The challenges of achieving high training coverage for IMCI

Case studies from Kenya and Tanzania

Bibliographic Data

ID11492285
AuthorsH P Mushi, Honoratha Mushi (0009-0009-1580-0936, Ifakara Health Institute, corresponding author), K Mullei (University of London), J Macha (University of London), Francis Wafula (0000-0002-5761-6151, University of London), Josephine Borghi (0000-0002-0482-5451, University of London), Carl Goodman (0000-0002-2241-3485, University of London), Lucy Gilson (0000-0002-2775-7703, University of London)
Year2011
Volume26
Issue5
Pages395-404
Publication date2011-09-01
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czq068
PMID21047808
PMCIDPMC3157918
OpenAlexW2115398118
LanguageEN
Citations received4
References cited13

Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007-08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally.

Business · Capacity building · Decentralization · Developing country · Economic growth · Economics · Environmental health · Geography · Health facility · Health services · Integrated Management of Childhood Illness · Political science · Population · Socioeconomics · Tanzania · Training (meteorology) · Child Nutrition and Water Access · Global Maternal and Child Health · Medicine · Poverty, Education, and Child Welfare

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