Table 3 Perspectives of respondents about IMCI and child-appropriate dosage formulations

MoH officials

• Budget constraints and lack of information about ‘better medicines for children’ meant limited national level reflections about policies, revision of guidelines, budgets and guidelines for child-appropriate dosage formulations

• MoH decentralized refresher training and support supervision for IMCI for the districts and their development partners

• Lack of global initiatives to support the resolution of ‘better medicines for children’ at the national level and challenges of sustainable financing for IMCI implementation

• When IMCI funding reduced and MoH could no longer provide oversight and refresher training for IMCI and these roles were left for local governments under decentralized services. However, MoH continues to acknowledge the fact that there were no sufficient resources for implementing IMCI under the decentralized arrangement

• Concerns that donors and development partners had shifted their goals to fund the community based ICCM program completely leaving out support for IMCI at the facility level

• Since the markets and prices for some of the child-appropriate dosage formulations such as sprinkles, pellets and dispersible tablet were not known. They were perceived to be expensive and therefore not affordable by the ministry. Other well-known child-friendly formulations such as syrups were too costly and moreover difficult to handle and store in a low income setting of Uganda. They were deleted from the EMHSLU 2012 due to these reasons.

The district health officials

• Underfunding of the decentralized responsibilities in the health sector

• Donors had shifted interest to ICCM and abandoned IMCI

• Jinja district was not ready for the decentralized roles of conducting IMCI refresher training and support supervision due to financial constraints. They were concerned about lack of revised IMCI treatment charts. Centralization of medical supplies to NMS has deprived the district the opportunities to decide on the procurement of the right medicines for children

Pediatricians

• Pediatricians are limited and are only available in hospitals

• Pediatricians are supposed to see children who are referred to them by the lower level health workers

• IMCI is a strategy to be used by the lower cadre staff. At the moment the approach is not robust enough to integrate new treatment changes

• The IMCI strategy would benefit from improved IMCI guidelines that would address evidence based and child-appropriate dosage formulations

• The Uganda Clinical Guidelines are insufficient and pediatricians were reportedly referring to other guidelines such as BNF and the internet to determine treatment. Prescribe some syrup such as amoxicillin syrup and other child-friendly syrups available in the private sector. Had an idea about dispersible tablets but did not use them because they were not available.

Lower cadre health workers (enrolled nurses and nursing assistants)

Cognitive Barriers, using outdated IMCI charts, limited interaction with the MoH officials in terms of support supervision

• Need refresher training on IMCI, updated guidelines and evidence based medicines

• Need support supervision to enable them improve their skills

• Some nursing assistants said that they did not know that the treatment policy for malaria had changed