Challenges to the implementation of the integrated management of childhood illness (IMCI) at community health centres in West Java province, Indonesia
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World Health Organization. Regional Office for South-East Asia
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Background: The integrated management of childhood illness (IMCI) is acomprehensive approach to child health, which has been adopted in Indonesiasince 1997. This study aims to provide an overview of IMCI implementation atcommunity health centres (puskesmas) in West Java province, Indonesia.Methods: Data were derived from a cross-sectional study conducted in 10 districtsof West Java province, from November to December 2012. Semi-structuredinterviews were used to obtain information from staff at 80 puskesmas, includingthe heads (80 informants), pharmacy staff (79 informants) and midwives/nursestrained in IMCI (148 informants), using semi-structured interviews. Quantitativedata were analysed using frequency tabulations and qualitative data were analysedby identifying themes that emerged in informants’ responses.Results: Almost all (N = 79) puskesmas implemented the IMCI strategy; however,only 64% applied it to all visiting children. Several barriers to IMCI implementationwere identified, including shortage of health workers trained in IMCI (only 43% ofpuskesmas had all health workers in the child care unit trained in IMCI and 40%of puskesmas conducted on-the-job training). Only 19% of puskesmas had all theessential drugs and equipment for IMCI. Nearly all health workers acknowledgedthe importance of IMCI in their routine services and very few did not perceive itsbenefits. Lack of supervision from district health office staff and low communityawareness regarding the importance of IMCI were reported. Complaints receivedfrom patients’ families were generally related to the long duration of treatment andno administration of medication after physical examination.Conclusion: Interventions aiming to create local regulations endorsing IMCIimplementation; promoting monitoring and supervision; encouraging on-the-jobtraining for health workers; and strengthening training programmes, counsellingand other promotional activities are important for promoting IMCI implementationin West Java province, and are also likely to be useful elsewhere in the country
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