MCE-IMCI Technical Advisors. Programmatic pathways to child survival: Results of multi-country evaluation of Integrated Management of Childhood Illness

Department of Child and Adolescent Health and Development, World Health Organization, Via Appia, 1211 Geneva 27, Switzerland.
Health Policy and Planning (Impact Factor: 3.47). 01/2006; 20 Suppl 1(Suppl 1):i5-i17. DOI: 10.1093/heapol/czi055
Source: PubMed


To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI), and to discuss the implications of these findings for child survival policies and programmes. Design: The MCE-IMCI study designs were based on an impact model developed in 1999-2000 to define how IMCI would be implemented at country level and below, and the outcomes and impact it would have on child health and survival. MCE-IMCI studies included: feasibility assessments documenting IMCI implementation in 12 countries (1999-2001); in-depth studies using compatible designs in Bangladesh, Brazil, Peru, Tanzania and Uganda; and cross-site analyses addressing the effectiveness of specific subsets of IMCI activities.
The IMCI strategy was successfully introduced in the great majority of countries with moderate to high levels of child mortality in the period from 1996 to 2001. Seven years of country-based evaluation, however, indicates that some of the basic expectations underlying the development of IMCI were not met. Four of the five countries (the exception is Tanzania) had difficulties in expanding the strategy at national level while maintaining adequate intervention quality. Technical guidelines on delivering interventions at family and community levels were slow to appear, and in their absence countries stalled in their efforts to increase population coverage with essential interventions related to care-seeking, nutrition, and correct care of the sick child at home. The full weight of health system limitations on IMCI implementation was not appreciated at the outset, and only now is it clear that solutions to larger problems in political commitment, human resources, financing, integrated or at least coordinated programme management, and effective decentralization are essential underpinnings of successful efforts to reduce child mortality.
This analysis highlights the need for a shift if child survival efforts are to be successful. Delivery systems that rely solely on government health facilities must be expanded to include the full range of potential channels in a setting and strong community-based approaches. The focus on process within child health programmes must change to include greater accountability for intervention coverage at population level. Global strategies that expect countries to make massive adaptations must be complemented by country-level implementation guidelines that begin with local epidemiology and rely on tools developed for specific epidemiological profiles.

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    • "In 1995, the clinical algorithm for Integrated Management of Childhood Illness (IMCI) was developed to address case management of the most common illnesses for children below 5 years: pneumonia, diarrhoea, malaria, measles and malnutrition (WHO 1997). The IMCI programme was originally articulated as being three pronged: improving (1) facility-based case management, (2) health systems and (3) family and community health practices (WHO 2013); however, the community component was often not successfully implemented in many African countries (Lambrechts et al. 1999; WHO 2003; Bryce et al. 2005). The evidence base for the delivery of curative services at the community level for the individual pathologies of diarrhoea, malaria and pneumonia is substantial (Sazawal and Black 1992; 2003; Delacollette et al. 1996; Bhutta et al. 1999; Kidane and Morrow 2000; Victora et al. 2000; Baqui et al. 2002; 2004), while the research supporting the 'integrated' delivery of these services is more sparse (Lewin et al. 2010; Yeboah-Antwi et al. 2010; Christopher et al. 2011; Chinbuah et al. 2012). "

    Health Policy and Planning 12/2015; 30(suppl 2):ii36-ii45. DOI:10.1093/heapol/czv033 · 3.47 Impact Factor
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    • "Research is needed to understand how fathers, who are often neglected in programmes to improve complementary feeding, can be positively engaged. Beyond health services, other platforms are needed to address the contextual factors at the base of the conceptual framework developed by Stewart et al. (2013), which may act to either enable or impede progress towards improving child growth and development (Victora et al. 2005). These include services related to agriculture and food systems, and water, sanitation and the environment. "
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