The Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, antibiotics misuse, polypharmacy and overhospitalisation. This study in 16 countries analyses status, strengths of and barriers to IMCI implementation and investigates how health systems affect the problems IMCI aims to address. 220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data were analysed for arising themes and peer-reviewed. IMCI has not been fully used either as a strategy or as an algorithmic diagnostic and treatment decision tool. Inherent incentives include: economic factors taking precedence over evidence and the best interest of the child in treatment decisions; financing mechanisms and payment schemes incentivising unnecessary or prolonged hospitalisation; prescription of drugs other than IMCI drugs for revenue generation or because believed superior by doctors or parents; parents’ perception that the quality of care at the primary healthcare level is poor; preference for invasive treatment and medicalised care. Despite the long-standing recognition that supportive health systems are a requirement for IMCI implementation, efforts to address health system barriers have been limited. Making healthcare truly universal for children will require a shift towards health systems designed around and for children and away from systems centred on providers’ needs and parents’ expectations. Prerequisites will be sufficient remuneration, sound training, improved health literacy among parents, conducive laws and regulations and reimbursement systems with adequate checks and balances to ensure the best possible care.
- paediatric practice
- health service
- general paediatrics
- qualitative research
- children's rights
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Contributors SC wrote the first draft of the manuscript and subsequent revision, and interpreted it in collaboration with the other authors. All authors contributed to the reviews in countries and the writing.
Funding This work was commissioned by the WHO Regional office for Europe and funded by the Bill and Melinda Gates Foundation.
Disclaimer The authors alone are responsible for the views expressed in this article, which do not necessarily represent the policies and positions of WHO.
Competing interests Most of the authors are or were WHO staff members and at some stage involved in the implementation of IMCI.
Patient consent for publication Not required.
Ethics approval This study was deemed exempt from ethical review by the WHO Ethics Review Committee (ERC.0002743003540/13).
Provenance and peer review Not commissioned; externally peer reviewed.
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