Evaluation of the Integrated Management of Childhood Illness Program Adopted in the Ministry of Health-Gaza Governorates

Abeer Mohammed Abu Seif
عبير محمد ابو سيف
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Al-Quds University
In 1995, WHO and UNICEF developed a strategy known as the Integrated Management of Childhood Illnesses (IMCI), which provides a syndromic approach for managing sick children aiming at reduce mortality and morbidity associated with the five major causes of diseases among children under age five. In 2002 the Palestinian Ministry of Health endorsed the IMCI as a strategy for managing childhood illnesses and performed active steps in this regard including; adaptation, training and early implementation. The over all aim of this study is to evaluate the effectiveness of the implementation of the IMCI strategy and to identify how the implementation could be strengthened. The design of the study was a triangulated cross sectional one and included administering an interviewed questionnaire for all trainees who received the IMCI training (160), in-depth interviews with purposively selected eight participants, facility audit for equipment and resources needed for the IMCI implementation and reviewing medical files of children (150). Response rate was high (90.6%) and data validity was assured through standardization of the implementation and experts' review of the study tool. Random meetings with 37 care takers (mothers), asking about counseling regarding nutrition and breast feeding were available at the PHCC visits. The study revealed that around 77 % of the trainees perceived the training time on the IMCI as sufficient but still 86% of them requested further refreshing courses. The majority of participants believed that IMCI should be provided through the undergraduate curriculum. Only around half of participants knew that the IMCI has been adopted by the MOH. Although trainees' perceptions about the IMCI are positive in general, less than 10% of them often practice it in their clinics while the rest are either do not practice it or rarely practice it. The study showed that only around a quarter of supervisors are checking case management of the sick child and having the standard supervisory form. Drugs and equipment needed for the implementation of the IMCI are not always available (availability around 70%). The review of children records illustrates that only 25% of children are treated according to the IMCI guidelines and in only 20 of files, the IMCI related records were properly filled. This raises a big question about the impact of the IMCI training and its implementations in the field. Interviews with the key informants showed that implementation of the IMCI has been unnecessarily delayed and called for more effective supervision. The study recommends that the whole IMCI strategy requires more attention including provision of equipment, drugs and facilities, intensifying training and follow up of trainees and strengthening supervision and monitoring