Review of health system barriers to implementation of the integrated management of childhood illness strategy in Uzbekistan



A study was conducted in Uzbekistan in 2008 to review the barriers in the health system to implementing the IMCI strategy, assessing the quality of care delivered to sick children attending outpatient health facilities, caregivers' understanding of home treatment and key messages after visiting these facilities, and health system supports and barriers for quality care. The study found that, in general, health workers trained in IMCI correctly assess, classify and treat sick children. However, assessment and counselling on child feeding and growth require substantial improvements that can be addressed through enhancing the quality of undergraduate and postgraduate training of health professionals. Health facilities have a minimal list of equipment and supplies, but consistent and full
availability of essential medicines for children remains a problem. The reasons for that are complex and derived from inadequate funding and drug distribution, and lack of some basic IMCI medicines in the essential drug list. Support for the implementation of IMCI in health facilities is sporadic and not sufficient. Health managers do visit health facilities but in most cases they do not directly observe sick child management and they lack problems analysis and practical support. Most supervisors are not aware of the principles of IMCI strategy. The capacity of management staff in programme planning, management, monitoring and evaluation needs to be strengthened. The policy and tools for supportive supervision in child services should be revised and developed.