of community leaders to manage the VHC |
Skills building |
Devolution of HSAs training to district level |
Leadership of district IMCI coordinators and engagement of DHMT members |
Appropriate case load in district hospitals for inpatient and outpatient clinical practice during training |
Supervision |
Assignment of specified responsibilities to various cadres of staff (senior HSA, environmental officer, and community nurse) |
Training supervisors in iCCM and supervisory skills |
Development of integrated checklists incorporating key elements of the sick child recording form |
Creation of a mentorship program for periodic skills reinforcement of trained HSAs |
Medicines and supplies |
Provision of medicines to HSAs during their monthly visits to the designated health center |
Supervisors carrying medicines and supplies to alleviate stock outs |
Guidance on quantification of medicines to DHMTs |
Rollout of standard operating procedures for logistics management information systems to strengthen use and management of medicines and other supplies |
Referral |
Designation of health centers where HSA should refer |
Use of referral note and feedback on the same |
Engagement of VHC in finding solutions to facilitate referral, such as bicycles or ox cart as transport, and escorts at night |
Monitoring |
Recruitment of a national monitoring and evaluation officer in the IMCI unit |
Development of the iCCM register based on the sick child recording form |
Quality of care assessment of HSAs performance |
District-based village clinic review meetings to strengthen implementation |
Motivation |
Recognition of HSAs as formal members of the health work force |
Provision of adequate housing to HSAs in hard-to-reach areas through village health committees |
Innovations |
Provision of mobile phones to HSAs to facilitate contact and SMS-based reporting and ordering of medicines and supplies |