Article Text
Abstract
Objective To assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries.
Setting The 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs).
Methods We conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI’s three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11.
Participants In-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef.
Results Eighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18).
Conclusion This survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.
- child health
- IMCI
- strategic review
- IMCI global survey
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Footnotes
Contributors The authors bring a combination of expertise in epidemiology, demography, statistics, child health interventions and policies, public health and advocacy. CB-P conceptualised and wrote the first drafts of the paper. GL, TRD and NO performed the analysis. GL conceptualised and performed the illustrations and revised the first draft. SLD analysed the qualitative information and wrote the last section of the paper (Strengths, barriers and ways forward). BD and SA developed the questionnaire. SA revised several versions of the paper, providing advice on IMCI-specific issues, helped coordinate the distribution and application of questionnaires and followed up with WHO Regional Offices. OAA-P, TD, PH, BB-R, JA-R, KS, AK, MW, RM and NR organised, tested, followed up and reviewed the questionnaires sent to countries. All authors contributed intellectual content and critical revisions to the manuscript. All authors approved the final manuscript. CB-P is the guarantor.
Funding The Strategic Review of IMCI and iCCM was funded by the Bill and Melinda Gates Foundation; the authors donated their time to writing the article; the publication fees for the supplement were funded by the Health Systems Research Unit, South African Medical Research Council.
Disclaimer The authors are staff members of WHO. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data will be available in the public domain (IMCI Global Implementation Survey Report) at: http://who.int/maternal_child_adolescent/documents/imci-global-survey-report/