Scaling up Integrated Management of Childhood Illness to the national level:: achievements and challenges in Peru
Scaling up Integrated Management of Childhood Illness to the national level:: achievements and challenges in Peru
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DOI：
10.1093/heapol/czi002
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发表时间：
2005-01-01
影响因子：
3.2
通讯作者：
Victora, CG
中科院分区：
文献类型：
--
作者：
Huicho, L;Dávila, M;Victora, CG
本文介绍了第一份关于国家一级大规模实施儿童疾病综合管理战略的报告。秘鲁于1996年底开始实施儿童疾病综合管理战略，1997年开始实施初期阶段，1998年开始推广阶段。在这里，我们报告的回顾性评价，旨在描述和分析的过程中，采取IMCI：规模在秘鲁，进行的五项研究之一，在多国评估IMCI的有效性，成本和影响（MCE）由世界卫生组织协调。经过培训的调查员访问了秘鲁的34个区，采访了区保健工作人员，并审查了区记录。调查结果表明，儿童疾病综合管理在秘鲁没有制度化：它是与现有的急性呼吸道感染和腹泻方案并行实施的，共用预算项目和管理人员。接受儿童疾病综合管理培训的卫生工作者人数一直增加到1999年，然后在2000年和2001年下降，医生和护士的总覆盖率计算为10.3%。2000年，在培训社区保健工作者的同时，开始努力执行儿童疾病综合管理的社区部分，但保健设施和社区干预措施之间的预期协同作用没有实现，因为临床培训最密集的地区并不是儿童疾病综合管理社区培训最强的地区。我们总结的限制，以扩大IMCI，并检查方法和政策的影响的研究结果。秘鲁几乎没有监测数据来记录儿童疾病综合管理的执行情况，限制了追溯性评价对方案改进的贡献。即使是建议国家监测的基本指标也无法在地区或国家一级计算。调查结果表明，对儿童疾病综合管理的政策和方案支持存在缺陷，这将削弱通过保健服务提供系统提供的任何干预措施。秘鲁卫生部目前正在努力解决这些弱点;其他国家正在努力通过基本的儿童生存干预措施实现高覆盖率和公平覆盖率，这些国家可以学习它们的经验。
This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale, IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to: scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.