Low cost life saver: child health care in Tanzania

The Integrated Management of Childhood Illness (IMCI) strategy for improving child health has been adopted in many countries.  What impact has it had so far in Tanzania? And is it more cost-effective than conventional approaches to child health care?

A World HealthOrganisation multi-country evaluation of IMCI was set up to identifyinformation to help improve the delivery of the strategy.  In Tanzania, the study focuses on two ruraldistricts where facility-based components of IMCI are being implemented.  Two neighbouringdistricts where IMCI was not implemented were included in the study ascomparisons.

The researcherscompared, in both sets of facilities:

• the care given to sick children attendingthe facilities
• the health nutritional status ofchildren in the community
• households' responses to their sickchildren
• and child survival over the period from1997 to 2002.

They also identifiedother factors that might influence child survival rates, and collected detailedcost of care data at national, district, hospital, primary care facility andhousehold levels.

In the twointervention districts, Morogoro and Rufiji, the council health management teams (CHMTs) gave high priority to the introduction of IMCI,partly due to technical and financial support from the Tanzania EssentialHealth Interventions Project.  By mid-2000,they reported that over 80 percent of health workers managing children inprimary care facilities had received an 11-day trainingin IMCI, with about 30 percent of training time spent in clinicalpractice. 

Further researchfindings include:

• Afterthe end of the period of phasing in IMCI, more than twice as many children werechecked for cough, diarrhoea and fever, and sick children were more likely tobe correctly classified and drugs correctly prescribed with IMCI than incomparison districts.
• Duringthe phase-in period, the death rate for children under the age of five was virtuallyidentical in the IMCI and comparison districts. Over the following two years itwas 13 percent lower in the IMCI districts.
• Otherfactors, such as the use of mosquito nets or vitamin A supplements, were eitherequally prevalent or more prevalent in comparison than in IMCI districts, andso cannot account for the greater reduction in mortality in the IMCI districts.
• Theeconomic costs of IMCI per child were similar to or less than those ofconventional child health care.
• IMCIis affordable. District health management teams in Tanzania can implement IMCIusing their existing health funds.

The evaluationshows that, with the use of IMCI, case management has improved and mortalityrates are lower than in comparison areas. Facility-based IMCI is good value for money, and these findings supportthe widespread implementation of this intervention in Tanzania.

No countries inAfrica have yet implemented IMCI widely enough to show clear measurable impactson mortality at national level. The findings suggest that facility-based IMCIcan help to reduce child mortality within existing health budgets.