3.1. Proposed subsidiary products
Although these recommendations were developed in the context of updating the Pocket Book of Hospital Care for Children used at the referral level, they will also be used to update the IMCI guidelines and other subsidiary child health implementation tools. Key tools to assist countries in the revision and update of national paediatric guidelines that are to be updated or developed include, but are not limited to:
Pocket Book training CD-ROM
Hospital and self assessment tools
A manual for clinical use of oxygen
Integrated Management of Childhood Illiness clinical algorithms.
The recommendations will be disseminated through various tools for improving quality of care and capacity building. The Pocket Book training CD-ROM used for in-service and pre-service training will be updated and widely distributed. The recommendations and the Pocket Book will be made available electronically as part of the quality of care improvement CD-ROM resource package, which will include quality assessment tools, a framework for quality improvement, and self-assessment tools to support managers and clinicians with improving quality of hospital care.
3.2. Implementation of the recommendations
In addition to publishing the recommendations as a stand alone reference document, they will be incorporated into various products mentioned above. They will mainly be circulated through the Pocket Book of Hospital Care for Children, which is the standard guideline used at first-referral level. The updated second edition of the Pocket Book will be translated into French, Spanish, and Russian in collaboration with regional offices for wider circulation and readership. The Pocket Book will be linked to the recommendations and the evidence used.
To increase its accessibility to the evidence used as the basis for the recommendations, it will also be made available for download from all of the WHO websites (headquarters, regional offices, and country offices) and select WHO Collaborating Centres websites in various electronic formats. While wider dissemination will continue through the Pocket Book sales in the WHO Bookshop, as well as through a distribution network to all medical libraries or individuals and through the non-profit Teaching-Aids at Low Cost (TALC) website.1
The Pocket Book will be introduced in medical and paramedical training institutions through national societies and in collaboration with the International Paediatric Association (IPA). WHO will also continue collaborating with various child health groups that have been instrumental in dissemination, implementation, and evaluation of the Pocket Book, including:
International Child Health Review Collaboration (ICHRC), a database of the evidence-base for the
Pocket Book recommendations (
http://www.ichrc.org).
Centre for International Child health, a WHO Collaborating Centre in Melbourne, Australia (
www.rch.org.au/cich).
National and regional networks whose missions are to improve the quality of care for children in hospitals, like the Kenya Medical Research Institute (KEMRI) (
http://www.idoc-africa.org/).
Collaboration with various partners like the International Paediatric Association (IPA) who are collaborating with WHO on improving quality of care through their regional and national societies.
Collaboration with child health specialists at national, regional, and international levels to support national adaptation and implementation of the Pocket Book as part of the process of improving quality of care.
Collaboration with medical students through national, regional, and international societies.
Evaluation of the guidelines will continue to be undertaken through periodic quality of care assessments in hospitals and through country reviews undertaken by the department of Maternal, Newborn, Child and Adolescent Health using the quality of care framework and the hospital assessment tools mentioned above.
3.3. National adaptation and implementation
These recommendations have been developed mainly to provide guidance in the updating and development of standard paediatric treatment guidelines at national level in resource-limited settings. It is expected that each country will adapt these recommendations to suit their context in consideration of the necessary resources required for implementation. This will be facilitated by updating the current Pocket Book of Hospital Care for Children, which countries may adapt in developing national standards of care.
Countries may already have various paediatric guidelines in the form of national treatment guidelines or hospital case management protocols. These guidelines would have to be reviewed and compared against the WHO Pocket Book for standards of care. It is recognized that implementation of some of the recommendations may be challenging as they require updating national essential medicine lists and building consensus at national level.
Establishing national standards for hospital care for children is critical in improving quality of care and is a major component of the quality improvement process. Countries will be encouraged to set up national technical working groups to support the national adaptation process with the involvement of all stakeholders. The standards will then be adapted and endorsed by stakeholders, locally translated as required, and disseminated to all hospitals in the country. In most cases, it may require orientation of the health workers on the new case management protocols as part of the quality of care improvement process.
