Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China

Aim: To explore the impact of implementation of the Integrated Management of Childhood Illness (IMCI) strategy on the Chinese health system. Methods: Pre- and post-intervention field surveys, based on the adapted World Health Organization protocol of health facility surveys and follow-up assessment tools, respectively. Three hundred and forty-five health facilities were investigated pre intervention and 74 health facilities post intervention. Observation of case management of health workers, interviews with mothers and systematic checking of equipment and drug supplies were conducted in both pre- and post-intervention surveys. Results: There were significant improvements demonstrated with implementation of the IMCI strategy in terms of rational use of drugs, provision of basic equipment and drug supplies of both township and village facilities. The inappropriate use of drugs significantly decreased: injection/IV (from 43.6% to 2.7%), antibiotics (from 59.3% to 6.2%) and hormones (from 4.9% to 0). The availability of basic equipment and supplies of health facilities was improved greatly: children's scales (from 27.8% to 90.5%), timing devices (from 89.3% to 97.3%) and utilities for mixing oral rehydration salts (ORS) (from 36.5% to 100.0%). The supply of all recommended drugs increased, with ORS, vitamin A/D, iron, tetracycline eye ointment, vitamin B complex and diazepam increased greatly. Conclusions: The IMCI strategy has been shown to contribute to the improvement of the health system, promoting the efficient management of medical care at township and village level, as well as improving the relationship between doctors and patients.