Field Note October 13, 2015

An Important Milestone

REFLECTIONS FROM

After months of training, planning and preparation by our entire staff, PIVOT health center nurses started our malnutrition and pediatric activities at the Ranomafana and Kelilalina health centers last week.  This will be followed in the next 2-3 months (once we hire more medical personnel and complete infrastructure improvements) by the start of PIVOT malnutrition and pediatric activities at 2 additional health centers in the district.

Madagascar is one of the 10 countries in the world with the highest

burden of chronic malnutrition, and one of the 20 countries where

90 percent of the world’s stunted children live. (UNICEF)

PIVOT nurses will be integrated into the health centers by starting the patient visits and triaging all children under 5 years old.  Following the motto of “no opportunity missed,” the idea is that PIVOT nurses will see and triage all children under 5 years old to help ensure that any of those children who comes to the health center (for any reason) will receive as much preventive care and treatment as possible during that visit.

For example, in the past, if a child came to a health center with acute diarrhea, the child would often be treated only for acute diarrhea and sent home.  The child may not have ever received any vaccines or other preventive care, and perhaps the child would not have returned to a health center for months or years, or would have died from a vaccine-preventable illness or an infectious disease complicated by malnutrition.  We hope that with this new triage system, the child who comes to the health center with acute diarrhea will also be screened (and treated if appropriate) for malnutrition, have their vaccine and other preventive care status checked, be screened for other infectious diseases, have their IMCI forms completed, etc.

IMCI stands for Integrated Management of Childhood Illness, a systematic approach developed by UNICEF and WHO that guides healthcare providers in low resource settings to assess, diagnose and treat illnesses and assess nutrition and vaccine status in children under 5 years old, the age group that bears the highest burden of deaths from common childhood diseases.

Here are some pictures from the past couple of weeks that show the PIVOT team in action:

PIVOT Primary Care Manager Dr. Njaka presents to 25 PIVOT and Ministry of Health nurses, midwives and doctors during a week-long Ministry of Health-led, PIVOT-financed, training on the ambulatory treatment of severe acute malnutrition.

PIVOT Primary Care Manager Dr. Njaka presents to 25 PIVOT and Ministry of Health nurses, midwives and doctors during a week-long Ministry of Health-led, PIVOT-financed, training on the ambulatory treatment of severe acute malnutrition.

PIVOT nurses Aimée and Adolphe ready to go--first day back in the Ranomafana health center

PIVOT nurses Aimée and Adolphe ready to go–first day back in the Ranomafana health center

All patients under 5 years old are measured, weighed, have vital signs checked, screening and triage questions, malnutrition screening, and a review of their vaccine status.

All patients under 5 years old are measured, weighed, have vital signs checked, screening and triage questions, malnutrition screening, and a review of their vaccine status.

PIVOT staff will also work on improving data collection and data quality by working with the health center staff to accurately complete patient registers, monthly reports, IMCI and malnutrition forms, and to serve as a focal point to identify areas for data and patient care quality improvement. 


This will certainly be a work in progress, and I know there will be bumps along the road, but we all feel good that this system will support the health centers and improve healthcare and save lives for children under 5 years old. Thank you all for all of your support.