Improving and sustaining quality of child health care through IMCI training and supervision

Experience from rural Bangladesh

D. M Emdadul Hoque, Shams E. Arifeen, Muntasirur Rahman, Enayet K. Chowdhury, Twaha M. Haque, Khadija Begum, M. Altaf Hossain, Tasnima Akter, Fazlul Haque, Tariq Anwar, Sk Masum Billah, Ahmed Ehsanur Rahman, Md Hamidul Huque, Aliki Christou, Abdullah Baqui, Jennifer Bryce, Robert E Black

Research output: Contribution to journalArticle

Abstract

Background The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.

Objectives To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.

Methods Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.

Findings Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.

Conclusion IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.

Original languageEnglish (US)
Pages (from-to)753-762
Number of pages10
JournalHealth Policy and Planning
Volume29
Issue number6
DOIs
StatePublished - 2013

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Bangladesh
Quality of Health Care
Case Management
Child Care
Health Facilities
Health Status
Guidelines
Health
Health Surveys
Administrative Personnel
Physicians
Child Health

ASJC Scopus subject areas

  • Health Policy

Cite this

Improving and sustaining quality of child health care through IMCI training and supervision : Experience from rural Bangladesh. / Hoque, D. M Emdadul; Arifeen, Shams E.; Rahman, Muntasirur; Chowdhury, Enayet K.; Haque, Twaha M.; Begum, Khadija; Hossain, M. Altaf; Akter, Tasnima; Haque, Fazlul; Anwar, Tariq; Billah, Sk Masum; Rahman, Ahmed Ehsanur; Huque, Md Hamidul; Christou, Aliki; Baqui, Abdullah; Bryce, Jennifer; Black, Robert E.

In: Health Policy and Planning, Vol. 29, No. 6, 2013, p. 753-762.

Research output: Contribution to journalArticle

Hoque, DME, Arifeen, SE, Rahman, M, Chowdhury, EK, Haque, TM, Begum, K, Hossain, MA, Akter, T, Haque, F, Anwar, T, Billah, SM, Rahman, AE, Huque, MH, Christou, A, Baqui, A, Bryce, J & Black, RE 2013, 'Improving and sustaining quality of child health care through IMCI training and supervision: Experience from rural Bangladesh', Health Policy and Planning, vol. 29, no. 6, pp. 753-762. https://doi.org/10.1093/heapol/czt059
Hoque, D. M Emdadul ; Arifeen, Shams E. ; Rahman, Muntasirur ; Chowdhury, Enayet K. ; Haque, Twaha M. ; Begum, Khadija ; Hossain, M. Altaf ; Akter, Tasnima ; Haque, Fazlul ; Anwar, Tariq ; Billah, Sk Masum ; Rahman, Ahmed Ehsanur ; Huque, Md Hamidul ; Christou, Aliki ; Baqui, Abdullah ; Bryce, Jennifer ; Black, Robert E. / Improving and sustaining quality of child health care through IMCI training and supervision : Experience from rural Bangladesh. In: Health Policy and Planning. 2013 ; Vol. 29, No. 6. pp. 753-762.
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abstract = "Background The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.Objectives To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.Methods Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.Findings Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.Conclusion IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.",
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T1 - Improving and sustaining quality of child health care through IMCI training and supervision

T2 - Experience from rural Bangladesh

AU - Hoque, D. M Emdadul

AU - Arifeen, Shams E.

AU - Rahman, Muntasirur

AU - Chowdhury, Enayet K.

AU - Haque, Twaha M.

AU - Begum, Khadija

AU - Hossain, M. Altaf

AU - Akter, Tasnima

AU - Haque, Fazlul

AU - Anwar, Tariq

AU - Billah, Sk Masum

AU - Rahman, Ahmed Ehsanur

AU - Huque, Md Hamidul

AU - Christou, Aliki

AU - Baqui, Abdullah

AU - Bryce, Jennifer

AU - Black, Robert E

PY - 2013

Y1 - 2013

N2 - Background The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.Objectives To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.Methods Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.Findings Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.Conclusion IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.

AB - Background The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.Objectives To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.Methods Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.Findings Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.Conclusion IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.

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