Integrated Management of Childhood Illness strategy implementation in a rural district of Pakistan through the lens of planners and implementers

Abstract

Objective: Integrated Management of Childhood Illness (IMCI) strategy aims to reduce under-five morbidity and mortality in developing countries. This qualitative study aimed to explore and analyze stakeholders’ perceptions about IMCI implementation process at Primary Health Care facilities in Matiari district, Sindh Province, Pakistan. Methods: This study used qualitative exploratory design. Through purposive sampling technique, eight stakeholders particularly involved in IMCI implementation process at district (n=3) and provincial level (n=5) were recruited for in-depth interviews. Interview data was manually transcribed and analyzed using content analysis. Results: The interviews provided information on factors supporting and constraining IMCI implementation process. Stakeholders’ perception of the significance of the strategy was the single most influential support factor. Constraint factors mainly consist of discrepancies in views toward the lead role in implementation, trained physicians’ lack of willingness to practice IMCI strategy (as perceived by the stakeholders), inadequate logistic support, weak monitoring and supervisory system, lack of awareness about IMCI drugs and supplies, hindrances in the reporting system and corruption in the district health system affecting the practice of IMCI trained physicians. Conclusions: The study showed inadequate health system support for IMCI implementation in the district with major discrepancies in views amongst planners and implementers toward IMCI implementation process. We recommend Provincial Maternal Neonatal and Child Health Program to synchronize the implementation process and provide necessary support to the district in IMCI implementation.