Integrated Management of Childhood Illness: efficiency of primary health in Northeast Brazil

Abstract

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...

Assessment of IMCI Management of Undernutrition and Anemia in an Urban MCH Center; Assiut City

“…Data entry and analysis was conducted using SPSS program (version 20). 20,19 Data analysis included descriptive statistics; frequencies, percentages, the mean and standard deviation. Comparison between groups was done using chi-square, Fisher's Exact tests and Exact tests for qualitative variables.…”

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs

“…According to the Ministry of Health (3) priorities (22) . The strategy has therefore passed through difficulties regarding the process of training health professionals and lecturers.…”

Percepciones de gestores de salud y facilitadores de la estrategia Atención Integrada a las Enfermedades Prevalentes (AIEPI) en una zona del Noreste de Brasil y Perú

“…Se suspendió el apoyo al AIEPI en los últimos 8 años" (2C). Dicha información es refrendada en una publicación donde señalan que el gobierno del Brasil, desde el año 2003 redujo su participación en la capacitación en AIEPI, redefiniendo sus prioridades en la atención de salud infantil 17 .…”

“…Por otro lado, la participación limitada de los gobiernos en la implementación de la estrategia AIEPI 17 ; con un menor involucramiento de autoridades locales con la necesaria autoridad y jerarquía, y dificultades en la coordinación con los organismos impulsores de la estrategia (ONU, OMS, UNICEF) 25 , podría explicarse por la insuficiente participación de los países beneficiarios en la concepción de la estrategia 1 , lo que podría haber condicionado un menor involucramiento en la implementación y expansión de la estrategia. Distinto a ello se observa en Brasil, con el desarrollo de diversas iniciativas concebidas dentro del ámbito local que surgieron y se desarrollaron en los periodos de la estrategia AIEPI como: la creación de comités para la prevención de la mortalidad infantil (2005), el pacto por la vida, para la reducción de la mortalidad (2006), iniciativas específicas (promoción de la inmunización, la lactancia materna y el alojamiento conjunto), mejoras en el acceso a la atención preventiva y curativa de la salud, incluyendo el SUS, el PSF, el PACS, de la Pastoral y, otros políticas y programas sociales que repercutieron en la mejora de la salud infantil 20,26 .…”