Global Health Watch 1 in one file

100
80
Percent
60
40
20
South Asia
Sub-Saharan Africa
Global
0
80 82 84 86 88 90 92 94 96 98
00 02 Year
Figure B1.1 Immunization coverage 1980–2001, 3 doses DPT – global
and by region (Source: WHO/UNICEF/World Bank 2002)
tions, and that any further improvements will need major efforts to strengthen
the overall quality of health services (Box B1.5). Moreover, reductions in child
mortality may not be sustained unless national health systems take over some
of the roles played by donors and international NGOs in funding and deliver-
Box B1.5 Integrated Management of Childhood Illness
WHO and UNICEF have promoted the Integrated Management of Childhood
Illness (IMCI) to reduce child mortality and morbidity. IMCI has a
proven efficacy (Schellenberg et al 2004) and governments in more than
100 countries have committed themselves to implementing it. However,
a systematic multi-country evaluation of IMCI has shown that, in most
countries, fewer than 10% of all health workers providing child care have
been trained, and that the rate of training was not sufficient to achieve high
coverage in the foreseeable future (Amaral et al, forthcoming). Barriers to
scaling up and sustaining high-quality care over time include the cost of
training, problems caused by health workers being removed from clinical
duties for a significant period to attend training courses, the limited availability
of trainers and high rates of staff turnover – up to 40% in a two-year
period in some countries (Bryce et al. 2003). IMCI programmes, no matter
how good in theory, will struggle to make a widespread and long-lasting
impact unless they are integrated into a comprehensive strategy for health
systems development, especially in terms of human infrastructure.
Approaches to health care
71