IMCI was introduced in Tanzania in 1996. Currently health facilities in all districts both on the Mainland and in Zanzibar are implementing the Integrated Management of Childhood Illnesses (IMCI). Forty-four percent of the districts have reached the target of having 80% of health workers trained and 75% have been followed-up at least once. Almost 8000 health care providers have been trained in IMCI. According to the WHO Multi-country evaluation, the implementation of IMCI led to nearly 13% reduction in childhood mortality over the last two years.
A number of important commitments have been made by the Tanzanian government to ensure sustainability of the IMCI implementation. This includes the establishment of a national IMCI coordinator, the development of a national Infant and Young Child Feeding strategy, the recent launching of a Maternal Newborn and Child Health roadmap (April, 2008) and ensuring a national budget line for IMCI activities. On the district level district councils have been instructed to direct 5% of their budgets to IMCI activities.
Initial efforts of IMCI implementation in Tanzania were focusing on improving the skills of health workers through in-service training using the 11-day standard IMCI course. Pre-service IMCI training was later introduced in order to increase coverage. It address the issue of big organizational and resource demand created by in-service training. Currently IMCI taught in two medical schools, 34 allied health/nursing schools. Eight zonal training centers have been setup to support IMCI training at the distric level.
Though Tanzania has made significant progress in implementing IMCI at a national scale a number of important challenges remain:
- The current 11-days IMCI training course places a big burden on the country's human resources keeping the workforce for a long time away from their respective facilities
- The process of updating the IMCI training materials and clinical guidelines is a cumbersome, expensive and time consuming. Tanzania mainland has updated their materials last year (2007). However due to the rapid changes in the HIV/AIDS environment the HIV-guideline is already out of date
- The availability of training materials is a challenge for all institutions and districts carrying out IMCI training
- The availability of appropriate reference materials at both national and district level is compromised
- There is a great need for refresher training and follow-up with health workers who have already been trained in IMCI
- There is a need for building and sustaining a conducive environment for health workers trained in IMCI to practice IMCI routinely during their daily work
A series of consultative meetings were held in November 2007 to introduce ICATT to the country. The main outcome of those consultations was the common understanding that ICATT could be very useful for adaptation and/or revision processes of the IMCI guidelines as well as training of different levels of health care providers. The consultations further set up a working group to coordinate the early use of ICATT in Tanzania.
During 28 April to 3 May, 2008 the National working group conducted a workshop to familiarize MOHSW staff and representatives from various training institutions with the ICATT application. Another workshop objective was to adapt the Tanzanian IMCI chart booklet and to plan for the early implementation of ICATT in Tanzania (see News page for more details on the workshop).
During the next few months the working group will continue to adapt the generic ICATT tool to the Tanzanian IMCI guideline and to translate the materials into Kiswahili.
In 2009 Tanzania completed local adaptation of IMCI ICATT materails both in English and Kiswahili. Currently Tanzania uses IMCI ICATT-based training both for pre-service and inservice training. See the news page for the latest development.