\u201cThe staff are not motivated anymore\u201d:\xa0Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI)\xa0program in the Philippines

Mark Donald C Reñosa,Maria Paz Demonteverde,Socorro Lupisan,Jhoys Landicho-Guevarra,Kate Bärnighausen,Veronica L Tallo,Carol Malacad,Shannon A Mcmahon,Thea Andrea Bravo,Mary Lorraine Mationg,Sarah L Dalglish

doi:10.1186/s12913-021-06209-6

Abstract

BackgroundStudies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond.MethodsIn-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model.ResultsHCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols.ConclusionAlthough the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.

Highlights

Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program
Conclusion: the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in primary health care (PHC) facilities
Since the introduction of IMCI in the 1990s, several studies have shown that given the right capacity, resources, and commitment from the government and stakeholders, the program contributes to important gains in Millennium Developmental Goal 4 (MDG4: reduce child mortality) [5,6,7]

Summary

Introduction

Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. We describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond. Robust studies have provided evidence on IMCI’s role in reducing hospital admissions, and improving key newborn and childcare practices such as early and exclusive breastfeeding and increased health-seeking for acute respiratory infections and other illnesses covered by IMCI [6, 10, 11].

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