Advantages
There are many practical and substantial advantages of introducing the IMCI (Integrated Management of Child Health) public health approach into pre-service education. These potential benefits form the rationale for this intervention.
Planting deeper roots in students
Students are usually more receptive to new knowledge and skills than already practising (“in-service”) health professionals: the training received in schools often “plants deeper roots” and it takes more efforts to update it later on, especially if it concerns major changes in medical knowledge, attitudes and practices.
By exposing students to this approach since their medical or health-related studies, pre-service education offers the major advantage of preparing them for the “world outside” and the tasks ahead since then, reducing the gap between the educational and outside settings.
Easing in-service training burden
This is expected to ease the burden of long, time-consuming and resource-intensive in-service training after they qualify and start providing health services.
Sustainability
Since pre-service education is already part of the education system to produce human resources, initiatives which incorporate public health approaches into pre-service teaching curriculum have the potential to be more sustainable than those which rely only on continuous in-service training.
The impact of the high staff turnover—a chronic problem in many developing countries’ public health systems—is reduced.
What this approach does
The IMCI pre-service training approach then:
Gives priority in teaching to the most common child health problems which represent a major cause of childhood mortality and morbidity in the country;
Provides a direct link between the academic setting and the real-life situation in which the future graduates will operate, often with limited diagnostic and therapeutic options. The “syndromic approach” proposed in IMCI is also believed to be more relevant to clinical practice than the traditional “textbook-oriented” type of teaching alone;
Increases student exposure to supervised clinical practice in outpatient settings;
Employs standard protocols which enable prompt identification of severe cases, are action-oriented, represent a practical guide to outpatient management and home care of young children, rationalize the use of medicines and reduce treatment costs;
Promotes active learning;
Introduces in teaching the development of additional, essential skills, such as feeding assessment and counselling, and counselling on psychosocial development, to improve family home child care;
Promotes a health care approach which is effective, feasible and affordable, while ensuring quality care;
Has the potential to reduce the costs of in-service training of health providers, qualifying as a sustainable intervention, by producing health cadres already familiar with the guidelines on outpatient child care. These cadres should later require only short, re-fresher in-service courses (as in continuing medical education). This will also contribute to reducing the overall burden that pre-service training has on ministries of health limited resources;
Prepares health cadres who will be operating both in the public and private sectors, unlike in-service training courses which predominantly reach the public health system;
Establishes a clearer link between curative and preventive care;
Improves collaboration on child-related care and research between academic and professional institutions on one side and ministries of health and other key partners on the other side.
Students appreciate it
Preliminary information from informal field visits and observations suggests that this approach is highly appreciated by students as it provides them with the tools to confront real-life situations and a more active learning process.
Students enjoy practising their clinical and communication skills in outpatient settings and learning how to deal with the most common causes of consultation.
Benefits
There are therefore also benefits for the academic institutions, which among other things see their reputation further enhanced by these changes.
Some have argued that the benefits described above are only theoretical and have yet to be proved. The Regional Office has developed standard instruments and methodology to evaluate the IMCI pre-service training experience in the Region. The findings from structured evaluations will provide the evidence base for IMCI pre-service education, help identify issues and suggest ways to further strengthen the approach followed to date.
