Introductory commentary: a strategic review of options for building on lessons learnt from IMCI and iCCM

Jacobs, Marian; Merson, Michael H.

doi:10.1136/bmj.k3013

Cited by 11 publications

(18 citation statements)

References 13 publications

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“…To ensure that the IMCI program stays relevant after 20 years, further implementation research is needed to understand what works and what does not at the implementation level [56,57]. International and national efforts to strengthen district health management teams should be the linchpin of this effort, and it is imperative to update existing policies to ensure adequate fiscal space for the IMCI program at this level [18,19,58]. It is critical for the future of the IMCI program and child health that policy and implementation levels work more closely.…”

Section: Discussionmentioning

confidence: 99%

“…However, evidence suggests implementation has suffered from larger structural problems and weakness in IMCI program execution by global and in-country partners [8,11,12]. Jacobs and Merson [18] note the failures of IMCI to provide continuous care between the home, first level PHC-facilities and referring health facilities. Generally speaking, IMCI's impact on reducing inequity is difficult to assess given the varied extent of implementation [19].…”

Section: Introductionmentioning

confidence: 99%

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Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

View full text Add to dashboard Cite

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“…A key conclusion of WHO's 2016 strategic review of IMCI stated that "with attention focused on specific child health areas such as immunization and communicable diseases, a holistic view of child health has arguably been lost inside the continuum of reproductive, maternal, newborn, child and adolescent health." [12,15] In the Western Cape province of South Africa almost every public sector primary care facility employs an IMCI-trained nurse, and it is these nurses who attend to the majority of children's healthcare care needs. At a series of meetings with key stakeholders in provincial paediatric health -primary care nurses, doctors, managers and educators, hospital-level paediatricians and policy makers -the growing gaps in knowledge and expertise for children at primary care level were recognised as well as a need to integrate well child routine care into the delivery of everyday paediatric primary care.…”

Section: Introductionmentioning

confidence: 99%

Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

Murdoch

Curran

Cornick

et al. 2020

BMC Health Serv Res

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Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO's Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0-13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017-2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods: Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semistructured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results: Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation.

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“… 12 13 While evidence has mounted showing the potential impact on child mortality through increased coverage of quality treatment services, challenges remain in achieving the greatest impact from iCCM. 6 14 15 …”

Section: Introductionmentioning

confidence: 99%

The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses

et al. 2021

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Improving health outcomes in countries with the greatest burden of under-5 child mortality requires implementing innovative approaches like integrated community case management (iCCM) to improve coverage and access for hard-to-reach populations. ICCM improves access for hard-to-reach populations by deploying community health workers to manage malaria, diarrhoea and pneumonia. Despite documented impact, challenges remain in programme implementation and sustainability. An analytical review was conducted using evidence from published and grey literature from 2010 to 2019. The goal was to understand the link between governance, policy development and programme sustainability for iCCM. A Governance Analytical Framework revealed thematic challenges and successes for iCCM adaptation to national health systems. Governance in iCCM included the collective problems, actors in coordination and policy-setting, contextual norms and programmatic interactions. Key challenges were country leadership, contextual evidence and information-sharing, dependence on external funding, and disease-specific stovepipes that impede funding and coordination. Countries that tailor and adapt programmes to suit their governance processes and meet their specific needs and capacities are better able to achieve sustainability and impact in iCCM.

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Introductory commentary: a strategic review of options for building on lessons learnt from IMCI and iCCM

Cited by 11 publications

References 13 publications

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses

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