The implementation status of the Integrated Management of Newborn and Childhood Illness(IMNCI) Strategy in Ethiopia

Abstract

IMNCI is a cost effective strategy that deals with diseases and conditions of the greatest health burden to children. The IMNCI strategy aims to improve the skills of health workers, the health system and the family and community practices and strengthen the link between the health system and the community.
Currently, Ethiopia is in the expansion phase with all regions implementing IMNCI and there has been progress in all the three components of IMNCI. Out of 662 public hospitals and health centers, 261(40%) have IMNCI trained health workers managing under five children. Out of 622 Districts in the country, 220(35%) are actively implementing IMNCI. Fifty two percent (52%) of the 14500 target health workers (Pediatricians, General Practitioners, Health officers and Nurses working in under five clinics) have been trained either in pre service or in- service trainings. Seventy percent (23/31) of government health professional training institutions are conducting pre-service IMNCI training for nursing, health officer and recently medical students. Community IMNCI interventions are well underway in forty one (41) districts in seven (7) regional states and total of 849 health personnel(541 health workers and 298 HEWs) were trained in the training of trainers(TOT) course on C-IMNCI. These in turn trained 4652 community Resource Persons (CRP) who were deployed serving 237.370 households in 216 Kebelles and are working under immediate supervision of the Health Extension Workers.
A mini health facility survey was conducted in all regions in 2006 involving 3-4 facilities per region and covering a total of 42 reportedly IMNCI implementing health facilities which were selected by convenience. On the day of the visit, 38% (16/42)were not implementing IMNCI case management; mainly due to attrition of the trained health workers in 8 of them, and due to improper assignment and inadequate attention given to the service by the facilities. This finding underlines the critical importance of regular supportive supervision and the need for continuous capacity building for sustained implementation of IMNCI. On the other hand, observation of the case management process in 27 sick children revealed that they were able to correctly check for the presence of general danger signs in 78% the four main symptoms in 93% nutritional and immunization status in 81% and 78% of the children respectively. Besides, 96% of the sick children had been prescribed the correct treatments. However, only 56% of the care takers got complete counseling for their children conditions and this calls for more emphasis on counseling skills during IMNCI Trainings and more importantly the need for skills re-enforcement through close follow up and supportive supervision.
Resources and lack of clear guidelines for remuneration of resource persons were some of the major constraining factors affecting the scaling up of IMNCI implementation the lack of adequate supportive supervision is a major factor affecting the implementation of IMNCI at facility level and needs to be addressed properly.
Scaling up IMNCI implementation requires strong partnership and continuous advocacy for effective mobilization and utilization of available resources. Scaling up of IMNCI implementation through training of at least two health workers per health facility is fundamental to ensure continuity of care. Strengthening of pre service and community IMNCI , improvements of the quality of referral care in first referral hospitals, creating more synergy with HEP and actively engaging the private sector are the future directions for universal coverage and effective implementation of IMNCI in Ethiopia.