Letters to the Editor
Indian Pediatrics 1999;36: 1177-1178
After RCH Program be Ready for IMCI Strategy
I read with interest the editorial entitled "Is India ready for Integrated Management of Childhood Illness strategy"(1). The author has correctly commented that "Why should the country's health planners be distracted by another grand scheme from the International Agencies". We in India, in recent past have seen many strategies initially being advocated and subsequently being implemented in the country without even conducting pilot studies in few selected districts of the country. Each strategy developed, advocated and sponsored by an International Agency has a strong training component. This has been true for each of the programs implemented like GOBI, UIP, CDD, ARI, CSSM, and presently RCH program. The training component of the strategy is imple-mented first and by the time the training component is completed the strategy is either modified or a new strategy is advocated by another international agency. Till date, no published report is available for evaluating the impact of the any of the earlier strategies.
Training component of any strategy (sponsored by an International Organization) is most suited to the trainers as well as trainees because both receive adequate honorarium, appropriate facilities and budget for conducting and attending training courses. We, academi-cians in India have seen enough number of trainings being conducted under different strategies sponsored/advocated by international organizations. The most recently concluded trainings were under CSSM program and presently trainings of functionaries are ongoing under RCH program at state, districts, block and PHC levels.
The results of evaluation of IMCI strategy are encouraging(2). However, we should not forget that Sachdev is an eminent pediatrician and Shah was doing his post graduation in the speciality of pediatrics with commitment while undertaking the study. Also, the research was conducted in one of the premier medical institution of capital of India which has all the facilities required by tertiary level care hospital for management of childhood diseases. The findings of the evaluation are extremely useful. However, before we initiate IMCI strategy in India, we must ensure that this strategy is launched only in selected districts where only basic infrastructure health facilities are available for management of common childhood illnesses.
At present, minimum pediatric care facilities are available at subcenter, PHC and CHC and even at block level health institutions. Majority of the district level hospitals might also be having infrastructure. It would be prudent to undertake a pilot study in one district each in 3 states with high, moderate and low infant mortality levels, to test the operational feasibility of implementation of IMCI strategy at district level before it is launched in the country. The lessons learnt from these pilot districts should be utilized for assessing the "readiness" of the country for the implementa-tion of IMCI strategy.
1. Costello A. Is India ready for the Integrated Management of Childhood Illness strategy. Indian Pediatr 1999; 36: 759-762.
2. Shah D, Sachdev HPS. Evaluation of the WHO/UNICEF algorithm for Integrated Management of Childhood Illness between the age of two months to five years. Indian Pediatr 1999; 36: 767-777.