Factors inhibiting implementation of integrated management of childhood illnesses in Primary Health Care Facilities in Mafikeng Sub-district
Meno, Felicia Omphemetse
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Integrated Management of Childhood Illness (IMCI) is a worldwide strategy started by the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF). The main objective for this IMCI strategy was to reduce child mortality and morbidity which are associated with major childhood illnesses IMCI offers a comprehensive health programme that is directed at the development needs of children under five year of age. This strategy also focuses on good nutrition, health promotion, immunization and preventive measures, the provision of counselling services to mothers or care givers and engenders an appropriate referral system for seriously ill children. I had been evident that there is poor implementation and application of IMCI and training of professional nurses, to the management of child illness in PHC settings. There is anecdotal evidence based on the researcher’s experience as a professional nurse and as clinical preceptor during student accompaniment has revealed that some children eventually die due to poor implementation of IMCI. Despite the training provided and the child booklet that PHC nurses refer to, they tend to diagnose rather than classify children according to the guideline, and furthermore, treatment is wrongly prescribed. When professional nurses attend to sick children, they only focus on the history provided by the mother or care giver other than applying all principles of IMCI as stipulated in the IMCI guidelines. The professional nurses focus on dealing with patients quickly and end up neglecting the IMCI guidelines. There is also a sense in which nurses’ take for granted that they can treat sick children from their experience with similar cases, but the reality is that each patient presents a unique case. The purpose of the study was to explore and describe factors inhibiting implementation of Integrated Management of Childhood Illness in PHC facilities in Mafikeng sub-district and make recommendations on how it can be effectively implemented. A qualitative exploratory descriptive –contextual was used and the target population of this study was Professional registered nurses working in the community health centres and Primary health care facilities. The professional registered nurse was selected using a non-probability purposive sampling. The inclusion criterion for the study was professional registered with South African Nursing Council who are trained on IMCI. The sample size was determined by saturation were 15 professional nurses participated and saturation was reached at participant 12. The researcher collected data using an in-depth individual semi structured interviews, USING an audio tape recorder and field notes. Then data transcribed to verbatim. Data was analysed using a software programme called Atlas TI. was used for qualitative analysis of large bodies of textual, audio, graphic and video data. The researcher first noticed motifs in transcribed data while coding then make codes related to theme. Two phases of analysis were used which are the descriptive and conceptual levels of analysis. The results was discussed bases on following 4 themes and sub-themes: organisational and structural factors inhibiting IMCI implementation its sub themes are Time pressure factor, inadequate human resources, inadequate material resources, poor referral system and work related factors. Education, training and awareness sub themes under this theme are lack of training/in-service training, lack of education, lack of updates. Behaviour and attitude of nurses towards IMCI implementation its sub themes are behavioural and altitudinal factors. The last theme caregiver-related factors affecting IMCI implementation the following sub themes emerged, inability to provide adequate information, inaccessibility of facilities, uncooperative patients or clients and lack of care giver awareness. The limitations of the study were also discussed and recommendations were made for nursing practice, nursing education and nursing research. The study revealed factors inhibiting implementation of IMCI based on themes and subthemes mentioned above. For IMCI to be implemented properly and efficiently, the following should be in place: adequate space for consultation, staffing, and adequate updated chart booklets. PHC facilities should be adequately provided with drugs. Professional nurses need effective support, mentoring and supervision throughout IMCI implementation by the MCWH coordinators. Supportive supervision reduces work-related stress and nurtures a positive attitude towards implementation of IMCI. There is a dire need to ensure capacity building of professional nurses with regard to IMCI. Caregivers and mothers need to know the importance of providing comprehensive child history to professional nurses and therefore they need to be encouraged to disclose all relevant information during IMCI process.
- Health Sciences