Table 2 The process of IMCI Development and implementation landmarks in Uganda
Levels | Implementation phases | ||
|---|---|---|---|
Adoption phase | Early implementation | Situation at the time of the study | |
National | In 1995 IMCI selected as the main approach for Uganda. A 22- member working group was established for planning, training and adaptation. IMCI algorithm was adopted to fit the national health policy and treatment guidelines | By 1998 there was a national expansion plan with a pool of 250 trainers, 10 zonal teams to supervise IMCI implementation. Donors: World Bank, USAID, UNICEF and WHO put in resources for early implementation of IMCI. By 2003 all the districts in Uganda had been trained in IMCI | Budget constraints and lack of information about ‘better medicnes for children’ meant limited national level reflections about policies, plans, budgets and guidelines for child-appropriate dosage formulations. No resources for the sustainability of IMCI in terms of refresher trainings, revision of job aids and support supervision. The decentralization of IMCI to districts minimized the central MoH role both technically and financially. |
Local (district) | Districts health officials were prepared in terms of training about IMCI. | Districts were prepared in terms of training about IMCI. | Resources were not available for the districts. Districts were getting minimal support from the ministry in form of PHC grants which covered a little on support supervision. Therefore, the districts were not prepared for training health workers on child-appropriate dosage formulations |
Facility/individual levels | Health workers were sensitized on the new approach of IMCI. | Health workers were trained on the new approach of IMCI for 3 weeks. | Health workers were no longer receiving refresher training and support supervision for IMCI related activities from the district health team because districts did not have the financial capacity to do so. |