Health Promotion Initiative: Integrated Management of Childhood Illnesses - Term Paper Example

Health Promotion Initiative: Integrated Management of Childhood Illnesses (IMCI) Introduction One of the current health promotion initiatives and campaigns aimed at improving public health, especially the health of children is the Integrated Management of Childhood Illnesses or the IMCI. This program is a program by the World Health Organization (WHO) and is geared towards implementing an integrated style in managing child health, highlighting the holistic management of the child. It seeks to decrease death, illness, and disability for the child and support the growth and development of children below five years of age. This program covers preventive as well as curative aspects of healthcare. Its main components include: improvement of case management skills for healthcare personnel; improvement of overall health processes; and the improvement of family and community health processes (WHO, 2013). The IMCI also seeks to ensure the accurate identification of childhood diseases within outpatient conditions, allowing for the sufficient combination of interventions for major diseases, improving counselling processes for caretakers, and ensuring the referral of very sick children. This program has also been set to promote sufficient care seeking attitudes, as well as better nutrition and preventative care, including the appropriate indication of prescribed interventions (WHO, 2013). This program is being implemented with the introduction of its strategy in countries following different phased of implementation. There is a required coordination in terms of current health programmes being implemented in the country. It also requires close links and relations with local government units, including the agencies of health, adapting these principles based on local conditions (WHO, 2013). Phases include the implementation of the integrated approach to child health and development within the national level of policy-making; implementing IMCI guidelines based on the needs of the country, existing policies, and language of the population; improving care in local health centres by training health workers in new methods of treating children; ensuring that the health facilities have sufficient supply of the appropriate low-cost medications; supporting care for hospitals for children who are too sick to be managed within outpatient settings; and implementing support processes in communities in the prevention of diseases, assisting families in managing the sick children, and getting these children to the hospitals where necessary (WHO, 2013). So far, the IMCI has already been implemented in 75 countries. Based on the above background for the health initiative, a critical analysis of this campaign will now be carried out, evaluating its efficacy, its outcomes, possible improvements which can be adopted by the program, and mostly the advantages and disadvantages of the health program, as well as the issues which have emerged during the implementation of the program. Possible recommendations shall also be presented in this paper, either on measures to eliminate or improve this program. Body The monitoring and evaluation of the IMCI is important in order to assess the progress of the program and to establish future plans of action in order to improve its coverage. Indicators relate to the measurement of the track progress of a program over time in relation to its goals and objectives. The application of standard IMCI measures for monitoring and assessment assists the decision-makers in securing comparable data within varying settings. Main indicators for evaluating the progress of child health within the region has mostly related to the Regional Child Survival Strategy (WHO, 2010). Data is essential to determine input and output and to evaluate the implementation of the IMCI. Such measures determine whether human, maternal, and financial elements are available and whether the corresponding activities are actually being implemented. Population-based measures determine whether the mothers and the children have been covered by the specific interventions. Improved coverage is essential in order to gain sufficient impact. Coverage is based on population-based assessments (WHO, 2010). Indicators are then measures alongside the specific continuum of care for the mother and the child. Impact indicators for the IMCI have also covered mortality, morbidity, and the nutritional status of the children. Improvements in these elements are expected within five to 10 years or longer from the time of its implementation. The impact is the general and ultimate purposes relating to IMCI seen to affect changes and goals for strategy. Different methods are also available for monitoring the program, with methods including population-based surveys, health facility surveys, service availability mapping, routine health information systems, and short programme reviews on child health in the areas covered (WHO, 2010). Based on the measures and standards indicated above, benefits and challenges have both been observed in the implementation of the IMCI. In the 2010 assessment by the World Health Organization of the Western Pacific Region, they established that most countries in the region have made major progress in the monitoring of the IMCI using the standard indicators already mentioned above. Challenges observed based on their report include issues in the systematic planning of the IMCI monitoring (Arifeen, et.al., 2009). Inadequate funds have also been observed in the implementation of the programme, interfering with the improvement of health personnel skills and the improvement of health information systems for children below five years of age (Freitas do Amaral, et.al., 2008). It is also noted that programme inputs are not often applied in assessing the implementation of activities and policies. The use of these measures would assist managers in eventually determining whether activities are actually being implemented (Pariyo, et.al., 2005). In some countries, the assessments of health facilities are not actually being carried out. The staff members are sometimes not included in their survey data collection which is usually carried out by consultants. Feedback in this case is inadequate and delayed (Pariyo, et.al., 2005). The stakeholders are also not often well coordinated in their actions. The elements needed in data collection and management are often not applied accordingly. Various surveys often apply non-specific assessments in their indicators. The health personnel are also not informed about the outcomes for the surveys as well as assessments (WHO, 2010). Within a more specific context, the IMCI has provided major benefits for countries like Egypt, India, the Philippines, as well as other developing countries in Asia and Africa. In Egypt, the study by Rakha and colleagues (2012) set out to evaluate the impact of the IMCI on child mortality. The authors compared annual levels of mortality for children below five years of age from the time the IMCI has been implemented to before the implementation of the program. This study has provided clear evidence of the significant benefit of the IMCI for children, especially with the doubling in reduction of under-five mortality rates for Egypt since the implementation of the program (Rakha, et.al., 2012). The impact of mortality is very much significant, especially as major improvements have been seen in the different components used to measure the program’s efficacy. There were more sick children who were able to receive appropriate illness management under the IMCI program. This was mostly due to the fact that the caregivers were more likely to recall specific interventions on home care, including cues for follow-up care. Surveys carried out in Egypt from 2000 to 2008 also indicate major increases in antenatal care including improvements in the skills of birth attendants. More investments on safe motherhood practices and programs were also observed as the IMCI was implemented in Egypt (Rakha, et.al., 2012). The findings of the study also indicate that if the implementation of the IMCI is carried out systematically, improvements in the management of childhood diseases and improvements in caregiver knowledge would be observed. These observed improvements can also be seen in terms of lower mortality risks for children. This strategy can only be observed however for those children who are able to access health services with the IMCI program (Rakha, et.al., 2012). In Egypt, the number of children with possible pneumonia diagnosis seeking interventions from the appropriate health provider increased to 73% in 2008, from 66% in 2000. These results represent major improvements in service delivery, especially for child health services (Rakha et.al., 2012). In a 2009 qualitative study by Horwood, et.al. (2009), the authors focused on the training and the implementation of the IMCI training course in South Africa. From this study, it can be observed that the training course gave the health professionals and trainees more confidence in managing children, including young infants, especially in terms of common illnesses plaguing these young children. Before the training, the health professionals were reluctant to assess and examine children because they felt that they did not have sufficient skills to actually examine them (Horwood, et.al., 2009). However, after their IMCI training, they were given the necessary skills to make a proper examination of the children. These trainees often expressed however that implementing the essential elements of the IMCI was time consuming. Nevertheless, they observed that the slower pace of the IMCI implementation helped improve the relationship with mothers. Moreover, with more improvements in their examination skills, the confidence of the mothers on the skills of the health professionals was also improved. The health personnel also felt that with the IMCI guidelines in place, they felt that they are less likely to commit errors in the management of their patients (Horwood, et.al., 2009). Barriers in implementation were nevertheless raised by the above authors, even with significant benefits observed in the implementation of the program. A major barrier involved the longer time often involved in carried out IMCI consultations (Adam, et.al., 2005). This is mostly attributed to the staff shortages in clinics which did not allow for a speedy transition of patients. Not all staff members are trained in IMCI and those who are trained cannot rush through their patient care because it would decrease the quality of the examination process and defeat the purpose of the IMCI. Admittedly, there is also lack of support from other colleagues in the clinic, especially those who have not undergone IMCI training (Adam, et.al., 2005). It has therefore become important to include as many health personnel as possible in IMCI training in order to improve the attitude towards the programme and to ensure a more integrated and a more coordinated implementation of the programme. There would also be an improved understanding of the programme among health personnel, better support for its policies and elements, as well as decreased waiting times for patients (Pariyo, et.al., 2005). In general, the quality of child care can be improved, especially in terms of decreased mortality and morbidity rates for children below five years of age. In a study by Ragnarsson (2005), the implementation of the IMCI in Malawi was evaluated and was also able to reveal specific and valuable insight into the benefits and the issues relating to the implementation of the health promotion program. The study revealed that the IMCI guidelines were based on different applications which were considered effective. The author also pointed out that the IMCI can be successful if the health workers in developing states embrace the program and apply it into their practice. For the administrators and trainers for IMCI, their concerns mostly relate to health workers not actually applying their training into their practice (Ragnarsson, et.al., 2005). Nevertheless, many health workers have changed the way they administer to the needs of the children after undergoing IMCI training. Although the IMCI standards were mostly based on studies which have indicated technical assessments for the program, the efficacy and relative financial burdens of the IMCI had to be evaluated. At present, the Multi-country Evaluation of the IMCI has already covered five countries in various continents. These countries include Bangladesh, Brazil, Peru, Tanzania, and Uganda. Their purpose has been to assess efficacy, costs of care, and the impact of the program in these five states. In the study by Schellenberg and colleagues (2004) indicated significant results in terms of reduced child mortality rates. This study matches the Multi-country evaluation for IMCI which indicated decreased rates in child mortality in at least two districts where the IMCI was implemented (Bryce, et.al. 2004). In the study by Adam, et.al., (2005), the authors also indicated that the IMCI program was not more expensive in terms of implementation as compared to other standard health programs in the covered districts. The fact that it also produced better results in terms of reducing child mortality and morbidity clearly indicated how the IMCI is a much more effective program in promoting the health of children under five years of age. The IMCI admittedly cannot be successful unless the quality of its services is secured. Gouws, et.al., (2005) discusses various indicators to assess the quality of childcare within primary health facilities. These indicators present valid and reliable indicators which include integrated child health assessment; availability of vaccines; availability of oral and injectable drugs; and primary healthcare workers’ knowledge of correct case management for severe illness and young infants. These indicators can be secured further with the use of IMCI and are important in the essential application of the IMCI policies and applications. It can be noted that improved attendance for government health facilities relates to patient preference in facilities and services which do not charge for services even with patient overflows (Choudhary, et.al., 2005). Due to the financial issues in developing counties, one important consideration for health facilities is the improvement of health services delivery. Moreover, government authorities are also encouraged to persist in the implementation of effective policies in securing healthcare services with minimal costs to those who most need it (Qazi and Muhe, 2006). In western countries, IMCI has not reached widespread implementation because western and developed countries have better access to hospitals and private care where patients can easily seek medical care. The elements of IMCI which often include pneumonia or dehydration diagnosis and management are not carried out in remote areas where available care is administered by midwives or nurses who have no medical training (Thapar and Sanderson, 2004). In developed countries, the diagnosis and management of these cases are immediately carried out by doctors who have the knowledge and advanced means to detect, diagnose, and treat these diseases. Opportunities for primary care management can only be observed in lesser developed countries, among populations who are not able to immediately access medical care (Thapar and Sanderson, 2004). The management of cases like pneumonia, diarrhoea, or even malaria are therefore carried out by primary healthcare givers, including nurses and midwives. Essential training for these personnel in IMCI is therefore very much important. Conclusion Implementing IMCI for these developing countries is very significant and appropriate because it represents minimal cost for the government and it presents the most improvements in mortality and morbidity rates for children below five years of age. However, regardless of these benefits, the implementation of the program requires strict processes and examination routes which have to be improved and revised to match the needs of the people. The improvement of accessibility to more effective drugs within the IMCI program is also an important element or aspect of the IMCI program. Properly implementing the IMCI program can potentially bring about major benefits for the general population, including the primary healthcare workers implementing its policies. These health workers would be able to reach maximum efficacy and would be able to greatly contribute to the reduction of child mortality and morbidity not just in their country but in the global scene as well. All in all, these improvements would also help the country and the World Health Organization achieve the pertinent elements relating to the Millennium Development Goals. References Adam, T., Manzi, F., Schellenberg, J., Mgalula, L., de Savigny, D. & Evans, D., 2005. Does the Integrated Management of Childhood Illness cost more than routine care? Results from the United Republic of Tanzania. Bull World Health Organ, 83, pp. 369-77. Arifeen, S., Hoque, D. & Akter, T., 2009. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomized trial. Lancet, 374, pp. 393–403. Bryce, J., Victora, C., Habicht, J., Vaughan, J., & Black, R., 2004. The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions. Am J Public Health, 94, pp. 406-15. Chaudhary, N., Mohanty, P., & Sharma, M., 2005. Integrated management of childhood illness (IMCI) follow-up of basic health workers. Indian J Pediatr, 72(9), pp. 735-739. Freitas do Amaral, J., Victora, C., & Leite, A., 2008. Implementation of the Integrated Management of Childhood Illness strategy in Northeastern Brazil. Rev Saude Publica, 42, pp. 598–606. Gouws, E., Bryce, J., Pariyo, G., Schellenberg, A., Amaral, J. & Habicht, J. 2005. Measuring the quality of child health care at first-level facilities. Soc Sci Med, 61, pp. 613-25. Horwood, C., Voce, A., Vermaak, K., Rollins, N., & Qazi, S., 2009. Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course. BMC pediatrics, 9(1), p. 62. Pariyo, G., Gouws, E., Bryce, J. & Burnham, G., 2005. Improving facility-based care for sick children in Uganda: training is not enough. Health policy and planning, 20(Suppl 1), i58-i68. Qazi, S. & Muhe, L., 2006. Integrating HIV management for children into the Integrated Management of Childhood Illness guidelines. Trans R Soc Trop Med Hyg., 100(1), pp. 10-13. Ragnarsson, S., 2005. The Implementation of Integrated Management of Childhood Illness in the Monkey Bay Health Zone in Malawi. University of Iceland Faculty of Medicine [online]. Available at: http://www.iceida.is/media/uttektarskyrslur/Sigurdur_Ragnarsson.pdf [Accessed 22 January 2014. Rakha, M. A., Abdelmoneim, A. N. M., Farhoud, S., Pièche, S., Cousens, S., Daelmans, B., & Bahl, R., 2013. Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt. BMJ open, 3(1). Schellenberg, A., Adam, T. & Mshinda, H. 2004. Effectiveness and costs of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania. Lancet, 364, pp. 1583–1594. Thapar, N., & Sanderson, I. R., 2004. Diarrhoea in children: an interface between developing and developed countries. The Lancet, 363(9409), pp. 641-653. WHO, 2013. Integrated Management of Childhood Illness (IMCI) [online]. Available at: http://www.who.int/maternal_child_adolescent/topics/child/imci/en/ [Accessed 22 January 2014]. WHO, 2010. IMCI Monitoring and Evaluation [online]. Available at: http://www.wpro.who.int/child_adolescent_health/documents/info_package8.pdf [Accessed 23 January 2014]. Read More