Assessment of implementation of CB-IMNCI program at primary health centers and health posts of Morang district of Nepal: A cross-sectional study.

Research Report.

EXECUTIVE SUMMARY: Community-based integrated management of neonatal and childhood illness (CBIMNCI) is a government-run priority one program to decrease the morbidities and mortalities of under-five children globally. This innovative program has helped to develop interventions strategies and packages to save newborns and under-five children. CB-IMCI program was launched throughout the country since 2009, yet program implementation gaps such as training of healthcare providers, availability of medicine, and follow up visits are frequently observed. We conducted this study with the objective to identify the implementation gap on CB-IMNCI program at Primary Health Centers and Health Posts in the Morang district of Nepal. We assessed the baseline situation of health care provider's training status on the CB-IMNCI program, availability of medicines as per CB-IMNCI guideline, follow-up visits of patients for the last 6 months and their clinical outcome and cost associated with each visit. This is a quantitative cross-sectional study conducted in a Morang district of Province 1 of Nepal. Ethical approval was taken from the ethical review board (ERB) of Nepal Health Research Council (NHRC) (ERB Protocol Registration Number: 14212021P). The institutional permission was taken from District Health Office (DHO), Morang and each selected PHCs and HPs. Informed written consent were taken from implementer of CB-IMNCI of each health center and parent/caretaker of children who came for CBIMNCI service utilization. We enrolled 9 (53%) out of 17 local governments including 14 health centers for the study by simple random sampling method. Implementers of the CB-IMNCI program of selected health centers and the parents/caretaker of client enrolled for CB-IMNCI services were included. Data was collected using a specifically designed proforma. The collected data were extracted in the MS Excel file. SPSS version 23 software was used for data analysis. The majority of healthcare workers were in their early age of 26-35 years (57.2%), male (85.7%) and Auxiliary Health Worker (78.6%). The mean duration of practice was 15.1 years. The overall percentage of healthcare providers trained for the CB-IMNCI program is 46.5 percent. The overall percentage of availability of medicine as per CB-IMNCI guideline is 52.9 percent. There was no record for total number of required follow up in the last 6 months and total number of actual follow up visit in last 6 months. There was no recorded data found on total number of actual follow up in last 6 months and total number of clinical outcome as cured in last 6 months in our samples. This study found that less than half healthcare providers were trained for CB-IMNCI program and disparity of the trained health personnel existed in health care institutions. Hence, it is recommended to train the eligible healthcare providers and balance the trained and untrained manpower in each health institutions for effective implementation. Only half of the required medicines were available in the health institutions which emphasize on monitoring and procuring of listed medicines. This study also found the implementation gap on record keeping and follow up visit of patients which is a powerful tool to identify the effectiveness of the service provided. Health care providers need to be trained on effective documentation of the program.