Assessment of the quality of IMCI implementation in four districts in Zimababwe

[摘要] The Integrated Management of Childhood Illness (IMCI) strategy was introduced inZimbabwe in 1996 to integrate vertical child health care programmes. It has sinceexpanded to cover over 300 first level health facilities out of 897 in 23 districts out of atotal of 59 districts in the country. This survey was conducted to measure the quality ofcare delivered to sick children aged 2 months up to 5 years at first level health facilitiesimplementing IMCI.The management of sick children was observed for 226 children aged 2 months up to 5years who were brought to primary level health facilities. 226 interviews with childcaretakers were conducted, all children included in the survey were re-examined by anexperienced IMCI practitioner to ascertain the classification (diagnosis) of child’s illnessand the appropriate treatment needed. Finally facilities, services and supplies wereassessed in the 35 facilities visited. Seventy one percent of cases were children under 2years old. The majority of caretakers (88%) were mothers of the sick children.All children were systematically checked for the four main symptoms, 80% of childrenwere checked for general danger signs. About 70% of cases classified as havingpneumonia received correct treatment for pneumonia. Almost 50% of cases observedreceived correct treatment for malaria. Half of the children observed (50%) receivedtheir 1st dose at the facility. Just less than half (48%) of the children who neededvaccines left the health facilities with all the needed vaccines.Eighty five percent of caretakers were advised on drug treatment. As a result of theadvice received, almost two third (65%) of the caretakers who had been prescribed anantibiotic/antimalarial were able to correctly describe how to give the antibiotic to theivchild. The large majority of caretakers (78%) were satisfied with the health servicesprovided. Over half (54%) of facilities visited had at least 60% of health workers trainedin IMCI; 88% of children were managed by health workers who had been trained inIMCI. Drugs were available with the exception with oral rehydration salts (ORS) or sugarsalt solution (SSS). Most facilities had supplies and equipment for vaccination, and mosthad other basic supplies and materials; IMCI chart booklets were found in 91% offacilities. Health facilities which received at least one supervisory visit that includedobservation of -case management in the last 6 months was only 11% indicating thatsupervision is not carried out on a regular basis.The management of sick children seen by providers trained in IMCI followed asystematic approach in most cases but there is room for further improvement. Drugs wereused rationally. Key supportive elements of the health system were in place in thefacilities visited with the exception of regular supervision. However only 38% needingurgent referral were identified and prescribed urgent referral. Weaknesses were alsoobserved in the management of diarrhea, fever and in counseling the caretaker. Only 15%of caretakers were given or shown the mothers card as a job aid and only 23% ofcaretakers were told on when to return immediately. The IMCI strategy has the potentialto act as a powerful channel to improve the quality of services. As the survey was unableto determine reasons for poor performance observed, further research is required toinvestigate the factors leading to poor health worker performance.

[发布机构] University of the Witwatersrand