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The WHO Department of Child and Adolescent
Health and Development in Geneva has developed a manual to assist
country programme managers in evaluating the quality of care delivered
to sick children attending outpatient facilities (using the IMCI
clinical guidelines as best practices).
The manual is available at WHO CAH HQ website.
The Child and Adolescent Health and Development Unit (CAH) of the
Eastern Mediterranean Regional Office (EMRO) has revised the methodology
for use in the Region, taking into consideration: a) previous, extensive
experience in the conduct of similar health facility surveys on
diarrhoeal diseases and acute respiratory infections; and b) needs for
adaptation to the situation in countries in the Region. Major changes
concern the collection of:
- Information on not only whether key clinical management tasks are
performed but also whether they are performed correctly;
- Additional information on items of particular relevance to a
particular country setting (e.g., out-of-pocket health expenditure,
relationship of caretakers’ report of breathing signs with pneumonia and
care-seeking, etc.)
- Qualitative information, as an additional resource for data analysis
to assist in the interpretation of the quantitative data. This
information, collected using a semi-structured form, includes
observations of the survey team on issues mostly related to health
systems support, such as organization of work at the facility, drugs
(procurement, uninterrupted supply, etc.), referral, utilization of
services, routine reporting, and constraints to the implementation of
the IMCI strategy.
The adapted survey forms are available from the reports on the
IMCI
health facility surveys conducted in the Region. Additional tools have
been developed by CAH/EMRO to assist in preparing for the survey,
collecting the required data and information for planning. The
guidelines “Survey procedures and question-by-question explanations”
have been thoroughly revised to include more examples and details to
meet the needs in the field (see file on the survey in Sudan).
The survey instruments enable the collection of health facility data on
child health service outcome indicators and, together with data on
outcome indicators from other sources, are useful to monitor progress
towards the achievement of the child health-related
Millennium Development Goals.
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A standard methodology has been developed by WHO to
conduct follow-up visits after IMCI training. These visits have the objective to
reinforce the skills of health providers trained in IMCI, review those health
system elements required to support them in the delivery of quality outpatient
child health services according to the IMCI strategy, assess caretaker
satisfaction with the care received, and identify and help solve problems faced
by the trained providers. Staff who conduct follow-up visits receive a standard
training on the follow-up methodology and gather information using standard
forms. As such, the follow-up visits are at the same time an integral part of
training, a strong supervisory tool and a means of collecting information on
health provider performance after training. This last aspect is increasingly
being used in the Region to assist in monitoring progress towards provider
performance targets, set as an intermediate step towards measuring final outcome
indicators by other means. While acknowledging that they have some limitations
when used for this purpose, follow-up visits offer the advantage of requiring
skills already available in a country and less human and financial resources
than surveys. Follow-up visits can not replace surveys but may be conducted more
frequently than surveys to help guide planning and managers’ decisions. Plans
are currently being considered in some countries in the Region to monitor the
performance of child health services in facilities in which the IMCI strategy is
being implemented, using the methodology of the follow-up visits in samples of
facilities. Findings from follow-up visits are reported by country in the
IMCI
implementation section. Top
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IMCI
health facility surveys in the Region
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The CAH unit of the Eastern Mediterranean
Regional Office has directly collaborated and been involved in the
planning and conduct of health facility surveys on the quality of
outpatient child health services in the following countries:
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Morocco, October - December 2007 |
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Sudan, March - April 2003 |
Egypt, March - April 2002
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 Morocco
Report
Sudan
Report
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