The implementation of a child health strategy can serve as an opportunity to strengthen selected elements of health systems. At the same time, such a strategy depends on functioning health systems to deliver equitable, quality care and reach those who need it.
About this section on health systems
Strengthening health systems
It has become obvious over the years that unless health systems’ capacity is strengthened, child health programme efforts will not be sustainable in the long-term and it may be difficult to expand coverage of their interventions. Temporary, ad hoc initiatives may initially work but are short-lived.
As functioning, equitable and effective health systems are a requirement for quality care of essential services and their sustainability, strengthened health systems are essential for the achievement of the health-related Millennium Development Goals.
The issues of major concern are substantial, as they relate to planning and management, human resources, financing, drug supply, etc., and have a considerable effect on child health programme activities.
This is the reason why two of the three components of the IMCI strategy (Integrated Management of Child Health) deal with health systems: the 1st component, which emphasizes the importance of human resource development in child health, and the 2nd component, which deals with health system support.
Plans for improvement of both the components should be developed at the same time. An IMCI training initiative to upgrade health providers’ case management skills (IMCI 1st component) without proper preparation of the health system (IMCI 2nd component) is not considered an “IMCI strategy” and is unlikely to have significant and lasting impact.
The IMCI strategy also calls for the establishment of strong links between health systems and the community (IMCI 3rd component). As emphasized in an intercountry workshop on the IMCI community component, community health workers are seen as an integral part of the public health system, a ‘bridge’, or even an extension of the primary health care facility into the community and also of the community into the health system.
In this Region, the Child and Adolescent Health and Development Programme (CAH) has promoted the importance of health systems as part of a child health strategy. It has developed tools to standardize the process. It has been possible to strengthen selected aspects of health systems through the IMCI strategy in countries with a functioning health system.
A child health strategy cannot on its own strengthen or reform the whole health system. However, it can contribute to improving selected aspects of it, setting priorities, allocating resources, developing tools, raising key issues and working closely with the sectors responsible for health system support elements to propose and find long-term solutions. This is needed to achieve an acceptable level of performance and coverage, and sustain it over time.
The Regional office has also launched an initiative to assist countries in developing national child health policies. Such policies are meant to go beyond the specific technical guidelines of each programme component and aim to address also major issues such as human resources and financing. This approach is critical to create favourable conditions to expand interventions and reach those in most need, the poor and disadvantaged families.
Child health policy initiative
Intercountry workshop on the IMCI community component
Quality care
If “coverage” is an important aim of public health interventions, “quality” is another key, leading principle. Only care of affordable, sustainable high quality standards can produce good results for the health of individuals. Investing in quality means having high returns in the long term.
The challenge in public health is often that of finding the right balance between “quantity” and “quality” of activities, to have impact within an acceptable period of time.
It is essential to define minimum standards of quality care and quality activities: the pressure to increase coverage should respect such standards. When quality is sacrificed and standards fall below the minimum originally set, then the investments made are likely to be ‘lost’.
What characterizes the IMCI approach in the Region is the stress placed on quality. Clearly defined and agreed upon quality standards are set in each country for key IMCI activities (from planning to implementation and evaluation). Measurable indicators are selected and monitored to ensure that standards are met throughout implementation.
There is global and regional evidence that this approach gives results, improving health provider performance, the use of drugs, caretaker satisfaction with services received and their utilization. The cost of care may then even be reduced, as resources are more effectively used. Thus, investing in quality may bring savings, in addition to better care.
About this section on health systems
This section of the website provides some information on the work carried out in the Region to strengthen health system support elements for the delivery of quality child health care services. It is not meant to be a review of health systems.
A short description of health system issues affecting child health programme performance is provided under each topic as an introduction to the work specifically undertaken by public child health programme managers in the Region and the CAH unit of this Regional office to address them.
Additional information on work carried out in this area by individual countries, including some of the tools developed, is available in the section on implementation.
Key issues in the area of health systems to be considered when planning for IMCI are described in the IMCI planning guide developed by CAH headquarters.
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