Scaling up Integrated Management of Childhood Illness
Date
2010-10-01Author
Huicho, Luis.
Dávila, Miguel.
Drasbeck, Christopher.
Bryce, Jennifer.
Victora, Cesar G.
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This paper presents the first published report of a national-level effort to implement the Integrated
Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the
early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report
on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in
Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost
and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of
Peru’s 34 districts, interviewed district health staff and reviewed district records. Findings show that
IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address
acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of
health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and
2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to
implement the community component of IMCI began with the training of community health workers in
2000, but expected synergies between health facility and community interventions were not realized
because districts where clinical training was most intense were not those where community IMCI
training was strongest. We summarize the constraints to scaling up IMCI, and examine both the
methodological and policy implications of the findings. Few monitoring data were available to
document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute
to programme improvement. Even basic indicators recommended for national monitoring could not be
calculated at either district or national levels. The findings document weaknesses in the policy and
programme supports for IMCI that would cripple any intervention delivered through the health service
delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other
countries working to achieve high and equitable coverage with essential child survival interventions can
learn from their experience.
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