Supplement Article |
Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness
1 WHO Consultant, 2081 Danby Road, Ithaca, NY, USA, 2 Universidade Federal de Pelotas, Pelotas, Brazil, 3 Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA, 4 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and 5 Department of Child and Adolescent Health and Development, Family and Child Health Cluster, World Health Organization, Geneva, Switzerland
Correspondence: Robert Scherpbier, Department of Child and Adolescent Health and Development, World Health Organization, Via Appia, 1211 Geneva 27, Switzerland. Tel: +41 22 791 2693; Fax: +41 22 791 4853; E-mail: scherpbierr{at}who.int
Objective: 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.
Results: 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 careseeking, 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.
Conclusions: 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.
Key Words: child survival, IMCI, public health programme evaluation, child health
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. K. deWilde, A. Milman, Y. Flores, J. Salmeron, and I. Ray An integrated method for evaluating community-based safe water programmes and an application in rural Mexico Health Policy Plan., November 1, 2008; 23(6): 452 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. McCoy, D. Sanders, and G. Kvale Broader Vision Required for the New Child Survival Revolution J Trop Pediatr, February 1, 2007; 53(1): 1 - 3. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Leroy, J.-P. Habicht, G. Pelto, and S. M. Bertozzi Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year Am J Public Health, February 1, 2007; 97(2): 219 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Haws and G. L. Darmstadt Integrated, Evidence-Based Approaches to Save Newborn Lives in Developing Countries Arch Pediatr Adolesc Med, January 1, 2007; 161(1): 99 - 102. [Full Text] [PDF]
|
|
|
|
 |
|
 M Ellis and S Allen Towards millennium development goal four. Arch. Dis. Child., September 1, 2006; 91(9): 728 - 730. [Full Text] [PDF]
|
|