Rapid assessment of IMNCI programme in Bhavnagar District, Gujarat.

Background & Objectives: The desired impact of IMNCI is the reduction of mortality, morbidity and suffering, through assuring children’s access to quality health care in health facilities and improved case management at home. Maintaining the performance of health and village workers is essential to achieve this impact. So objective of this study is to assess IMNCI implementation in Bhavnagar district of Gujarat to strategize for accelerating effective implementation. Methods: A cross sectional study was carried out in March 2012 in Bhavnagar district. Four blocks of Bhavnagar district were purposefully selected out of seven blocks on the basis of immunization coverage of previous year. From each block one best PHC and from selected PHC one best sub-centre and one best Anganwadi were selected purposefully by solely on basis of perception of Medical Officer in charge PHC and BHO for implementation of IMNCI in their area in last one year. The purpose of adopting such method was to evaluate the performance of IMNCI implementation in centres (PHC, SC, AW) that was judged best by their supervisors. After selection, PHC, SC and Anganwadi centre were visited to assess the practice of IMNCI by ANM and Anganwadi Worker. Medical Officer, Health Supervisors and ICDS officers were interviewed to understand overall implementation process. For collecting data pre-tested and predesigned questionnaire was utilized. Results: Basic IMNCI training in Bhavnagar was completed in 90% of health and ICDS workers. More than 87.5% workers said that their knowledge, skill, confidence and credibility among community were increased after IMNCI training. Logistic and drugs supply were insufficient at sub centre and Anganwadi centre. Out of the total 80 filled IMNCI case sheets by the health and ICDS workers, 32(40%) were found accurately complete as the correctly filling of all the column (assessment and classification and treatment) in form considered as complete form. Accurate classification, management and advice of cases according to IMNCI guidelines were 62 (77.5%), 42 (52.5%) and 38 (47.5%) respectively as the accurate classification (assessment, classification and treatment) of the entire column in form correctly. Combination of one correct and other incorrect assessment or classification or treatment considered as partial accurate and inaccurate if all the column were not assessed or not classified or not given the treatment correctly. While observing actual practice of IMNCI, accuracy among health and ICDS workers was found in assessment 5(31.3%), Classification 8(50%) and treatment 7(43.8%). Supportive supervision and feedback mechanism were lacking at all level. Interpretation & Conclusion: Supportive supervision and feedback mechanism are key concern and must address. Proper logistic and drugs planning and management also main concern for IMNCI programme.