Indian Academy of Pediatrics

IAP ACTION PLAN 2006

Background

It is impressive that Indian Academy of Pediatrics (IAP) has grown from 3,000 plus members in 1990s to 15,000 plus members now. However what is more impressive is the positive change in the focus of Academy's plan of actions in the recent years. IAP now is involved more closely with programming and planning of child health policies, and is playing a decisive role in public health projects concerning child health and child survival. This has resulted in IAP's advise being sought more often now than ever before by the health authorities.

As a nation, we have achieved a lot in last 2 to 3 decades in child health and child survival through various child health programs. That is how our UFMR now stands at 87, IMR at 63 and NMR at 42. However this is not enough. India still annually contributes 2.5 million of the global 10.8 million under 5 deaths and this is not acceptable. We know that most of these children die of ARI, acute diarrhea, neonatal causes, measles, malaria and HIV. We also know that 65% of these deaths are preventable if we could somehow manage to deliver some of the 17 low cost, time tested interventions to those who need them the most; interventions like breast feeding, zinc and iron supplementation, immunization, ORS, antibiotics for ARI, neonatal services etc. Effective implementation of these measures will involve huge programmatic and planning efforts. While we are aware that IAP can not do what the health authorities and other NGOs can and need to do, we are also aware that we have a huge responsibility in doing our part of work, in playing our role. The entire IAP 2006 Plan of action revolves around this issue and IAP proposes one program each to look after these important child health issues.

The leading cause of under-5 deaths is ARI which contributes to approximately 25% of these deaths. We plan to have IAP National Task Force to evolve Standardization of the Management of the Respiratory Tract Infections in children.

Similarly acute diarrhea contributes 22% of the under-5 deaths. It is disheartening to note that ORS is used in less than 20% of diarrhea episodes while antibiotics are misused in most of them. IAP proposes to have a National consultative meeting to have a re-look at the comprehensive management of Acute Diarrhea in children.

The major stumbling block in further reduction of IMR now is Neonatal deaths which contribute 50% of the under-5 deaths and 75% of the infant deaths. While we know that it will need huge scaling up of the existing neonatal services to bring down NMR significantly, the least we can do is to use the force of 15,000 plus members who we feel are all neonatologists in their own capacity. It is heartening to note that IAP and NNF will work together for this cause and the IAP-NNF National Task force will evolve standard level 2 care protocols for the management of common neonatal problems.

Pediatric HIV/AIDS as a problem has a special place for IAP and we have formed the IAP National Task Force in HIV/AIDS which will look in to 5 important issues i.e. management of perinatally exposed baby, antiretroviral therapy, management of opportunistic infections, training of health care workers including pediatricians and adaptation of Pediatric HIV care in IMNCI.

Two important diseases that cut across all the causes of under-5 deaths are malnutrition and anemia and we know that malnutrition is seen in almost 65% of our children and anemia in 90% of them. Hence IAP proposes a National Consultation Meeting to look in to each of these problems.

Lastly, we need to go beyond 70% national coverage for the routine vaccines and we plan to conduct more than 30 regional Immunization updates which will sensitize further our members in to correct immunization practices.

This is as far as our public health responsibilities are concerned.

Our academy also owes a lot to its members, a large proportion of who are private practitioners. In today's era of evidence based practice, we need to empower them with what is the latest. Hence we plan to conduct various training programs for them.

First major activity envisaged this year is "AskIAP" program where we have compiled best practice statements on day to day problems written by National experts.

Secondly, it is proposed to have CMEs in each specialty and IAP Hematology Oncology Chapter has already started IAP PHO Practical Training in Hematology.

Thirdly, we propose to have IAP specialty books which will augment the IAP Text Book. This IAP specialty series will include books on major specialties in pediatrics including Hematology, Oncology, Anemia, Neurology, Neonatology, Respiratory medicine, Intensive care, Gastroenterology, Pediatric Quiz, Pediatric color atlas, Infectious diseases etc. These books will be available before the end of this year.

As in past, IAP also has proposes to have National Consensus Meetings followed by National Guidelines; and the topics targeted for 2006 are Iron Deficiency, Growth Monitoring, ITP, Blood Components, Leukemia, Enteric Fever, Epilepsy and role of Iron and Zinc in health and disease.

Lastly IAP has duties towards its other partners who equally look after the child health namely Family Physicians, Nurses and last but not the least the Parents themselves. We have planned for a novel and interactive CME for family physicians. We also propose to revive the IAP Refresher Course for Nurses in Basic Maternal and Child Health. And we will also conduct "Parvarish", the ideal parenting workshops for parents.

Main highlights of the IAP Plan of Action 2006

1)	IMNCI: Training workshops for the in-service pediatric post-graduates. IAP through its HOD cell (Head of Departments cell), plans to conduct a National training workshop for the master trainers followed by zonal training workshop for training further trainers in each of the medical college. This will than be followed by a training workshop every year in each medical college to train all the post graduates in Pediatrics, This will ensure a great pool of trained pediatricians in country in coming years.
2)	District support: IAP proposes to move beyond its role of advocacy and form district support with the help of 5 pediatricians from each district along with the local UNICEF. To start with 25 districts will be targeted and this will then be extended all over the country. This support group will help implement, provide training and monitoring in the existing health programs including IMNCI.
3)	National HIV & AIDS Roadmap meeting will be held on 25th & 26th February 2005 followed by training workshops for pediatricians in 8 high risk states. This will also address to the issue of the orphans and vulnerable children. We also plan for a regional meeting involving the SAARC countries.
4)	IAP-NNF National consultative meeting on "Neonatal Health - How to improve it in India?" will be held on 29th & 30th April 2006. We will mainly focus on the development of simple protocols for the management of the common neonatal health problems and standardize the management of the newborn at the level II of neonatal health care. This will be followed by sensitizing 5 zonal workshops all over the country. We will also discuss the other problems like how to set up a small newborn care unit in nursing home, inventory and net working of existing NICUs in 4 metro cities based on the Mumbai model, standardize the instruments required in NICU and supporting the essential newborn care through IMNCI.
5)	"Rational management of acute diarrhea" - We will have a re-look at the rational management of diarrhea in children including the use of low osmolality ORS. A national meeting is proposed during the ORS day followed by sensitizing CMEs in 5 zones of the country.
6)	"Management Protocols of malnourished children" - Malnutrition is a common denominator for the various causes of UFMR. We intend to look in to the management of the malnourished children both at home and in the hospital.
7)	"Askiap" program: Here we have tried to compile the best practice statements from the experts on daily debates that we have in our practice. The first National training of the trainers workshop has already been done and now we will conduct 30 more such workshops all over India.
8)	"Rationalizing the Management of the Respiratory Tract infections" is another major project. The preparatory meeting is already held and the 1st National Consultative meeting will be held on 5th & 6th March 2006. This will be followed by 30 CMEs all over the country.
9)	"IAP-PHO-PPH" - IAP PHO chapter has evolved a practical training program in pediatric hematology. This will be a novel CME which will be entirely based on case discussion and interactive sessions. The 1st pilot program has already been conducted at Gurgaon. We will now conduct 10 more such workshops all over the country.
10)	"IAP-CMEG office software" - Along with the IAP Computer & Medical Electronics Group, the IAP is about to finalize the IAP software for office practice. This will be available by end of July 2006 for use by our members.
11)	IAP sub-specialty books - Many of the IAP Sub-specialty books are being edited by the invited Guest Editors and will be out by mid 2006. These include Hematology, Oncology, Anemia, Neurology, Neonatology, Respiratory medicine, Intensive care, Gastroenterology, Pediatric Quiz, Pediatric color atlas, Infectious diseases etc.
12)	National consensus meetings on important Child Health issues are scheduled to be held in the first half of 2006 which include the expert meetings for each of the topics like diagnosis and management of Enteric fever, Diagnosis and management of ITP, Guidelines for the use of Blood Components, Role of Iron and Zinc in health & disease, Growth monitoring, Diagnosis and management of Acute Lymphoblastic Leukemia, Epilepsy, etc. National conveners have been assigned the task of preparing for these meetings.
13)	IAP Nurse's training project will start from March 2006 and we plan to conduct 36 such workshops training 75 nurses mainly from private sector who do not get a chance to learn again.
14)	Parvarish, 36 such parent's education programs will start in mid 2006.
15)	IAP Immunization Updates: We will aim at sensitizing our members in to correct immunization practices, including the EPI vaccines and future vaccines. We plan to conduct 30 such workshops all over the country.
16)	IAP CME for family physicians: IAP plans to conduct 20 CME for family physicians covering basic day to day pediatric problems in an interactive way.
17)	IAP Office - Last but not least is the upgrading of the IAP office. It will include the updating of its website. The work in this regards too is on.
18)	IAP Health Policies 2006 - A compilation of all the documents prepared while conducting all above projects for distribution to the members so as to sensitize them towards the IAP policies.
19)	IAP Safe Injection Practice and Safe Waste Disposal - 20 National and 1 SAARC regional workshop on safe injection practices and safe waste disposal.
20)	IAP Influenza and IAP Rota boards - IAP has formed to look in to the problem if Influenza and Rota viral infections and need for the respective vaccines. We have already planned to start 2 years project to study the epidemiology of influenza with the help from ICMR through a net work of 25 surveillance members from IAP.
21)	IAP Research Methodology workshops - IAP, through its research advisory committee proposes to conduct 5 zonal research methodology workshops for the teaching staff so as to enable them to conduct quality research.