Niger

This study examines the relationship between IMCI compliance and three cost issues: the length of client-provider consultations, treatment drugs, and workload. The setting was 26 health clinics in Niger, the only developing country setting where QA was implemented before IMCI. [publisher’s description]

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams. The report details the impact of each intervention, noting that sustaining performance is problematical under any intervention. The cost of IIMCI training was four times that of performance feedback. [publisher’s description]

For a health district to function, referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. [from abstract]