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Scaling up Integrated Management of Childhood Illness to the national level: achievements and challenges in Peru.

机译：将儿童疾病综合管理扩大到国家一级：秘鲁的成就和挑战。

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This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peruis now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.
机译：本文介绍了在全国范围内大规模实施儿童疾病综合管理（IMCI）策略的工作的第一份报告。 IMCI于1996年底在秘鲁推出，早期实施阶段始于1997年，扩展阶段始于1998年。在这里，我们报告了一项回顾性评估，旨在描述和分析将IMCI扩大到秘鲁的规模，该评估是世界卫生组织协调的IMCI有效性，成本和影响多国评估中的五项研究。受过培训的测量师访问了秘鲁34个区中的每个区，采访了区卫生人员并查看了区记录。调查结果表明，IMCI在秘鲁没有制度化：它与现有计划并行实施，以解决急性呼吸道感染和腹泻，共享预算项目和管理人员。经过IMCI病例管理培训的卫生工作者人数一直增加到1999年，然后在2000年和2001年减少，医生和护士的总体覆盖率估计为10.3％。实施IMCI社区组成部分的工作始于2000年对社区卫生工作者的培训，但由于医疗培训最密集的地区并非社区IMCI培训最强的地区，所以并未实现预期的医疗机构与社区干预措施之间的协同作用。我们总结了扩大IMCI的限制条件，并研究了发现的方法和政策含义。很少有监测数据可用来记录在秘鲁实施IMCI的情况，这限制了回顾性评估有助于计划改进的潜力。甚至建议用于国家监测的基本指标都无法在地区或国家级别进行计算。调查结果记录了IMCI的政策和计划支持方面的弱点，这些弱点将削弱通过卫生服务提供系统提供的任何干预措施。秘鲁的卫生部正在努力解决这些弱点;努力通过基本的儿童生存干预措施实现较高和公平的覆盖率的其他国家可以借鉴其经验。

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