( W .P)/CHU/lC.P/CHU/002-E Report series number: RS/2001/GE/39(CHN) English only REPORT REVIEW OF THE EARLY IMPLEMENTATION OF THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) AND PLANNING FOR EXPANSION Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC China 21 - 30 August 2001 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines October 2001 NOTE The views expressed in this report are those of the partiCipants in the Review of the Early Implementation of the Integrated Management of Childhood lllness (IMCI) and Planning for Expansion and do not necessarily reflect the policies of the Organization. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Review of the Early Implementation of the Integrated Management of Childhood lllness (IMCI) and Planning for Expansion, held in China, from 21 to 30 August 2001. t } CONTENTS SUMMARY ........................................ ..... ........ ... .... M .... ................................... .................. .. PART I- REVIEW OF THE EARLY IMPLEMENTATION OF THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS STRATEGY ........................... 9 1. INTRODUCTION........................................................................................ .. ..... .... .......... ..... 9 2. REVIEW PROCESS ............................................................................................................. 10 2.1 Obj~c~ives of the review.............................................................................................. 10 2.2 Participants ....... ..... .......... .... .. .. .. ... .. ...... ..... .... ..... .. ..... .. ... .. ..... ... .... ....... ..... ................. 10 2.3 Review steps ................................................................................................................ 10 3. SUMMARY OF FINDINGS ................................................................................................. 11 3.1 Organization and management .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11 3.2 Improving skills of health workers . .. .. .. ... .. .. .. .. .. .. ... .. .. .. .. ... .. .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. 14 3.3 Strengthening the health system................................................................. .. ............... 16 3.4 Improving family and community practices ................................................................ 19 4. CONCLUSIONS AND RECOMMENDATIONS ................................................................ 20 4.1 Conclusions ............................................................................... .............................. .... 20 4.2 Recommendations . ... ............... ... ....... .... ... ... .... .... .... .... ..... .. .... .... .. .. .... .. ... .... .. ... 20 PART II-PLANNING FOR EXPANDING THE IMPLEMENTATION OF IMCI ...... ...... 25 1. BACKGROUND . .... ..................... ...... ...... ..... .. ..... .. .. .. .. .. ........... ... ........ ..... .. ... ...... ......... ... .. 25 2. PLANNING PROCESS ...................................................................................................... .. 25 2.1 Objectives of the planning meeting............................................................................. 25 2.2 Participants ................................................................................................................... 26 2.3 Tasks completed . .... ...... .. .. ... .. .. .. ........ ... .. ... .. .. .. .. .... .. .. .. ... ... .... .... ... .... .. ... ..... ... ...... 26 3. SUMMARY OF MAIN ISSUES DISCUSSED AND AGREED UPON ............................. 27 3.1 Framework for introducing IMCI into a new province .. .. .. ...... .... .... ... ..... .... ...... .. .... ... 27 3.2 Organization and management ofiMCI at central, provincial and country levels ..... 29 3.3 Criteria for prioritizing provinces and counties for expansion ................................... 30 3.4 Introduction of new interventions ..... .......................................................................... 31 3.5 Pace and plan of expansion ......................................................................................... 32 3.6 Collaboration with partners ......................................................................................... 33 4. CONCLUSIONS AND RECOMMENDATIONS ................................................................ 35 4.1 Conclusions ................................................................................................................. 35 4.2 Recommendations ....................................................................................................... 36 ANNEXES: ANNEX 1 - LIST OF PARTICIPANTS, IMCI EARLY IMPLEMENTATION REVIEW MEETING, 21-24 August 2001 .......................................... ....... 39 ANNEX 2 - AGENDA, IMCI EARLY IMPLEMENTATION REVIEW MEETING, 21-24 August 2001 ...................................................................................... 41 ANNEX 3 - REPORT ON EARLY IMPLEMENTATION OF IMCI IN PEOPLE'S REPUBLIC OF CHINA Working document for IMCI Review and Planning Meeting 21-30 August 2001 .................................................................... ... .. ... .. ........ 45 ANNEX 4 - LIST OF PARTICIPANTS, IMCI EXPANSION PLANNING MEETING, 27-30 August 2001 ............................................. 105 ANNEX 5 - AGENDA, IMCI EXPANSION PLANNING MEETING, 27-30 August 2001 ...................................................................................... 109 ANNEX 6 - CENTRAL IMCI WORKING GROUP PLAN .......................................... 113 ANNEX 7 - POTENTIAL AREAS FOR IMCI EXPANSION IN CHINA .................... 115 Keywords: Child health services I Child welfare I Delivery of health care, Integrated Disease Management I China SUMMARY Integrated Management of Childhood Illness (IMCI) is a comprehensive strategy developed by WHO and the United Nations Children's Fund (UNICEF) to reduce morbidity and mortality among children, and promote their healthy growth and development. It includes a number of complementary interventions targeting health professionals, families and communities, and the health system as a whole. Since the initial stages in mid-1990s, the IMCI strategy has been introduced in more than 80 countries worldwide, and is widely recognized as the main strategy for addressing child health issues at the primary care level. The IMCI strategy was introduced in China at a national orientation meeting in November 1998. National health authorities agreed that IMCI would be a suitable strategy for reducing early childhood mortality and improving child health care in China. The Ministry of Health has been actively involved in the preparation for and implementation of IMCI in close collaboration with the Australian Agency for International Development (AusAID), UNICEF, WHO, and the World Bank. A Steering Committee and a Working Group were established, a focal person appointed, and a national plan for the early implementation was developed including activities to be undertaken at the central, provincial and county levels. Activities in the initial phase focused on adapting the IMCI guidelines and training materials, building capacity and gaining experience in two selected counties in two provinces (Chaling and Guidong counties in Hunan, and Lingwu and Yanchi in Ningxia). In addition, the Ministry of Health planned the expansion ofiMCI in four new provinces, i.e. Anhui, Gansu, Heilongjiang and Inner Mongolia. Upon completion of the early implementation phase, a review meeting was conducted in Beijing from 21 to 24 August 2001 to assess progress, and identify ways to strengthen and sustain IMCI implementation as a major strategy to realize the targets set in the National Programme of Action for Child Development in China, and to improve quality and equity in child health and development. Based on the recommendations of the review meeting, a plan of action for the expansion of IMCI was developed and discussed during the IMCI expansion planning meeting from 27 to 30 August 2001. Participants ofthe meetings included officials from relevant departments of the Ministry of Health, health authorities from central, provincial, county and township levels, members ofthe IMCI Steering Committee and Working Group, representatives from the Chinese Paediatric Society, and from the Technical Guidance Groups of the World Bank-funded projects. Representatives from partner agencies such as AusAID, the Department for International Development of the United Kingdom (DFID), UNICEF, and the World Bank also participated in the discussions. The early implementation phase has shown that IMCI is an effective strategy to strengthen child health services in China. The strategy is suitable for improving the skills and performance of health professionals at different levels. By rationalizing case management, it improves the quality of child health care and makes health services more affordable. The health managers appreciated the systematic planning process and quality of interventions. The systematic approach to orientation and planning facilitates capacity building for implementation and expansion of IMCI in a decentralized manner. The meeting concluded that the government