"The staff are not motivated anymore": Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI) program in the Philippines

• Published in: BMC health services research Vol. 21; no. 1; p. 270
• Main Authors: Reñosa, Mark Donald C, Bärnighausen, Kate, Dalglish, Sarah L, Tallo, Veronica L, Landicho-Guevarra, Jhoys, Demonteverde, Maria Paz, Malacad, Carol, Bravo, Thea Andrea, Mationg, Mary Lorraine, Lupisan, Socorro, McMahon, Shannon A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24.03.2021; BioMed Central; BMC
• Subjects: Beliefs, opinions and attitudes; Child; Child health; Child Health Services; Child mortality; Childhood illness; Children; Children & youth; Childrens health; Data analysis; Delivery of Health Care, Integrated; Diseases; Health Personnel; Health services; Humans; Illnesses; IMCI; Integrated Management of Childhood Illness; Interviews; Management; Medical personnel; Philippines; Primary health care; Qualitative research; Regions; Philippines; Luzon; Implementation research; Health programs; Integrated Management of Childhood Illness; Health services; Primary health care; Child health; IMCI; Health care workers; Child mortality; Childhood illness
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-06209-6

Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond. In-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model. HCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols. Although the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.