Abstract
The Ministry of Health and Family Planning of Madagascar introduced Integrated Management of Childhood Illness (IMCI) strategy in 2006, and community-based IMCI (c-IMCI), in Mahajanga II District in 2007. Following the 2009 political crisis, foreign organisations' suspension of development aid until 2012 significantly affected the implementation of c-IMCI. This study aimed to elucidate the perspectives of village health volunteers (VHVs) and public health officers (PHO) on c-IMCI. Semi-structured in-depth interviews with all VHVs working in three communes and PHOs working at central, district, and health centre levels were conducted in 2013. Textual data, created from transcripts, were translated into English and French. Data management involved analysis of sections of translated transcripts, which were marked, coded, and linked with similar experiences, challenges, and opinions; these were categorised into words and phrases to discover meaningful relationships between emerging themes. From all interviews of 30 VHV in three Mahajanga II communes and 4 PHOs, 3 themes emerged: 1) benefits of c-IMCI to the community and for VHVs, 2) challenges to continue c-IMCI, and 3) motivation to continue c-IMCI. Although all respondents considered c-IMCI as beneficial, they stated it was difficult to continue. The health system and implementation of c-IMCI should be strengthened to enable programme survival beyond the initial phase, especially during times of political instability.
Highlights
Under-five mortality in 81 countries with the highest burden of maternal, neonatal, and child mortality, including Madagascar, fell rapidly from 2000 to 2015
This study aimed to explore the perspectives of VHVs and public health officers (PHOs) involved in community-based IMCI (c-IMCI) in Mahajanga II after the second attempt at c-iMCI implementation reactivation during the political crisis
Weigh the sick children Care for acute respiratory infection, malaria, and diarrhoea Check the child's immunisation, vitamin A, and deworming status Refer the child with any general danger sign to the health centres children Set a follow-up visit and give follow-up care Management of medicine supplies Report community Integrated Management of Childhood Illness (c-IMCI) activities to the health centres Organise Information, Education, Communication (IEC) sessions and social mobilisation Promote 18 key family practices* set by the Government of Madagascar
Summary
Under-five mortality in 81 countries with the highest burden of maternal, neonatal, and child mortality, including Madagascar, fell rapidly from 2000 to 2015. IMCI has three components: 1) to improve case management skills of first level health workers, 2) to strengthen the health system for effective management of sick children, and 3) to promote good family and community child care practices (WHO 2004) (Horwood et al, 2009) (Basaleem and Amin, 2011) (Goga and Muhe 2011) (Pradhan et al, 2013). The third component of IMCI, community-based IMCI (c-IMCI), can be provided through facility-based health provider outreach or at the community level by community health workers or volunteers (WHO 2004) (Basaleem and Amin, 2011) (Ghimire et al, 2010) This component focuses on improving evidenced-based key family practices to provide good home care for children (WHO 2004) (CORE Group 2009) (CORE Group). When the protocol is followed correctly, IMCI has the potential to reduce under-five mortality (Mitchell et al, 2013)
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