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Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania.

Kiplagat A, Musto R, Mwizamholya D, Morona D - BMC Public Health (2014)

Bottom Line: 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.However, significant barriers impede a sustainable IMCI implementation.Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.

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Affiliation: Zonal Health Resource Centre-Lake Zone, Mwanza, Tanzania. augustinekip@yahoo.com.

ABSTRACT

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.

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Conceptual framework.
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Figure 1: Conceptual framework.

Mentions: According to WHO [1,2,7-11] the IMCI improves health worker performance on the management of childhood illness therefore reducing mortality and morbidity. However, a study in Tanzania [3,12] has shown that many health care workers do not adhere to IMCI guidelines and the reasons for this remain unclear. Decision-making by health care workers may be shaped by economic, patient-related, training, professional and organizational factors as summarized in conceptual framework in FigureĀ 1. Understanding non-adherence will help policy and decision makers to improve IMCI implementation.


Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania.

Kiplagat A, Musto R, Mwizamholya D, Morona D - BMC Public Health (2014)

Conceptual framework.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3987128&req=5

Figure 1: Conceptual framework.
Mentions: According to WHO [1,2,7-11] the IMCI improves health worker performance on the management of childhood illness therefore reducing mortality and morbidity. However, a study in Tanzania [3,12] has shown that many health care workers do not adhere to IMCI guidelines and the reasons for this remain unclear. Decision-making by health care workers may be shaped by economic, patient-related, training, professional and organizational factors as summarized in conceptual framework in FigureĀ 1. Understanding non-adherence will help policy and decision makers to improve IMCI implementation.

Bottom Line: 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.However, significant barriers impede a sustainable IMCI implementation.Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.

View Article: PubMed Central - HTML - PubMed

Affiliation: Zonal Health Resource Centre-Lake Zone, Mwanza, Tanzania. augustinekip@yahoo.com.

ABSTRACT

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.

Show MeSH