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In Tanzania Demographic Surveillance Systems (DSS) are operating in four contiguous districts (see map). Combined with TEHIP and AMMP research in two of these districts and Ifakara Health Research and Development Centre (IHRDC) research in the other two, the initiative has created the opportunity to develop a rural Research and Development (R&D) platform. The districts forming the platform are Kilombero, Ulanga, Morogoro Rural and Rufiji. This unique situation creates an excellent platform for nested comparative studies of health and health services such as the IMCI Multi-Country Evaluation (MCE) and the Interdisciplinary Monitoring Programme for Antimalarial Combination Therapy in Tanzania (IMPACT-Tz).

IMCI Multi-Country Evaluation

The Integrated Management of Childhood Illnesses (IMCI) Strategy was developed by WHO and UNICEF to address five leading causes of childhood mortality namely: malaria, pneumonia, diarrhoea, measles and malnutrition. The three main components addressed by the strategy are: improved case management, improved health systems and improved family and community practices.

WHO is supporting a multi-country evaluation (MCE) of the impact of IMCI on reducing under five morbidity and mortality.Worldwide there are 30 countries at different stages of implementation of IMCI among which Uganda, Peru, Bangladesh and Tanzania will participate in the MCE. The IMCI-Multi-Country Evaluation in Tanzania is implemented as a collaboration between: the Tanzania Essential Health Interventions Project (TEHIP), Ifakara Health Research and Development Centre (IHRDC), Adult Morbidity and Mortality Project (AMMP), World Health Organization (WHO) and the Ministry of Health (MoH). Tanzania presents a special opportunity where the two TEHIP collaborating districts (Morogoro Rural and Rufiji) are implementing IMCI and doing regular population based monitoring of births, deaths and migration. These two districts can therefore be compared to two other contiguous and rather similar districts (Kilombero and Ulanga) not implementing IMCI but having a similar population based monitoring. The IMCI MCE will be able to show whether or not this intervention is successful, how successful it is and at what cost. This information is vital for making policy at national and international levels. The inclusion of Tanzania in the global evaluation exercise is a manifestation of Tanzania's impressive promotion of this very important health intervention.

IMCI Multi-Country Evaluation will:

• Document the effects of IMCI interventions on health workers performance, health systems and family behaviours;
• Determine whether and to what extent, the IMCI strategy as a whole has a measurable impact on health outcomes;
• Describe the cost of IMCI implementation at national, district and health facility levels;
• Increase the sustainability of IMCI and other child health strategies by providing a basis for the improvement of implementation; and
• Support planning and advocacy for childhood interventions by ministries of health in developing countries and national and international partners in development.

Document(s) 5 of 10