Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania.

Publisher: World Health Organization Country of Publication: Switzerland NLM ID: 7507052 Publication Model: Print Cited Medium: Print ISSN: 0042-9686 (Print) Linking ISSN: 00429686 NLM ISO Abbreviation: Bull World Health Organ Subsets: MEDLINE

Original Publication: Geneva : World Health Organization,

Delivery of Health Care, Integrated* ; Health Plan Implementation* ; Medically Underserved Area* ; Poverty*; Child Health Services/*organization & administration; Brazil/epidemiology ; Child ; Child Health Services/supply & distribution ; Child, Preschool ; Diffusion of Innovation ; Geography ; Health Care Surveys ; Health Services Accessibility ; Health Services Needs and Demand ; Humans ; Infant ; Infant, Newborn ; Interviews as Topic ; Peru/epidemiology ; Program Evaluation ; Tanzania/epidemiology

Objective: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs.
Methods: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years.
Findings: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied.
Conclusion: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most.

Comment in: Bull World Health Organ. 2006 Oct;84(10):768. (PMID: 17128350)
Comment in: Bull World Health Organ. 2008 Mar;86(3):A-B. (PMID: 18368190)

Date Created: 20061128 Date Completed: 20061227 Latest Revision: 20220317

20231215

PMC2627500

10.2471/blt.06.030502

17128359