Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course (original) (raw)
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Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer)
ABSTRACTBackground: At the Community and Primary Health Care Center in Bantul, the number of paramedics receiving Integrated Management of Childhood Illness (IMCI) training is very limited and not evenly distributed. With the low number of IMCI trained officers, this affects the skill of the officers in conducting the IMCI. Fewer skills affect the handling of sick children including the recognition of general danger signs, classification, designing appropriate action, as well as providing treatment and counseling.Objective: This study aimed to know the effectiveness of IMCI Mini Training intervention to improve health workers’ skills in handling sick children with IMCI.Methods: This research was a quasi-experimental study with a non-equivalent pre-post control group design. The sample of this study was a group of health workers who implement IMCI in daily work at 20 Community and Primary Health Care Centers in Bantul. Data were collected by observing 20 health workers in the control...
Bmc Public Health, 2014
Background: Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) and aims at reducing childhood morbidity and mortality in resource-limited settings including Tanzania. It was introduced in 1996 and has been scaled up in all districts in the country. The purpose of this study was to identify factors influencing the implementation of IMCI in the health facilities in Mwanza, Tanzania since reports indicates that the guidelines are not full adhered to by the healthcare workers. Methods: A cross-sectional study design was used and a sample size of 95 healthcare workers drawn from health centers and dispensaries within Mwanza city were interviewed using self-administered questionnaires. Structured interview was also used to get views from the city IMCI focal person and the 2 facilitators. Data were analyzed using SPSS and presented using figures and tables. Results: Only 51% of healthcare workers interviewed had been trained. 69% of trained Healthcare workers expressed understanding of the IMCI approach. Most of the respondents (77%) had a positive attitude that IMCI approach was a better approach in managing common childhood illnesses especially with the reality of resource constraint in the health facilities. The main challenges identified in the implementation of IMCI are low initial training coverage among health care workers, lack of essential drugs and supplies, lack of onsite mentoring and lack of refresher courses and regular supportive supervision. Supporting the healthcare workers through training, onsite mentoring, supportive supervision and strengthening the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management were the major interventions that could assist in IMCI implementation. Conclusions: The healthcare workers can implement better IMCI through the collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.
Health Research Policy and Systems, 2009
Background: The Integrated Management of Childhood Illness Strategy (IMCI) is effective in improving management of sick children, and thus child survival. It is currently recommended that in-service IMCI case management training (ICMT) occur over 11-days; that the participant: facilitator ratio should be ≤4:1 and that at least 30% of ICMT time be spent on clinical practice. In 2006-2007, approximately ten years after IMCI implementation, we conducted a multi-country exploratory questionnaire survey to document country experiences with ICMT, and to determine the acceptability of shortening duration of ICMT. Methods: Questionnaires (QA) were sent to national IMCI focal persons in 27 purposively-selected countries. To probe further, questionnaires (QB and QC respectively) were also sent to course-directors or facilitators and IMCI trainees, selected using snowball sampling after applying pre-defined criteria, in these countries. Questionnaires gathered quantitative and qualitative data. Results: Thirty-three QA, 163 QB, 272 QC and two summaries were returned from 24 countries. All countries continued to adapt course content to local disease burden. All countries offer shorter ICMT courses, ranging from 3-10 days (commonest being 5-8 days). The shorter ICMT courses offer fewer exercises, more homework, less individual feedback and reduced clinical practice (<30% time). Whereas changes to course content were usually evidence-based, changes to training methodology and course duration evolved as pressure to expand implementation mounted. Participants varied in their self-reported skill and perception about each course. However, the varied methodology and integrated approach to management of illnesses were commonly cited as strengths of ICMT, and the chart booklet and clinical practice sessions were identified as critical components of ICMT. Four themes emerged from the qualitative work, viz. the current 11-day course is too expensive and should be shortened; advocacy around IMCI should increase; content should be regularly updated, new content areas should be introduced cautiously and more attention should be paid to skills-building rather than knowledge accumulation. Conclusion: Whilst the 11-day ICMT course is still recommended, as efforts intensify to increase access to quality care and meet MDG4, standardized shorter ICMT courses, that include participatory methodologies and adequate clinical practice, could be acceptable globally.
Global Health Action
Background: Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized. Purpose: To determine the key challenges affecting IMCI implementation from the perspective of health care workers (HCWs) in primary health care facilities. Methods: A scoping review based on the five-step framework of Arskey and O'Malley was utilized to identify key challenges faced by HCWs implementing the IMCI program in primary health care facilities. A comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and Google Scholar was conducted. A total of 1,475 publications were screened for eligibility and 41 publications identified for full-text evaluation. Twentyfour (24) published articles met our inclusion criteria, and were investigated to tease out common themes related to challenges of HCWs in terms of implementing the IMCI program. Results: Four key challenges emerged from our analysis: 1) Insufficient financial resources to fund program activities, 2) Lack of training, mentoring and supervision from the tertiary level, 3) Length of time required for effective and meaningful IMCI consultations conflicts with competing demands and 4) Lack of planning and coordination between policy makers and implementers resulting in ambiguity of roles and accountability. Although the IMCI program can provide substantial benefits, more information is still needed regarding implementation processes and acceptability in primary health care settings. Conclusion: Recognizing and understanding insights of those enacting health programs such as IMCI can spark meaningful strategic recommendations to improve IMCI program effectiveness. This review suggests four domains that merit consideration in the context of efforts to scale and expand IMCI programs.
Integrated management of childhood illness
The Lancet, 1997
IMCI PLANNING GUIDE 2.3.2.5 Optional: Discuss how to introduce IMCI in pre-service training 2.3.3 Plan for improvement in the health system 2.3.3.1 Plan for availability of drugs and supplies needed for IMCI 2.3.3.2 Plan for improving referral pathways and services 2.3.3.3 Optional: Plan for organization of work in health facilities 2.3.3.4 Plan for supervision 2.3.3.5 Plan for linking IMCI classifications and the health information system 2.3.4 Plan for improvement in family and community practices 2.3.5 Plan documentation of early implementation 2.3.6 Plan for selection of districts for early implementation 2.3.7 Plan the budget for the IMCI early implementation phase 2.3.8 Compile the national plan for the IMCI early implementation phase Overview of steps 1.0-5.0 of the IMCI planning process 3. Adapt the generic IMCI guidelines and training materials 3.1 Initiate adaptation 3.2 Do adaptation tasks 3.2.1 Adapt clinical guidelines 3.2.2 Adapt feeding recommendations, determine local terms and develop the mother's counselling card 3.2.3 Plan for consistency of messages about child health communicated to families 3.3 Circulate adapted guidelines for review and to build consensus 3.4 Produce adapted training materials 3.4.1 Adapt training materials to reflect the adapted guidelines and translate them 3.4.2 Produce copies of adapted materials to use in the first central-level IMCI case management course 4. Initiate activities to improve the health system and prepare for health worker training 4.1 Initiate work of the Implementation Subgroup 4.2 Initiate work with the district health teams 4.2.1 Conduct an orientation meeting in each selected district (half day) 4.2.2 Have individual meetings and discussions with key district persons v 4.2.3 Obtain information about the district that will be useful for planning 4.3 Plan at the central level for follow-up after training, drug availability, improving referral pathways and services, supervision, linking IMCI classifications and the HIS, and documentation of the early implementation phase 4.3.1 Plan for follow-up after training 4.3.2 Plan for availability of drugs needed for implementation of IMCI 4.3.3 Plan for improving referral pathways and services 4.3.4 Plan for supervision 4.3.5 Plan for linking IMCI classifications and the HIS 4.3.6 Plan for documentation of early implementation 4.4 Finalize arrangements for the first IMCI training course at central level 4.4.1 Identify participants for the central-level IMCI case management course 4.4.2 Prepare the central-level training site and obtain a course director, clinical instructor and facilitators 5. Initiate activities to improve family and community practices 5.1 Initiate work of the Family and Community Practices Subgroup 5.2 Implement activities as agreed in the national planning workshop 5.2.1 Collaborate with the Adaptation Subgroup to adapt feeding recommendations, identify local terms, develop the mother's card and ensure consistency of health education messages 5.2.2 Conduct a national-level assessment of key family practices and available resources 5.2.2.1 Collect and review existing information regarding key family and community practices 5.2.2.2 Assess existing resources, opportunities and constraints to improve family and community practices 5.2.3 Select the districts to initiate community-based interventions 5.2.4 Review the core IMCI indicators at household level, and decide upon a process to monitor changes in keys family practices 6. Build national capacity for IMCI implementation through training 6.1 Train facilitators for the first central-level IMCI training course 6.2 Conduct the first central-level IMCI training course(s) CONTENTS vi IMCI PLANNING GUIDE 6.3 Train future course directors and clinical instructors for their roles in first district-level courses 6.4 Finalize and reproduce the IMCI materials 7. Develop district plans for IMCI early implementation (Conduct district planning workshops) 7.1 Plan for improvement of skills of health staff 7.2 Plan for improvement in the health system 7.3 Plan for improvement in family and community practices 7.4 Plan for documentation of early implementation 7.5 Develop a district budget 7.6 Compile the district plans 8. Implement district-level IMCI activities 8.1 Implement district-level IMCI training courses for first-level health workers 8.2 Implement follow-up after training 8.3 Implement solutions to improve the health system 8.4 Implement community-based interventions 8.5 Document progress and take action to solve problems 9. Review the IMCI early implementation phase 9.1 Summarize information on early implementation and prepare for review 9.2 Review early implementation 10. Plan for the expansion phase 10.1 Agree on specific quality adjustments, based on what was learned in the early implementation phase 10.2 Discuss structural and organizational issues 10.3 Discuss how the IMCI strategy fits within the national health policy and, where relevant, health sector reforms 10.4 Decide on emphasis and select activities for the expansion phase 10.5 Decide on the general pace of expansion and the number of districts that will be included in IMCI activities during the next phase 10.6 Select districts for expansion 10.7 Plan activities in the districts 10.8 Set targets for coverage and performance 10.9 Plan for documentation and evaluation of IMCI vii 10.10 Plan a budget and compile the plans and recommendations into a summary plan for the expansion phase 10.11 Conduct a consensus meeting to present the findings, recommendations and plan for expansion Annexes Annex A: IMCI national orientation meeting Annex B: Methods and process for documenting IMCI early implementation Annex C: Tools for data collection and summary Annex D: Breastfeeding aspects of the IMCI strategy Annex E: Drugs and supplies needed for implementation of IMCI Annex F: Use and design of a translation table for IMCI and health information system classifications Annex G: Review of the IMCI early implementation phase Annex H: Priority IMCI indicators at health-facility level and at household level Annex I: Milestones for IMCI implementation Annex J: Selected exercises from the IMCI training course for first-level health workers: Participant's notes 3 Once a commitment has been made to the IMCI strategy, a country should gain experience with the strategy in a limited geographical area, which will be used to guide future planning and implementation. In the early implementation phase, the IMCI Working Group develops a national plan for IMCI activities and selects the initial districts for early implementation. The working group coordinates the adaptation of the clinical guidelines and training materials for the country. The group plans for IMCI activities and helps prepare the districts to implement them. District health teams participate in planning and then conduct activities in the district, including several training courses, follow-up visits after training, and ensuring drug availability. Existing community-based programmes or interventions should be strengthened and utilized to promote family and community practices. The experience explores how the IMCI strategy will fit into the overall planning system at both central and district levels, how to link with health sector reforms, how much it costs, and how district capacity to do IMCI activities can be built. It includes a careful documentation of activities to identify and solve problems. At the end of the early implementation phase, there is a review of the experiences. s Expansion phase: The purpose of this phase is to expand IMCI geographical coverage and activities based on the experience and lessons learned in the previous phase. Drawing on experience from the early implementation phase, the country plans how to expand IMCI activities in districts where IMCI activities were implemented on a limited scale and begins IMCI activities in other districts. A country may also broaden the range of IMCI activities within the three components of the IMCI strategy: improving case management skills, improving the health system, and improving family and community practices. IMCI evaluation activities begin in this phase. The IMCI Planning Guide What is the IMCI Planning Guide? The IMCI Planning Guide was developed by WHO to assist countries who want to undertake the IMCI strategy. It describes a phased process for planning and implementing interventions of the IMCI strategy and recommends steps for each phase up to planning for the expansion phase. The recommendations are based on experience in a limited number of countries. The guide sometimes describes different options and recognizes that countries may find various ways of carrying out the steps depending on their circumstances and ways of operating. Because the IMCI strategy is an integrated approach, staff and programmes will need to work together in new ways. Some important functions such as policy and guideline development, and setting minimal criteria for quality, will rest at the central level. However, most IMCI activities will be planned and implemented at district level. For these reasons, planning will require some innovative and cooperative approaches. Consensus-building, though it will take time, is essential.
2012
Integrated Management of Childhood Illnesses (IMCI) is a strategy that was developed by the World Health Organisation (WHO) and the United Nations Children"s Fund (UNICEF) to reduce the mortality and morbidity rate of children younger than 5 years and to improve the quality of life of these children. The reduction of child mortality and morbidity is one of the Millennium Developmental Goals (MDGs) as sub-Saharan Africa has a high child mortality and morbidity prevalence. The IMCI strategy has three components namely case management, the health system and the household and community component. This strategy was implemented internationally, including South Africa, where it is implemented within Primary Health Care (PHC) facilities. The implementation of the IMCI strategy was introduced to the PHC environment of South Africa and aims to enhance the equity, accessibility, affordability and availability of health care to all South African citizens, with the focus in this study on the child younger than 5 years. The North West province started training the professional nurses and implemented IMCI in 1998. The Dr. Kenneth Kaunda district (one of the districts in North West Province) and with specific focus on the Matlosana sub-district identified challenges in the implementation of the IMCI strategy by professional nurses. Challenges such as a lack of trained staff, the short time frame available for consultation amidst an already overburdened clinic and the physical infrastructure of the PHC facilities are such examples. The main aim of this research was to explore and gain insight and understanding in the challenges professional nurses working in PHC facilities face regarding the implementation of the IMCI strategy. A qualitative research design was used to conduct this study on daily work-life experiences of the professional nurses. Individual, semistructured interviews were used as the method of data collection. The main question asked was: "What are the challenges faced by professional nurses in PHC facilities v regarding the implementation of the IMCI strategy?" Data saturation was reached after 18 professional nurses were interviewed (N=18). Digitally voice recorded interviews were transcribed and content analysis was conducted. The findings of this research suggest that the professional nurses in the PHC facilities indeed experienced challenges regarding IMCI implementation. The main themes that emerged were challenges regarding the organisation and service delivery; challenges specific to the implementation of the IMCI strategy and also challenges external to the clinic that impacted directly on the IMCI strategy implementation. The findings were discussed with literature integration. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research, and community health practice.
Journal of Medical Education, 2021
Background: In most developing countries, undergraduate medical students rely upon books published by foreign publications of developed countries. These books often fail to include World Health Organization (WHO) recommended guidelines, which are vital for the national health mission of developing countries. As a result, medical students who are “future doctors” continue to lack the necessary skills when they graduate from medical schools and start working in their countries. Objectives: The aim of this study was to quantify the impact of the inclusion of the WHO-recommended integrated management of childhood illness (IMCI) guideline in the curriculum of undergraduate students. Methods: This case-control study was done on a group of 72 undergraduate medical students in the case (trained) group who underwent 12 days of IMCI training and 92 undergraduate students in control (untrained) group who did not receive IMCI training. An evaluation test, which included clinical case scenarios,...