Health Systems Research Unit, Medical Research Council, Pretoria, 0001 Pretoria, South Africa.
BMC Public Health. 2011 Jun 27;11:503. doi: 10.1186/1471-2458-11-503.
The Integrated Management of Childhood Illness Strategy (IMCI), developed by WHO/UNICEF, aims to contribute to reducing childhood morbidity and mortality (MDG4) in resource-limited settings. Since 1996 more than 100 countries have adopted IMCI. IMCI case management training (ICMT) is one of three IMCI components and training is usually residential over 11 consecutive days. Follow-up after ICMT is an essential part of training. We describe the barriers to rapid acceleration of ICMT and review country perspectives on how to address these barriers.
A multi-country exploratory cross-sectional questionnaire survey of in-service ICMT approaches, using quantitative and qualitative methods, was conducted in 2006-7: 27 countries were purposively selected from all six WHO regions. Data for this paper are from three questionnaires (QA, QB and QC), distributed to selected national focal IMCI persons/programme officers, course directors/facilitators and IMCI trainees respectively. QC only gathered data on experiences with IMCI follow-up.
33 QA, 163 QB and 272 QC were received. The commonest challenges to ICMT scale-up relate to funding (high cost and long duration of the residential ICMT), poor literacy of health workers, differing opinions about the role of IMCI in improving child health, lack of political support, frequent changes in staff or rules at Ministries of Health and lack of skilled facilitators. Countries addressed these challenges in several ways including increased advocacy, developing strategic linkages with other priorities, intensifying pre-service training, re-distribution of funds and shortening course duration. The commonest challenges to follow-up after ICMT were lack of funding (93.1% of respondents), inadequate funds for travelling or planning (75.9% and 44.8% respectively), lack of gas for travelling (41.4%), inadequately trained or few supervisors (41.4%) and inadequate job aids for follow-up (27.6%). Countries addressed these by piggy backing IMCI follow-up with routine supervisory visits.
Financial challenges to ICMT scale-up and follow-up after training are common. As IMCI is accepted globally as one of the key strategies to meet MDG4 several steps need to be taken to facilitate rapid acceleration of ICMT, including reviewing core competencies followed by competency-driven shortened training duration or 'on the job' training, 'distance learning' or training using mobile phones. Linkages with other 'better-funded' programmes e.g. HIV or malaria need to be improved. Routine Primary Health Care (PHC) supervision needs to include follow-up after ICMT.
世卫组织/儿基会制定的《儿童疾病综合管理》战略旨在帮助资源有限地区降低儿童发病率和死亡率（千年发展目标 4）。自 1996 年以来，已有 100 多个国家采用了《儿童疾病综合管理》。儿童疾病综合管理培训（ICMT）是该战略的三个组成部分之一，培训通常是为期 11 天的住宿培训。培训后的随访是培训的一个重要组成部分。我们描述了加速儿童疾病综合管理培训的障碍，并回顾了各国如何解决这些障碍。
2006-2007 年，我们对儿童疾病综合管理在职培训方法进行了多国家探索性横断面问卷调查，采用定量和定性方法：从世卫组织所有六个区域有目的地选择了 27 个国家。本文的数据来自三个问卷（QA、QB 和 QC），分别分发给选定的国家儿童疾病综合管理协调人/方案干事、课程主任/培训员和儿童疾病综合管理培训学员。QC 只收集儿童疾病综合管理培训后随访的经验数据。
共收到 33 份 QA、163 份 QB 和 272 份 QC。影响儿童疾病综合管理培训规模扩大的最常见挑战与资金有关（住宿式儿童疾病综合管理培训费用高、持续时间长）、卫生工作者文化程度低、对儿童疾病综合管理在改善儿童健康方面的作用存在不同意见、缺乏政治支持、卫生部频繁更换人员或规则以及缺乏熟练的培训员。各国通过多种方式解决了这些挑战，包括增加宣传、与其他优先事项建立战略联系、加强岗前培训、重新分配资金和缩短课程时间。培训后随访的最常见挑战是缺乏资金（93.1%的受访者）、差旅或计划资金不足（分别为 75.9%和 44.8%）、差旅用气量不足（41.4%）、培训或监督人员不足（41.4%）、缺乏随访工作辅助工具（27.6%）。各国通过将儿童疾病综合管理培训后的随访与常规监督访问相结合来解决这些问题。
儿童疾病综合管理培训规模扩大和培训后随访面临的财政挑战较为常见。由于儿童疾病综合管理已被全球接受为实现千年发展目标 4 的关键战略之一，需要采取若干步骤来促进儿童疾病综合管理的快速加速，包括审查核心能力，然后缩短以能力为导向的培训时间或“在职”培训、“远程学习”或使用移动电话进行培训。需要改善与其他“资金充足”的方案（如艾滋病毒或疟疾）的联系。常规初级卫生保健（PHC）监督需要包括儿童疾病综合管理培训后的随访。
