National level
Phases of introduction of IMCI (Integrated Management of Child Health) into pre-service training / education at national level:
- Preparatory and orientation phase
- Planning phase
- Implementation and monitoring phase
- Review and re-planning phase
1. Preparatory and orientation phase
This phase plays a vital role in creating a supportive environment, which is critical to generate interest and support to IMCI and, then, to its introduction in pre-service education.
Early and regular participation in the main steps and activities of the IMCI strategy in the country
Decision-makers’ commitment to support pre-service education
Establishment of a national management and coordination structure on IMCI pre-service education
Situation analysis to select institutions
Early and regular participation in the main steps and activities of the IMCI strategy in the country
Experience has shown that regular involvement of professionals from the academia and professional societies in the introduction and implementation of the IMCI strategy in a country since the very early stages is of high importance to:
introduce the public health initiative in the health system;
stimulate teaching institutions’ interest in the strategy and public child health approach;
raise awareness about child health problems;
involve professionals in all major aspects and issues of implementation; and
establish closer links and coordination between the academic world, the public health system and other partners.
This approach is key to the country’s full ownership of the initiative and further raising child health on the public health agenda.
Examples of involvement of the academia include:
their participation in the national IMCI Task Force and IMCI review committees;
courses for IMCI master trainers and facilitation skills to act as resources for in-service training
follow-up visits after IMCI training to health facilities—gaining invaluable feedback experience;
supervisory activities;
public-child-health-oriented research.
The WHO Regional Office has also made use of the rich expertise of academic staff among those trained in IMCI to assist other countries in the national adaptation of the IMCI clinical guidelines and conducting their first IMCI in-service training courses and follow-up visits.
Identification of partners
The establishment of effective partnerships is essential to support future efforts in the area of pre-service education. Key partners should be identified since the early introduction of IMCI in a country, so as to define roles and responsibilities when a national plan for IMCI implementation is prepared.
Partners in IMCI pre-service include the relevant departments of the ministry of health, legislative and advisory councils, professional societies and associations, international, multilateral and bilateral organizations.
Raising awareness
In addition to the activities described above, advocacy initiatives to further promote IMCI among the academia and partners play an important role to stimulate their interest and create a supportive environment at different levels.
Examples include the inclusion of IMCI as a topic or technical update in the programme of conferences or scientific meetings of professional societies, newsletters, the invitation of professionals from the academia to national public health events, etc.
Decision-makers’ commitment to support pre-service education
As a result of orientation meetings and advocacy on the IMCI strategy, it is important to obtain key decision-makers’ formal endorsement of the pre-service initiative in the country as a sustainable approach to strengthening human resource development in child health.
Establishment of a national management and coordination structure on IMCI pre-service education
The scope of work for the introduction of public health approaches such as IMCI into pre-service education is substantial, especially at the beginning, as it requires intensive contacts, advocacy and close coordination with the teaching institutions and partners involved.
It is recommended therefore that a functional management structure be established for this particular purpose at national level, either within the national IMCI committee or as a separate body linked to it.
Effective coordination requires the designation of a focal point for pre-service education, working full time for this task, to act as a secretariat for the organization of meetings, preparation of minutes and reports, documentation of the experience and dissemination of information among those concerned.
Situation analysis to select institutions
The type of pre-service education institutions to be targeted by the IMCI pre-service initiative depends on the categories of health providers who deliver primary health care services to children. These are the same categories targeted by IMCI in-service training. The institutions to be targeted will then be those which produce those health professionals.
Attention should be paid also to identifying those facilities where students practise their skills, as these play a key role in the process of skill development and attitudes and should be implementing IMCI.
Finally, to create a supportive environment, it is important to identify those individuals, groups or institutions which can influence pre-service education and represent key partners in the IMCI pre-service education initiative.
2. Planning phase
Before undertaking any activities, it is essential to develop a national plan for the introduction, implementation and evaluation of IMCI pre-service education.
As in any plan, also this plan should clearly:
list objectives, indicators to be monitored and targets to be achieved;
list selection criteria for targeted institutions by phase—if a phased approach is used;
list the main activities to be conducted, including also monitoring and evaluation;
define and assign responsibilities among all those involved—including partners;
identify the resources required—both human and financial; and
include a time-frame.
3. Implementation and monitoring phase
The central team which coordinates IMCI pre-service activities will closely cooperate with the teaching institutions to facilitate the process.
Follow-up visits are important to sustain the interest, identify gaps and promptly address issues.
4. Review and re-planning phase
In the same way as public health programmes are evaluated and their approaches are reviewed, the pre-service education initiative should be regularly reviewed and periodically evaluated to maximize the use of resources, strengthen its approach and improve results.
This information can then be used to advocate with key decision-makers and partners for further policy and financial support and collaboration.
The central team is expected to work closely with the teaching institutions, reviewing with them the information that is collected as the initiative is implemented in each school and collaborating in structured evaluations of students and graduates, when feasible.
Both ministries of health and schools have much to benefit from this initiative and have different expertise available in their domains which well complement each other when reviewing the pre-service education experience.
Finally, a major undertaking is the evaluation of IMCI pre-service education, which may take place after 3-5 years of well documented experience but should be planned since the very beginning, to ensure that key information is collected over time.
At national level, the evaluation will look at costs, benefits and effectiveness of the initiative. It helps understand to which extent IMCI pre-service education has succeeded in accomplishing its original objectives, that is not only student competency but also health provider performance in the field.
