Where’s the leadership? Future commitments of Unicef and WHO for global child health

Costello, Anthony; Peterson, Stefan; Rasanathan, Kumanan; Daelmans, Bernadette; Bahl, Rajiv

doi:10.1136/bmj.k3219

Cited by 13 publications

(13 citation statements)

References 7 publications

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“…The lack of training and resources, and minimal supervision after training were among the weakest areas of IMCI implementation, as identified here and in studies of other LMICs [27,32,33,43]. Our work also highlights the magnitude of the poor supervision and monitoring after the early phases of implementation of IMCI in LMICs, reflecting larger problems relating to scale-up, such as lack of political commitment, human resources issues, fragmented program management and ineffective decentralization [24,25,30,32,40,[44][45][46]. It appears that IMCI programs are also not harmonized to other vertical programs, creating linkage issues for HCWs [25,26,47].…”

Section: Discussionmentioning

confidence: 68%

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: 68%

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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“…If the cadres found an individual with a suspected illness, such as malnutrition or fever, they will contact the village midwife and then refer the case to the Puskesmas. A leadership and management practice should be emphasized by the local government to support and motivate them to perform these tasks (59) to support a good start of the Posyandu information system through the app and its integration to the national information system. Good leadership, communication, and coordination will engender a robust health information system in Indonesia (60).…”

Section: Discussionmentioning

confidence: 99%

Understanding mobile application development and implementation to monitor Posyandu data in Indonesia: a 3-year hybrid action research to build “a bridge” from the community to the national scale

Rinawan,

Susanti,

Amelia

et al. 2020

Preprint

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Background. There is a small number of facts available to better understand how mobile health application technology on mother and child health (MCH) is developed. This study is aimed: (a) to explore the process of developing the mobile app in MCH community-based services in the Indonesian setting/ Posyandu ( Pos Pelayanan Terpadu ), (b) to perform feasibility assessment among the community health workers (CHWs), and (c) to see the scalability of the mobile app to the national level in Indonesia. Methods. A hybrid method in which the action research principles and the mixed method, which comprise qualitative and quantitative methods, were synergistically combined for the end-users. The study was conducted in Pasawahan sub-district, Purwakarta, Indonesia from 2017 to 2019. Content analysis, coding, and categorizing were carried out using NVivo 12 Pro for the transcribed data. Wilcoxon Test (2018 and 2019) was conducted using STATA 15 Special Edition. Results. (1) The use of a CHW notebook for data entry in the Posyandu information system book delayed the data reporting process, resulting in the need to develop a mobile app; (2) There are significant differences in CHWs’ knowledge ( p =0.000) and skills ( p =0.0097) on training (2018) and Posyandu phases (2019); (3) There have been 964 Posyandu registered to the Posyandu mobile app from almost all provinces in Indonesia. Conclusions. The 3-year hybrid approach suggests the crucial phases to develop a mobile app in a more user-friendly manner to substitute the use of CHWs’ old-fashion book use, hence its implementation is promising for national use.

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“…Without this overarching guidance, individual MNCH interventions remain fragmented and under-resourced [17][18][19][20]. Although some countries were able to effectively implement the monitor-review-act approach, greater investment in accurate, responsive, and integrated monitoring and evaluation systems will be needed to assess progress towards the more complicated and ambitious SDGs [8,[21][22][23][24].…”

Section: A Summary Of Key Findingsmentioning

confidence: 99%

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

Brault

Mwinga

Kipp

et al. 2020

Global Health Action

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Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries-Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.

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Where’s the leadership? Future commitments of Unicef and WHO for global child health

Abstract: Anthony Costello and colleagues explain how WHO and Unicef are working closely together to support countries to achieve universal health coverage for children

Cited by 13 publications

References 7 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

Understanding mobile application development and implementation to monitor Posyandu data in Indonesia: a 3-year hybrid action research to build “a bridge” from the community to the national scale

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

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