Assessing Training Approaches and a Supportive Intervention for Managing Febrile Illness in Tanzania – Tibu Homa Performance Evaluation Report

Author(s): Weaver E, Markiewicz M, Kwesigabo G, Lugalla J

Year: 2017

Abstract:

Integrated management of childhood illnesses (IMCI) is an approach to case management that includes a detailed algorithm for how to assess a child, classify the child’s illness, determine if referral is necessary, treat the child, counsel the mother, and provide follow-up care (World Health Organization [WHO], 2014). Developed by WHO and the United Nations Children’s Fund (UNICEF), IMCI was introduced in Tanzania in 1996. While under-five (U5) mortality in Tanzania has declined over the past two decades, socioeconomic disparities in child mortality persist and are especially prominent in rural areas. The Lake Zone of Tanzania, which surrounds Lake Victoria, has the highest U5 mortality rate in the country. The chief causes of postneonatal deaths in children 1–59 months in Tanzania are estimated to be pneumonia (22%) and malaria (16%) (Liu, et al., 2015). Because severe febrile illness is a key symptom both of malaria and pneumonia, accurate diagnosis and treatment of severe febrile illness is critical to efforts to reduce U5 mortality.

To reduce U5 morbidity and mortality owing to diseases that cause severe febrile illness, the United States Agency for International Development (USAID) Tanzania established the Tibu Homa project (Swahili for “Treat Fever”) in the Lake Zone through a cooperative agreement with University Research Co., LLC. The goals of the project were these: (1) increase availability and accessibility of fundamental facility-based curative and preventive child health services; (2) ensure sustainability of critical child health activities; and (3) increase linkages with the community to promote healthy behaviors and increase knowledge and use of child health services. Tibu Homa was implemented from March 2011–September 2015.

Tibu Homa worked with health facilities to train healthcare workers (HCWs) in IMCI. During Phase 1 of Tibu Homa (2011–2012), HCWs were trained on IMCI through an abbreviated three-day, in-person training focused on febrile illness. This was a modified version of the standard 11-day in-person IMCI training. Beginning in 2013 (Phase 2 of Tibu Homa), distance integrated management of childhood illnesses (dIMCI) replaced the in-person training as required by guidelines at that time of Tanzania’s Ministry of Health and Social Welfare (MOHSW)— now the Ministry of Community Development, Gender, Elderly, and Children (MoHCDGE&C]).

USAID/Tanzania asked the USAID-funded MEASURE Evaluation to conduct a performance evaluation of the association between (1) the training modalities and (2) supportive components implemented by Tibu Homa, with quality of care (QOC). The results are intended to inform the selection of future supportive interventions that may be implemented by USAID/Tanzania or the government of Tanzania (GOT) in conjunction with dIMCI training to enhance HCW compliance with the IMCI algorithm. The broad objectives of the evaluation were to estimate the added value of Tibu Homa’s supportive components.

The evaluation uses a retrospective, mixed-methods approach. Data sources are a cross-sectional quantitative health facility survey, qualitative and costing data collection, secondary time series data, and project document review. Primary outcomes are measures of QOC, which are defined by the WHO Health Facility Survey (HFS) and include the Index of Integrated Assessment (called the “IMCI score”); correct classification; and correct treatment of cases observed or reviewed in patient records.