The Implementation Status of the Integrated Management of Newborn and Cmldhood Illness (Imnci) Strategy in Etmopia

Abstract

IMNCI is a cost effective strategy that deals with diseases and conditions of the greatest health burden to chilo
dren. The IMNCI strat<1fY 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 fMNCI. Out of 662 public Hospitals and Health Centers. 261
(40%) have IMNCltrained health workers managing under-Jive children. Out oJthe 622 Districts ill the
cOllntry. 220 (35%) are actively imple!llenting IMNCI. Fifty-two percent (52%) of the 14,500 target
health workers (Paediatricians, General Practitioners; Health Officers and Nurses working in under jive
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 inforty-
'one (41) districts in seven (7) regional states and a 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 the immediate supervision of the Health atension 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 oJ the visit, 38% (J 6/ 42) were not implementing IMNCI case management; mainly due
to allrition of the trained health workers in 8 of them. and due to improper assignment and inadequate
allention given to the service by the facilities. This finding underlines the critical importance of regular
supportive supervision and the need for continuous capaNty bui/ding for sustained implementation oJ
IMNCI. On the other hand, observation of the case management process in 27 sick children revealed shot
the IMNCI trained health workers were able to practice the integrated approach satisfactorily by the Jact
that they were able to correctly check for the presence oJ general danger signs in 78%, the four main
symptoms in 93%, nutritional and immunization status in 81% and 78% oJthe children respectively. Besides, 96% of the sick children had been prescribed the correct lreatments. However, only 56% of the
care takers got complete counselling for their children' conditions and this calls for more emphasis on
counselling 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 remuneralion of resource persons were some of lhe major constraining factors affecting the scaling lip of IMNel implementation. The lack of adequate supportive supen'ision is a major factor affecting the implementation of IMNeI at facility level and needs to be addressed properly.
Scaling "p IMNCI implementation requires strong partnership and continuous advocacy for effective mobili·
zation and utilization of available resources. Scaling-up of IUNCI 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 IMNCl, improvement of the qUf1 /ity of referral care in first referral hospitals. creating more synergy with the HEP and actively engaging the private sector are the future directionsfor universal coverage and effective implementation of IMNCI in Ethiopia .