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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.

Victora, C. G., Huicho, L., Amaral, J. J., Armstrong-Schellenberg, J., Manzi, F., Mason, E. and Scherpbier, R. (2006) 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, 84 (10). pp. 792-801. ISSN 0042-9686

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Abstract

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.

Item Type: Article
Keywords: Child health, illness, health interventions, Brazil, Peru, Tanzania, health policy, policy analysis
Subjects: Health Systems > Surveillance, monitoring & evaluation
Health Systems > Quality of Care
Divisions: Ifakara Health Institute > Policy Translation
Depositing User: Mr Joseph Madata
Date Deposited: 27 Jul 2012 08:35
Last Modified: 16 Aug 2012 15:57
URI: http://ihi.eprints.org/id/eprint/256

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