Project

ALMANACH - Implementation of ALMANACH in the ICRC

Background
The ‘ALMANACH’ (ALgorithms for the MANagement of Acute CHildhood illnesses) is an electronic version of the IMCI (Integrated Management of Childhood Illnesses) that is available on smartphones and tablets. The IMCI concept was initially developed and promoted by WHO for the management of common acute infections in children between two months and five years. IMCI is a series of integrated diagnostic and treatment algorithms that focus on the well-being of the child by reducing illness, disability and mortality and promoting better growth and development. IMCI includes both preventive and curative elements that require the collaboration of healthcare providers with families and communities.
ALMANACH is presently piloted in selected primary health care facilities in Afghanistan and Nigeria.  The project is financed by the International Committee of the Red Cross (ICRC) and implemented by the Swiss TPH. Local collaborators are mainly the Afghan Red Crescent Society in Afghanistan and the Adamawa State Primary Healthcare Development Agency in Nigeria.

Objectives
In their daily routine work, health care workers are led by the  tablet application step by step through the diagnostic process. The ‘ALMANACH’ aims to assist in diagnosing and treating sick children. Moreover, in a context of worldwide surge of antibiotic resistance, ALMANACH assists healthcare providers to screen patients who do not need any antibiotic treatment, therefore reducing over-prescription.

Duration
Since May 2016, ALMANACH has been piloted in selected health facilities of the region of Kabul, Afghanistan. The project is scheduled to start in Adamawa State, Nigeria, before the end of December 2016. In the current phase the project is expected to last until March 2018.

Methods
ALMANACH algorithms were initially drawn on paper, starting with WHO’s algorithms developed in the nineties and updated in accordance with evidence-based medicine, innovations in rapid diagnostic tests, the epidemiological profile of the country and with local resources in terms of staff, drugs and laboratory facilities.
The algorithms also took into account changes in diseases patterns and antibiotic resistance. After validation by the local health authorities in Afghanistan and Nigeria, they were computerised into a tablet computer to be used for healthcare providers. The collected data are sent to a server to be further analysed and turned into epidemiological information. A related Management Information System visualises epidemiological and health service data for improved health care management.

Results
Data collected by ALMANACH are available in real time as graphs and tables through a management information system (DHIS2).
Between May and November 2016 a total of 3’064 children were diagnosed and treated  by using ALMANACH. In May 2017, one year after the start of the project in Kabul, an evaluation will be conducted through a survey, looking at the impact, cost, acceptability by providers and patients, etc.

Next steps
In 2017, an ALMANACH implementation in Myanmar will be in focus. Further, a wide scale roll out in Nigeria is in planning. On the conceptional side, options to enlarge the ‘Almanach’ approach to add eLearning modules are assessed. Additional functions of the information management tool such as an early warning system are in preparation.

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