Factors influencing implementation of integrated management of childhood illness in Lindi Region, Southern Tanzania

Background: Save the Children Tanzania has been supporting several projects in Lindi Region including implementation of health facility based Integrated Management of Childhood Illness (IMCI) services in Kilwa, Ruangwa and Lindi rural districts. The objective of this study was to assess the IMCI services in a sample of health facilities and explore factors affecting the service provision and sustainability in Lindi, Tanzania.
Methods: A cross-sectional study was conducted involving 27 health facilities. Quantitative and qualitative approaches were used to collect the required data. Focus group discussions and in-depth interviews were also used to evaluate the IMCI services in these facilities.
Results: All health facilities visited were found to have adequate supply of IMCI equipment. However, there was inadequate availability and distribution of clinical officers in the districts. None of the 41 clinical officers observed, assessed sick children for all items in the IMCI checklist. Furthermore, health centres and dispensaries were found to have a serious shortage of essential medicines. Oral antibiotics for bacterial infections were available across health facilities. Amoxicillin was found in 4(44%) health centres and 7 (46.7%) dispensaries; Ampicillin was only available at 4(44.4%) health centres and 1 (6.7%) dispensary. Considerable challenges in access to health services were identified and they included long distances to health facilities, inadequate and unaffordable transport systems and continuous limited quality of care due to shortages of trained staff and drug stock outs. In addition, caregivers were found to have limited awareness of danger signs and symptoms of childhood illnesses.
Conclusions: The implementation of IMCI services in the three districts of Lindi region experiences multiple challenges despite the availability of adequate infrastructure for program implementation. This calls for strengthened supportive supervision, constant provision of medical supplies and training of IMCI health workers to improve services delivery to sick children. In addition community level promotion of prompt modern health care seeking behaviour is essential to enhance childhood illness care and treatment.