Evaluation of the Integrated Management of Childhood Illness Program Adopted in the Ministry of Health-Gaza Governorates
Date
2009-08-15
Authors
Abeer Mohammed Abu Seif
عبير محمد ابو سيف
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
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