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
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 informa...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The World Health Organization
|
| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006001000013&lng=en&tlng=en |
| _version_ | 1797284078624440320 |
|---|---|
| author | CG Victora L Huicho JJ Amaral J Armstrong-Schellenberg F Manzi E Mason R Scherpbier |
| author_facet | CG Victora L Huicho JJ Amaral J Armstrong-Schellenberg F Manzi E Mason R Scherpbier |
| author_sort | CG Victora |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T17:43:39Z |
| format | Article |
| id | doaj.art-20ce7099f56844a98a17ce8c0a8e00bc |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:43:39Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-20ce7099f56844a98a17ce8c0a8e00bc2024-03-02T15:32:37ZengThe World Health OrganizationBulletin of the World Health Organization0042-9686841079280110.1590/S0042-96862006001000013S0042-96862006001000013Are 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 TanzaniaCG Victora0L Huicho1JJ Amaral2J Armstrong-Schellenberg3F Manzi4E Mason5R Scherpbier6Universidade Federal de PelotasInstituto de Salud del NinoUniversidade Federal do CearáLondon School of Hygiene and Tropical MedicineIfakara Health Research and Development CenterWorld Health OrganizationWorld Health OrganizationOBJECTIVE: 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.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006001000013&lng=en&tlng=en |
| spellingShingle | CG Victora L Huicho JJ Amaral J Armstrong-Schellenberg F Manzi E Mason R Scherpbier 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 Bulletin of the World Health Organization |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862006001000013&lng=en&tlng=en |
| work_keys_str_mv | AT cgvictora arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT lhuicho arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT jjamaral arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT jarmstrongschellenberg arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT fmanzi arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT emason arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania AT rscherpbier arehealthinterventionsimplementedwheretheyaremostneededdistrictuptakeoftheintegratedmanagementofchildhoodillnessstrategyinbrazilperuandtheunitedrepublicoftanzania |