Reñosa Mark Donald C, Bärnighausen Kate, Dalglish Sarah L, Tallo Veronica L, Landicho-Guevarra Jhoys, Demonteverde Maria Paz, Malacad Carol, Bravo Thea Andrea, Mationg Mary Lorraine, Lupisan Socorro, McMahon Shannon A
Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.
Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines.
BMC Health Serv Res. 2021 Mar 24;21(1):270. doi: 10.1186/s12913-021-06209-6.
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. 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.
In-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.
HCWs 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.
Although 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.
针对菲律宾儿童疾病综合管理（IMCI）项目的研究有限，一线医护人员对于该项目的引入及当前实施情况的看法也基本未被涉及。在此，我们描述了在菲律宾五个地区实施IMCI的医护人员所面临的操作挑战与机遇。这些观点可为菲律宾及其他地区IMCI项目成熟过程中的强化措施提供见解。
我们对五个省份（北伊罗戈省、奎松省、国家首都地区、薄荷岛和达沃市）的46名医护人员进行了深入访谈，并根据需要进行了完整的转录和翻译。同时，数据收集者观察了医疗机构中与IMCI相关材料的状况（可用性和摆放位置）。所有数据均使用NVivo 12软件进行编码，并按照社会生态模型进行整理。
医护人员谈到了IMCI的益处，并讨论了他们如何制定变通方法以确保该项目的核心组成部分能够在一线医疗机构中得以实施。在初级卫生保健（PHC）机构实施IMCI方面出现了五个关键挑战：1）为项目活动提供资金的财政资源不足；2）提供者之间以及针对提供者的培训、指导和监督不足；3）领导力和治理分散；4）获取与IMCI相关书面文件的渠道不符合标准；5）专业等级制度对IMCI协议的忠诚度构成挑战。
尽管医护人员认为IMCI项目具有整体性且为社区带来了诸多益处，但仍需要更可行的实施流程来提高其在初级卫生保健机构中的可接受性。
