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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Date
2014-04
Authors
Titaley, C R
Jusril, H
Ariawan, I
Soeharno, N
Setiawan, T
Weber, M W
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
Background: The integrated management of childhood illness (IMCI) is a
comprehensive approach to child health, which has been adopted in Indonesia
since 1997. This study aims to provide an overview of IMCI implementation at
community health centres (puskesmas) in West Java province, Indonesia.
Methods: Data were derived from a cross-sectional study conducted in 10 districts
of West Java province, from November to December 2012. Semi-structured
interviews were used to obtain information from staff at 80 puskesmas, including
the heads (80 informants), pharmacy staff (79 informants) and midwives/nurses
trained in IMCI (148 informants), using semi-structured interviews. Quantitative
data were analysed using frequency tabulations and qualitative data were analysed
by 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 implementation
were identified, including shortage of health workers trained in IMCI (only 43% of
puskesmas 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 the
essential drugs and equipment for IMCI. Nearly all health workers acknowledged
the importance of IMCI in their routine services and very few did not perceive its
benefits. Lack of supervision from district health office staff and low community
awareness regarding the importance of IMCI were reported. Complaints received
from patients’ families were generally related to the long duration of treatment and
no administration of medication after physical examination.
Conclusion: Interventions aiming to create local regulations endorsing IMCI
implementation; promoting monitoring and supervision; encouraging on-the-job
training for health workers; and strengthening training programmes, counselling
and other promotional activities are important for promoting IMCI implementation
in West Java province, and are also likely to be useful elsewhere in the country.
Description
Keywords
community health centre, integrated management of childhood illness, puskesmas, West Java province, Indonesia
Citation
WHO South-East Asia Journal of Public Health 2014;3(2): 161-169.