Liberia has adapted and adopted the WHO Integrated Management of Neonatal and Childhood Illnesses (IMNCI) clinical training package for the management of illness in sick young infants and children up to five years of age. Initially, Liberia’s IMNCI curriculum required 11 days of training, in line with the international standard at that time. Clinicians across all 15 counties in Liberia were trained in IMNCI but most of these individuals subsequently left their posts. The high cost and long timeframe of the original 11-day curriculum made the training of additional clinicians prohibitive. As such, when the Maternal and Child Survival Program (MCSP) Restoration of Health Services Project (RHS) for post-Ebola recovery was initiated, many health facilities did not have clinicians trained in IMNCI and therefore the services being provided to children were not meeting national standards for quality care. In addition, there were no IMNCI protocols, guidelines or job aids in these health facilities.
In 2013, with support from USAID, the training curriculum was reduced to 6 days, a strategy implemented by many other countries globally to reduce both training time and cost. As a key activity of the Liberia MCSP/RHS project, 75 clinicians from 74 health facilities were trained using the new 6-day IMNCI curriculum. The Ministry of Health (MOH) IMNCI Master Trainers, under the direction and supervision of the Family Health Division and the National IMNCI Course Director, facilitated the training.
Andrew Cole, Officer in Charge (OIC) at Voinjama Free Pentecostal Mission Clinic in Lofa County, was one of the participants in the MCSP-supported IMNCI training activity. Andrew, along with many of his OIC colleagues, felt that the IMNCI training was one of the most relevant and useful skills building, in-service training activities that they have had the opportunity to participate in during their clinical careers. The training closed the gaps in the quality of care for assessing and managing sick young infant and children under five years of age. One key aspect cited by the trainees as a particular success was the piloting by MCSP of a one-page back and front IMNCI case recording form. Trainees found the form enabled them to follow the IMNCI protocols in a step-by-step fashion and facilitated the training of healthcare workers that did not have the opportunity to attend the formal training. Using the form involves simple circling and ticking of major symptoms in order to classify the condition and select treatment based on the presenting findings. Because the IMNCI case recording form was found to be so useful to the clinicians, several OICs were able to negotiate with the management of their hospitals or clinics to initiate the photocopying of the forms out of their own budgets – this was the case for Mr. Cole at the Voinjama Free Pentecostal Mission Clinic in Lofa.
“The use of the IMNCI Case Recording Form has made my work easier and simpler because it contains all major childhood illnesses, their signs and symptoms as well as key probing questions. This form enables me to follow step by step the approach to assessing, reaching a decision about the condition and treatment.” – Andrew Cole
Trainees and other health care workers at MCSP supported health facilities have also indicated the importance of the Liberia IMNCI Chart Booklet as another key job aid and training resource. Every MCSP supported health facility received at least one Chart Booklet after the training activity. In addition to the IMNCI protocols, the Chart Booklet contains appropriate drugs with required doses based on the child’s weight and age along with counseling steps for the mother and caregiver.
The feedback received by MCSP on the importance of key job aides for the delivery of quality IMNCI in health facilities has informed the development of the MOH Strategy to Institutionalize IMNCI at the HF level. The strategy aims to reduce the reliance on frequent and costly large-scale training activities through the delegation of key IMNCI tasks to various areas of the health facility and providing the individuals working in these areas with the necessary job aids and training resources. MCSP has been providing essential technical assistance to the MOH in the drafting of this strategy.
“I am so grateful to MCSP and the MOH for this training which has improved my competence and confidence in this clinical area. I have received commendations from mothers and caregivers for the quality of care and counseling” – Andrew Cole