Child health and development | Health systems support

Health systems support

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Policy, planning and management





A policy-supportive environment is essential to both the implementation and sustainability of public health interventions. Mechanisms should also be formally agreed and in place to monitor the implementation of such policies, evaluate them against the original objectives for which they were developed, and update them as needed.

Child health initiatives are no exception. For example, the incorporation of the principles and elements of IMCI (Integrated Management of Child Health) in key strategic documents and the updating of existing policies or the development of new policies to support IMCI implementation in the long-term is critical to achieve and sustain the child health outcomes for which specific interventions were designed. See an example of how essential policy decisions support effective child health care interventions.

A few countries in the Region have included IMCI as a key strategy in their national health development plans or similar documents which set mid-term or long-term directions.

During the process of country adaptation of the IMCI strategy when policies and guidelines are usually reviewed to ensure consistency, it was observed that many countries lacked written policies or had child health-related policies or guidelines scattered in different policy or training documents, often by programme.

This observation and the need felt in countries to have a national child health policy document, led the Regional office to launch the Child Health Policy Initiative. The initiative aimed to assist countries in developing national child health policy documents.

As part of this initiative, the Regional office developed the document “Development of National Child Health Policy – Phase I: The situation analysis” in September 2004, to guide countries in this phase, taking into consideration the experience gained in the Region.

Given the importance of the topic, a full section of this website is dedicated to the Child Health Policy Initiative, to which the reader is referred for more information and details.

Child Health Policy Initiative

Development of National Child Health Policy – Phase I: The situation analysis



The presence of a child health management structure at central and implementation levels facilitates the implementation of public child health programmes and interventions in developing countries, more so when under-five mortality rate—a key development indicator—is high.

In these situations, the management structure should preferably be reflected officially in the ministry of health organigram, with clear identification of responsibilities of staff at different levels. This helps to support the sustainability of any improvements in child health outcomes in the future.

The specific emphasis on child health is largely justified by the fact that investing in the health and development of children means investing in the future development of a nation.

Some countries in the Region have designated full-time focal points or ‘programme managers’ for child health, including IMCI—Integrated Management of Child Health (e.g. Egypt, Sudan, Tunisia and Syrian Arab Republic). This decision gives more visibility to child health, facilitates the allocation of funds to its interventions and the coordination with other programmes within the ministry of health and with partners, including donors.

The existence of a committee at national level with representatives and resource persons from other child health-related programmes, professional associations, teaching institutions and partners, improves also coordination and supports advocacy initiatives, as the experience with IMCI has shown in the Region. For example, involvement of key paediatricians and teaching faculty of medical schools in the adaptation of the IMCI clinical guidelines has raised interest in the IMCI approach among selected medical schools and led to its formal incorporation in the teaching of medical students in several countries.



The development of sound plans with indicators and targets is a pre-requisite for a successful implementation of activities.

Plans need to rely on a thorough situation analysis in order to be responsive to needs.

Countries implementing IMCI in the Region such as Egypt, Syrian Arab Republic and Tunisia reviewed the quality of child health services at health facilities in districts selected for IMCI as a standard approach before starting implementation. This helped to identify resources, strengths and weaknesses to be addressed in planning and to compare information collected after IMCI implementation with the baseline information, to measure intermediate outcomes.

As an alternative approach, Morocco and Sudan compared performance of districts implementing IMCI with districts not implementing IMCI.

As part of the situation analysis, most countries focused on the need to prepare health facilities for implementation.

Countries such as Egypt also reviewed health system issues at district level, such as the management structure and capacity, human resources, policy on exemption of fees for clinical follow-up visits, drug management, referral, supervision, health information system, and training capacity, including training facilities and caseload.

Since IMCI implementation is a decentralized process, planning skills need to be strengthened at implementation level.

A systematic approach to IMCI district planning, described in “Guide for district planning workshops” (in Arabic), was followed in Egypt to improve the planning capacity for IMCI implementation of the district team. The objectives of these workshops, which convened all the concerned governorate and district health authorities, were to develop a feasible plan for implementation in the district, ensure the commitment of health officials at that level, and build planning capacity through this guided process. Similar workshops were conducted in Pakistan, Sudan, Syrian Arab Republic and Tunisia.

The Regional office has developed a "Guide to planning for implementation of IMCI at district level", mostly based on the rich experience from Egypt, reviewed by a team of experts with large field experience and tested, as a reference for other countries in the Region. The Guide includes a library of practical, useful tools for adaptation and use by countries.

Related links

Preparing the health facility for IMCI implementation

Systematic approach to IMCI district planning, Egypt

Guide to planning for implementation of IMCI at district level

Third intercountry workshop on the child health policy initiative, 10–13 December 2006

Second intercountry workshop on the child health policy initiative, 13–16 November 2005

Intercountry workshop on child health policy development, 26–29 July 2004