Uganda was among the first countries to implement the Integrated Management of Childhood Illness (IMCI) approach on a national scale, beginning in 1995. The program benefited from strong child health structures in the Ministry of Health, and generous support of donors. This enabled the training of over 8000 health workers in IMCI methods and to begin pre-service training and training for private practitioners. Training was decentralized to district level in 2000, and a short training course was developed in 2002. When the results of the national program were examined in 10 districts, the presence of IMCI-trained health workers in health centers was patchy. Supervisors observed health workers using their IMCI skills at only about half of visits. However, turnover of health staff following IMCI training was generally low. Low utilization of health facilities has reduced the potential benefit of the IMCI program. The pressure for rapid implementation of IMCI resulted in neglecting development of strong monitoring methods, a consistent supervisions system, and methods to assess the quality of IMCI training. The need for a hospital referral component was not appreciated until well into implementation. Although the need for community IMCI was recognized early in Uganda, development of the core components and the implementation process required much longer than anticipated.

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