Information on how health workers spend their time can help programme managers determine whether it is possible to add new services or activities to their schedules and at what cost. One set of interventions with the potential to reduce under-five mortality is training of facility-based health workers according to the guidelines for Integrated Management of Childhood Illness (IMCI), along with improvements to supervision, procurement and information systems that are part of the IMCI strategy. Although it has been shown that IMCI is associated with improved quality of care, it is important to determine if it also requires additional consultation time. To investigate the amount of time required to provide clinical care to children under 5 years based on IMCI compared with routine care, a time and motion study was conducted in Northeast Brazil. IMCI-trained providers spent 1 minute and 26 seconds longer per consultation with under-fives than untrained providers, holding confounding factors constant at the mean levels observed in the sample. The difference was greater when patient load was low, and decreased as the number of patients a provider saw per day increased. This has three implications. First, the ability of the system to absorb new technologies depends on current capacity utilization. Secondly, the cost of treating a child also depends on the level of capacity utilization, at least in terms of provider time. Thirdly, where patient loads are high it is important to determine if the quality of care required for IMCI can be maintained.

OBJECTIVE:The Integrated Management of Childhood Illness is a strategy designed to address major causes of child mortality. The aim of this study was to assess the impact of the strategy on the quality of child health care provided at primary facilities. METHODS:Child health quality of care and costs were compared in four states in Northeastern Brazil, in 2001. There were studied 48 health facilities considered to have had stable strategy implementation at least two years before the start of study, with 48 matched comparison facilities in the same states. A single measure of correct management of sick children was used to assess care provided to all sick children. Costs included all resources at the national, state, local and facility levels associated with child health care. RESULTS:Facilities providing strategy-based care had signifi cantly better management of sick children at no additional cost to municipalities relative to the comparison municipalities. At strategy facilities 72% of children were correctly managed compared with 56% in comparison facilities (p=0.001). The cost per child managed correctly was US$13.20 versus US$21.05 in the strategy and comparison municipalities, respectively, after standardization for population size. CONCLUSIONS:The strategy improves the effi ciency of primary facilities in Northeastern Brazil. It leads to better health outcomes at no extra cost. In September 2005, fi ve years after signing the United Nations Millennium Declaration, heads of states reunited to review progress towards achieving the Millennium Development Goals (MDGs). Three of the eight MDGs are exclusive to health, one of which is entirely focused on child survival, with the aim of eliminating two thirds of child mortality by 2015.14 Except for very few notable examples, progress towards the child survival MDG has generally been disappointing, especially in sub-Saharan Africa.14 Many factors have contributed to this, but a common factor to all countries was lack of resources. In most settings there is also a potential for achieving more with the available resources, by reducing waste and by changing the mix of activities being undertaken. Many societies continue to provide or purchase high-cost, relatively ineffective health interventions or services, while low-cost, highly effective interventions are not fully implemented. Factors other than effi ciency infl uence the mix of health activities chosen, including patient preferences and RESUMO OBJETIVO: A atenção integrada às doenças prevalentes da infância é uma estratégia desenvolvida para contribuir na redução das principais causas de mortalidade infantil. O objetivo do estudo foi avaliar o impacto da estratégia sobre a saúde infantil. MÉTODOS:Compararam-se a qualidade do atendimento à saúde infantil e os custos associados em quatro estados da região Nordeste do Brasil, em 2001. Foram estudadas 48 unidades de saúde onde havia implementação estável da estratégia por pelo menos dois anos antes do início do estudo e 48 unidades sem (controle) nos mes...

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