PT  - JOURNAL ARTICLE
AU  - Susanne Carai
AU  - Aigul Kuttumuratova
AU  - Larisa Boderscova
AU  - Henrik Khachatryan
AU  - Ivan Lejnev
AU  - Kubanychbek Monolbaev
AU  - Sami Uka
AU  - Martin Weber
TI  - Review of Integrated Management of Childhood Illness (IMCI) in 16 countries in Central Asia and Europe: implications for primary healthcare in the era of universal health coverage
AID  - 10.1136/archdischild-2019-317072
DP  - 2019 Dec 01
TA  - Archives of Disease in Childhood
PG  - 1143--1149
VI  - 104
IP  - 12
4099  - http://adc.bmj.com/content/104/12/1143.short
4100  - http://adc.bmj.com/content/104/12/1143.full
SO  - Arch Dis Child2019 Dec 01; 104
AB  - 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.