< BACK TO E&L HOMEPAGE
Acceptability and Uptake of an
Electronic Decision-Making Tool to
Support the Implementation of IMCI in
KwaZulu-Natal, South Africa
July 17, 2020
June Lee
Director, Evidence & Learning
The ELMA Philanthropies
Photo: WHO
IMCI was developed by the World Health Organization and UNICEF to improve the quality of care for sick children under the age of five in primary health care facilities.
Integrated Management of Childhood Illness (IMCI) guidelines include an HIV component to identify and manage children who are HIV exposed or infected. Successful implementation of IMCI is integral to the identification, care, and treatment of children with HIV. Health workers receive training and implement IMCI using a chart booklet, which is intended to ensure that they follow step-by-step algorithms to correctly diagnose and manage common preventable and treatable childhood illnesses and HIV. Research suggests that IMCI can improve the quality of care, but there are many barriers to good implementation. Electronic IMCI (e-IMCI), implemented on desktop computers, automatically guides health workers through all the steps in assessing a child’s illness and guides correct classification, treatment, and counseling. e-IMCI can result in fewer errors and improve data collection and reporting. As part of the ELMA-funded Unfinished Business initiative, Zoe-Life piloted e-IMCI in 15 clinics in KwaZulu-Natal, South Africa. This article describes the findings. Building on the success of the pilot, ELMA is now supporting two partners--Trust for Health Systems and Zoe-Life--to scale e-IMCI to 30 primary care facilities in Umgungundlovu district and 30 facilities in Ilembe district in KwaZulu-Natal.
Cecilie Jensen, Neil H. McKerrow & Gabrielle Wills (2019) Acceptability and uptake of an electronic decision-making tool to support the implementation of IMCI in primary healthcare facilities in KwaZulu-Natal, South Africa, Paediatrics and International Child Health, DOI: 10.1080/20469047.2019.1697573
Abstract
Background: Despite progress in reducing child mortality, preventable child deaths remain a challenge in South Africa. Poor implementation of Integrated Management of Childhood Illness (IMCI) guidelines has been well described, and the reported barriers to implementation include a lack of user-friendly tools.
Aim: To investigate whether an electronic decision support tool to strengthen IMCI implementation is acceptable to nurses, clinic managers, and caregivers at primary care facilities in KwaZulu-Natal, South Africa.
Methods: The electronic IMCI (eIMCI) software was tested in 15 health facilities in uMgungundlovu district from May to July 2018. System use was tracked, and qualitative data obtained from three user groups. IMCI practitioners participated in questionnaires and focus groups, and operational managers participated in in-depth interviews with caregivers in exit interviews.
Results: Thirty-two IMCI practitioners, six operational managers and 30 caregivers were included. Acceptance was high among caregivers and operational managers, albeit less conclusive among IMCI practitioners whose eIMCI uptake indicated higher variability in acceptance than the qualitative reports. Despite suboptimal staff deployment after training and low baseline computer literacy levels, 3,626 eIMCI records were captured across 12 sites over 14 weeks, with a median of 19 records per facility per week. Practitioners’ indicators of self-efficacy improved significantly post-implementation compared to baseline. Seventy-six percent of caregivers reported a marked difference in experience compared to previous consultations, emphasizing the comprehensiveness and efficiency of care.
Conclusion: Uptake was promising and acceptance was good, with themes converging across participant groups to highlight improved comprehensiveness and efficiency of service. Limited computer literacy was the principal barrier to uptake. The next steps include incremental scale-up with stronger mentoring and supervision components and evaluations to assess the feasibility, effectiveness, and cost-effectiveness of eIMCI implementation.
