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  • (WP)/CHD/ICP/CHD/002-E

    Report series number: RS/2001/GE/40(VTN) English only

    REPORT

    REVIEW OF INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) IN VIETNAM IN THE CONTEXT OF HEALTH CARE FOR

    MOTHERS AND CHILDREN

    Convened by:

    WORLD HEALTH ORGANIZATION

    REGIONAL OFFICE FOR THE WESTERN PACIFIC

    VietNam 26 November- 14 December 2001

    Not for sale

    Printed and distributed by:

    World Health Organization Regional Office for the Western Pacific

    Manila, Philippines·

    December 2001

  • NOTE

    The views expressed in this report are those of the part1c1pants in the Review of Integrated Management of Childhood illness (IMCI) in VietNam in the Context of Health Care for Mothers and Children and do not necessarily reflect the policies of the Organization.

  • CONTENTS

    SlnviM.AR Y . . . .. .. . . .. . ... . .. .. .. . .. . . . .. .. .. .. . .. .. .. . .. . . . . .. . . . .. .. .. ... .. . . . .. ... .. . ... .. . . . . . . . . .. .. . .. . . . .. .. . .. ... .. . . . .. .... .. 1

    IN'TRODUCTION ....... .... . .. .... . . . ... . .. . .... . ...... . ... . . .. ........ .... ...... . ... .. . . .. . . . . . . .. . . . . .. .. ... ... ... ...... . . ... . .. 6

    FIN'DIN'GS .......... ................. ... .. ......... ............ .... .. ....... .. .. .......... ......... .............. .. ..... ... ... .. ..... .. 9

    1. ORGANIZATIONS AND MANAGEMENT..... .. ....................................... ............ .. ......... ... 9

    1.1 Central level organization .. .. .. .. .. ... .. .. .. .. . .. .. . .. .. .. .. . .. .. . .. .. . .. .. .. .. .. . .. .. .. .. . .. .. .. .. .. . .. .. .. .. .. .. 9 1.2 Provincial level organization .... ....... .......... ..... .......... ..... .. .. .. ... ... ..... .. ........ .. ... ...... .. .. . 11 1.3 Planning and management of integrated care .. .. . .. .. .. .. .. . .. .. .. .... .. .. .. . .. .... .. .. .. .. .. ...... ... . 11 1.4 Sharing of experience............................................ .......... .... ......... ......... ............. ....... 12

    2. Th1PLEMENT ATION OF llv.ICI .. .. ... .... . ....... ...... .. . ... ........... ... ....... ..... .. .... ..... . .. .. .. . . . . . .. .... .... . . 13

    3. RECOMMENDATIONS............... .. ................. .... ........ ........ ... ... .... .................. ..... .. ....... ..... .. 25

    ANNEXES:

    ANNEX 1 - MEMBERS OF THE REVIEW TEAM

    ANNEX 2 - VISITS IN' HANOI

    ANNEX 3 - VISITS IN' PROVIN'CES IN' THE NORTH

    ANNEX 4 - VISITS IN HO CHI MINH CITY AND PROVINCES IN THE SOUTH

    ANNEX 5 - MEETING INVITATION FROM THE MINISTRY OF HEALTH

    Keywords:

    Child health services I Child welfare I Maternal health services I Maternal welfare I Delivery of health care, Integrated I Program evaluation I VietNam

  • SUM:MARY

    Between 26 November and 14 December 2001, a team reviewed the status and implementation of the Integrated Management of Childhood illness (IMCI) strategy in VietNam. IMCI has been in operation since 1996, and a review was carried out in 1999. The main emphases of the fmdings of that review were on the need to develop all three components of IMCI and to expand implementation systematically.

    In addition to examining the achievements and constraints of implementation of!MCI, the present review aimed to focus particularly on the relationship ofiMCI to the programmes, projects and institutes which work for the health of mothers and children at all levels.

    The review team examined the organization and management of IMCI at all levels, with particular emphasis on the role, strengths .and weaknesses of the national level IMCI Technical Group and Steering Committee. The team visited provinces, districts and communes to observe the implementation ofiMCI as well as aspects of programmes concerned with the health of mothers and children at all levels. In HaNoi, Ho Chi Minh City and elsewhere as the opportunity arose, the team held discussions with staff of a wide variety of programmes, institutes, nongovernmental organizations (NGOs) and other bodies concerned with child health and IMCI.

    The main issues arising from the review are:

    Organization and management

    IMCI is seen as a strategy, the intention of the Ministry of Health being that all programmes concerned with the health of children less than five years of age will adopt its approaches as a basis for their activities. In practice, although there has been good collaboration in the development of IJ\1CI guidelines and materials and some programme staff have taken part in IMCI training, IMCI has not yet been adopted as a strategy to any great extent by the vertical programmes that provide most of the direction and resources for child health.

    The structure, position and resources of the IMCI Technical Group were quite appropriate for the early stages of implementation of IMCI, but the demands during the present phase of expansion now require a focus with more capacity and authority.

    The vertical nature of the health system makes it difficult for managers at any level to plan jointly or to make use of resources across project boundaries. Present donor policies tend to contribute to the verticality of the system. This situation makes it difficult to fund integrated activities such as IMCI unless they have been built into the original designs of the funded projects. Some major donors (United States Agency for International Development (AUSAID) and Danish Agency for Development Assistance (DANIDA) in particular) have done this, and the projects are providing training on a large scale in eight provinces. Much of the rest of the IMCI activity has been funded on an ad hoc basis, which makes long-term planning or development difficult.

  • - 2 -

    Training and follow-up

    More than 600 commune health workers (CHWs), mainly doctors, assistant doctors and nurses, have received in-service training in the past two years. The quality of training and its effect on health worker performance are encouraging. The training, however, has been spread too thinly over a large number of provinces, and most provinces have only a handful of districts and communes in which IMCI activity is taking place. Under these circumstances IMCI has not become a major focus in most of the operational provinces.

    Pre-service medical training has started in one medical school and will soon start in others . The medical schools are excited about this development, which is well fourided and will in the near future provide a large number of doctors and other CHW s with an understanding of IMCI. The only concern is that no effort has been made to plan the preparation of provinces and districts in conjunction with the IMCI training of the doctors and others who will come to work in their health facilities.

    Pre-service training is also planned in secondary medical schools. The potential output of these schools is enormous, but the team was concerned that the insertion ofiMCI into this training had not been adequately planned.

    Given that neonatal mortality is currently the largest contributor to infant mortality in VietNam, there is a great need to improve basic newborn resuscitation/care as well as the management oflow birth weight, premature and sick newborns at all level in the country. The team explored ways in which IMCI training could be linked, through training and follow-up, to the development of skills in antenatal, delivery and postnatal care.

    Strengthening the health system

    IMCI has m3:de some contribution to the strengthening of the health system. Drugs supplies are generally well organized, but IMCI has provided useful impetus to ensuring that the minimum drugs are available.

    There are a number of small-scale experiments with integrated supervision, but none are being widely applied and the IMCI Technical Group has not been able to develop a standard approach to supervision.

    Referral is a problem in many remote and disadvantaged areas. The team found that CHW s were managing well in areas where referral is not possible, using their previous training supplemented by Annex E of the Treat the Child Module. Work is under way to provide guidelines and other support to referral hospitals.

    Community child health

    There are many community health activities in VietNam which have a bearing on the health of mothers and children. IMCI has recently started the introduction of community-based activities focusing on the 16 key family practices ofiMCI. This does not target areas where IMCI training is being implemented. There is at present no specific IMCI community activity in the country, but IMCI has a role to support and assist the coordination of the existing community activities. The IMCI Technical Group need to define this role and to select and develop appropriate tools for the provinces, districts and child health programmes to use.

  • - 3-

    Recommendations

    The report contains a number of proposals for action under each topic. The following list is of those proposals to which the review team gives high priority:

    1. Coordination of IMCI activities at national level

    Appropriate elements of the IMCI strategy need to become an integral part of all programmes concerning the health of children.

    The Ministry of Health should facilitate the adoption of the IMCI strategy by programmes, including national programmes and NGO interventions, by establishing a body charged with responsibility for: