Future directions for reducing inequity and maximising impact of child health strategies

Dalglish, Sarah L; Vogel, Joanna; Begkoyian, Geneviève; Huicho, Luis; Mason, Elizabeth; Root, Elisabeth Dowling; Schellenberg, Joanna; Estifanos, Abiy Seifu; Ved, Rajani; Wehrmeister, Fernando César; Labadie, Guilhem; Victora, Cesar G

doi:10.1136/bmj.k2684

Cited by 7 publications

(9 citation statements)

References 33 publications

(34 reference statements)

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“…To ensure that the IMCI program stays relevant after 20 years, further implementation research is needed to understand what works and what does not at the implementation level [56,57]. International and national efforts to strengthen district health management teams should be the linchpin of this effort, and it is imperative to update existing policies to ensure adequate fiscal space for the IMCI program at this level [18,19,58]. It is critical for the future of the IMCI program and child health that policy and implementation levels work more closely.…”

Section: Discussionmentioning

confidence: 99%

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Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

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Background: Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized. Purpose: To determine the key challenges affecting IMCI implementation from the perspective of health care workers (HCWs) in primary health care facilities. Methods: A scoping review based on the five-step framework of Arskey and O'Malley was utilized to identify key challenges faced by HCWs implementing the IMCI program in primary health care facilities. A comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and Google Scholar was conducted. A total of 1,475 publications were screened for eligibility and 41 publications identified for full-text evaluation. Twentyfour (24) published articles met our inclusion criteria, and were investigated to tease out common themes related to challenges of HCWs in terms of implementing the IMCI program. Results: Four key challenges emerged from our analysis: 1) Insufficient financial resources to fund program activities, 2) Lack of training, mentoring and supervision from the tertiary level, 3) Length of time required for effective and meaningful IMCI consultations conflicts with competing demands and 4) Lack of planning and coordination between policy makers and implementers resulting in ambiguity of roles and accountability. Although the IMCI program can provide substantial benefits, more information is still needed regarding implementation processes and acceptability in primary health care settings. Conclusion: Recognizing and understanding insights of those enacting health programs such as IMCI can spark meaningful strategic recommendations to improve IMCI program effectiveness. This review suggests four domains that merit consideration in the context of efforts to scale and expand IMCI programs.

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Section: Discussionmentioning

confidence: 99%

“…Jacobs and Merson [18] note the failures of IMCI to provide continuous care between the home, first level PHC-facilities and referring health facilities. Generally speaking, IMCI's impact on reducing inequity is difficult to assess given the varied extent of implementation [19].…”

Section: Introductionmentioning

confidence: 99%

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Reñosa

Dalglish

Bärnighausen

et al. 2020

Global Health Action

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“…An additional concern is that country-level analyses of intervention coverage mask inequalities and disparities within countries themselves, whether within a city, across rural-urban communities, or within different rural areas [27,28]. Inadequate attention to these disparities can result in inefficient deployment of resources, limiting further reductions in U5M [29]. The larger the nation, the more potentially misleading a country summary might be, as with Nigeria or South Africa, India or China, Brazil or Mexico.…”

Section: Limitationsmentioning

confidence: 99%

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

Brault

Mwinga

Kipp

et al. 2020

Global Health Action

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Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries-Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.

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“…Thus policies should prioritise intersectoral interventions to deal with the social determinants of health, equity informed planning across countries and measures that reduce the financial burden on poor populations. 18 …”

Section: Findings and Insights Into Improving Child Health Strategiesmentioning

confidence: 99%

Introductory commentary: a strategic review of options for building on lessons learnt from IMCI and iCCM

Jacobs

Merson

2018

BMJ

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Future directions for reducing inequity and maximising impact of child health strategies

Abstract: Current global child health strategies have reduced wealth based inequities in care seeking for childhood illness, but we need much greater emphasis on equity in strategy design and implementation, say Sarah L Dalglish and colleagues

Cited by 7 publications

References 33 publications

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?

Introductory commentary: a strategic review of options for building on lessons learnt from IMCI and iCCM

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