Elsevier

Health Policy

Volume 96, Issue 2, July 2010, Pages 128-133
Health Policy

Review
National implementation of Integrated Management of Childhood Illness (IMCI): Policy constraints and strategies

https://doi.org/10.1016/j.healthpol.2010.01.013Get rights and content

Abstract

Integrated Management of Childhood Illness (IMCI) is a pediatric care management strategy that has been shown to improve health care service quality and increase health care cost savings in multi-country evaluations. However, many countries have faced significant training, health system, political, and financial constraints to national implementation and, as a result, have not been able to observe sustained benefits of IMCI. This article reviews the literature for evidence of IMCI health impacts, common implementation constraints, and policy strategies for health system strengthening and successful implementation.

Introduction

Approximately nine million children die of preventable and treatable conditions every year [1], [2], [3]. Integrated Management of Childhood Illness (IMCI) is a strategy that attempts to reduce childhood deaths due to most of these conditions, including acute respiratory infections, diarrhea, measles, malaria, and malnutrition [4]. First introduced in 1996 with the specific objective of reducing mortality for children under-five in countries with infant mortality rates of at least 40 per 1000 live births [5], [6], it ultimately aims to improve pediatric health by strengthening three core components: health worker skills and training, health systems, and family and community practices [7].

Since its introduction, multi-country evaluations of IMCI (MCE-IMCI) in Uganda, Tanzania, Bangladesh, Brazil, and Peru have shown benefits in health service quality as well as reductions in mortality and health care costs [8]. Based on this evidence, over 113 countries have since introduced IMCI to their health systems with varying levels of comprehensiveness [9], [10]. However, MCE showed several constraints to national implementation of IMCI, including training, health system, and financial constraints. As a result, many countries have only implemented the training components of IMCI without complementary reform of health systems or policy to support national expansion.

This article reviews the empirical evidence to-date regarding various IMCI benefits, commonly identified implementation constraints, and the proposed strategies for policy reform and successful implementation of programs. Literature search was conducted with PubMed using the search terms “IMCI” and any of “mortality, morbidity, implementation, cost, constraint, impact, and policy.” Inclusion criteria were manuscripts that described pediatric mortality, morbidity, health care service quality, costs, compliance, training, implementation constraints, or interventions associated with IMCI.

Section snippets

Evidence of benefits

Evaluations of IMCI in Uganda, Tanzania, Bangladesh, Brazil, Peru, South Africa, China, Armenia, Nigeria, and Morocco have shown various benefits in health service quality, mortality reduction, and health care cost savings. This section describes the successes in implementation in the areas of morbidity, mortality, and health service quality improvement; equipment supplies; and health care cost savings.

Gaps and constraints to national implementation

Despite the evidence available regarding improved health outcomes and potential cost savings with IMCI, there have been several reported local and national constraints to IMCI implementation in most countries. These constraints – low HCW compliance with IMCI guidelines, perceived length and expense of training, inadequate counseling of child caregivers, weakness of health systems to support IMCI policy, and lack of institutionalization or governmental budget allocations for IMCI implementation

Strategies for national implementation

The WHO's World Health Report defined health systems as including “all the activities whose primary purpose is to promote, restore or maintain health” [33]. Since then there has been a growing consensus that effective health programs require strong, well-functioning health systems [34], [35]. Weak health systems have not only been noted to hinder implementation of IMCI, but also a variety of community health programs globally [29], [35]. In 2006, the WHO recommended that in order to strengthen

Conclusion

IMCI has been shown to be effective in improving pediatric health service quality, increasing health care cost savings, and possibly reducing pediatric mortality in developing countries. However, many countries have faced significant training, health system, political, and financial constraints to national implementation and, as a result, have not been able to observe sustained benefits over time. As IMCI continues to be implemented in various countries, health officials must continue to

Conflicts of interest

There are no conflicts of interest reported.

References (45)

  • S. El Arifeen et al.

    Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study

    Lancet

    (2004)
  • World Health Organisation

    Annual report

    (2008)
  • H. Masanja et al.

    Impact of Integrated Management of Childhood Illness on inequalities in child health in Rural Tanzania

    Health Policy and Planning

    (2005)
  • S. El Arifeen et al.

    Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial

    Lancet

    (2009)
  • E. Gouws et al.

    Improving antimicrobial use among health workers in first-level facilities: results from the multi-country evaluation of the Integrated Management of Childhood Illness strategy

    Bulletin of the World Health Organization

    (2004)
  • D. Bishai et al.

    The cost of quality improvements due to Integrated Management of Childhood Illness (IMCI) in Uganda

    Health Economics

    (2008)
  • J.E. Amaral et al.

    Effect of Integrated Management of Childhood Illness (IMCI) on health worker performance in Northeast Brazil

    Cadernos de Saude Publica

    (2004)
  • M. Chopra et al.

    Effect of an IMCI intervention on quality of care across four districts in Cape Town, South Africa

    Archives of Disease in Childhood

    (2005)
  • Y. Zhang et al.

    Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China

    Journal of Paediatrics and Child Health

    (2007)
  • J.F. Naimoli et al.

    Effect of the Integrated Management of Childhood Illness strategy on health care quality in Morocco

    International Journal for Quality in Health Care

    (2006)
  • J.R. Armstrong Schellenberg et al.

    Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania

    Lancet

    (2004)
  • J. Amaral et al.

    Impact of IMCI health worker training on routinely collected child health indicators in Northeast Brazil

    Health Policy and Planning

    (2005)
  • Cited by (0)

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