Abstract:

Background: Integrated Management of Childhood Illness (IMCI) was introduced in Tanzania in 1996 and has been scaled up in all districts in the country. In Biharamulo District, the IMCI guidelines were implemented in 2003 with the training of 20 health workers from different health facilities. Since then, the training of health workers continued on a yearly basis until 2010.

Objective: The purpose of this study was to identify health system related factors that contribute to the implementation of the IMCI guidelines, focusing on the management of febrile illness among under-five children in Biharamulo District, Kagera Region.

Methods: A cross sectional study in which 126 health workers from all health facilities in Biharamulo District were interviewed using questionnaire. Facility pharmacy store ledgers were reviewed using a checklist to assess the availability of drugs and supplies.

Results: Of the 127 respondents, 68 (53.5%) had attended IMCI training. The duration IMCI training of all workers was 11 days. Furthermore, 36 (52.9%) of the respondents who had attended IMCI training had attended refresher training on the IMCI guidelines. In addition, 73 (57.5%) received supportive supervision about 2 to 5 times in a month. The providers of supportive supervision were the national IMCI team, the CHMT and RHMT. There were 47 (37.0%) respondents who had an excellent knowledge about the IMCI guidelines. There were 72 (57%), 35 (28%) and 20 (16%) respondents pointed out that there were no adequate drugs, laboratory reagents and IMCI guideline books respectively.

Conclusion: Addressing and tackling health system related factors challenges and constraints, such as drugs supplies and equipment availability, training of health staff on IMCI guidelines, availability of adequate qualified staff and effective supportive supervision and mentorship would facilitate IMCI implementation.