Assessing Quality Of Health Services Delivery For Children In Sub-saharan Africa During The Implementation Of The Integrated Management Of Childhood Illness (imci): Kenya, 1999-2010
Introduction The Integrated Management of Childhood Illness (IMCI) is a multicomponent health system strengthening initiative widely adopted in Sub-Saharan Africa to improve poor child health outcomes. Implementation and subsequent evaluation have largely centered on the clinical management component. This study examines the clinical component in tandem with the facility improvement component, while capturing aspects of the community component over a ten year period. Methods The study utilizes a modified Donabedian quality measurement model where expected outcomes are a function of the process and structural components of healthcare quality which corresponds respectively to the clinical management and facility improvement components of the IMCI strategy. The data source is the Demographic Health Survey-Services Provision Assessment on Kenya for years 1999, 2004 and 2010 and it consists of a sample of 3,884 children and their caretakers seeking care at 1,523 health facilities. Bivariate analyses examine the change in health quality indicators and the quality indices (aggregated quality indicators) over time. Then negative binomial models assess the effect of the process and structural quality indices on the Caretaker Perceived Quality of Care (CPQoC) over time. Results Since IMCI implementation in Kenya, the clinical management and facility improvement indicators have not followed a pattern of consistent improvement while the quality indices increased consistently over time. The technical aspects of care have a higher effect on the CPQoC than the structural aspects and some of the interpersonal aspects of care were statistically significant. Privately managed facilities showed the highest impact while access to care had no impact on the CPQoC. Conclusion The findings underscore the importance of clinical management while recognizing the importance of the facility and community components of the IMCI. Revising the strategy to encourage implementation of all components with increased emphasis on the community components as well as ownership from national governments can improve child health outcomes in the region.