Assessing the impact of an intervention to implement the referral care component of Integrated Management of Childhood Illnesses (IMCI) in district hospitals.

Abstract

We intend to conduct a unique public health efficacy study of an intervention to improve care for children in district hospitals in Kenya. The intervention has been developed, based on the referral care component of the IMCI strategy, with the Ministry of Health. It comprises, training, guidelines, job aides, supervision and quality improvement activities and will be delivered over 1.5 years to four intervention hospitals. Four control hospitals will receive guidelines and information from regular surveys. Random selection will be used to decide allocation to the hospital groupings. The impact of the interventions in hospitals from both groups will be monitored over 2.5-3.0 years (extending before and after intervention) with performance assessed against the guidelines provided and pre-defined standard criteria. Assessments will include: 1) Process measures of the quality of care, representing proximate impacts of the intervention, 2) Paediatric inpatient mortality and the adequacy of resources and the environment (outcomes with a complex causal pathway) 3) Exploration of factors at hospital and health worker levels (including institutional and person-specific factors such as motivation) that may affect the delivery of care 4) The costs and cost-effectiveness of the intervention Qualitative studies will be used to describe: each hospital’s context and the broader institutional response to intervention. Results will critically inform the debates on scaling-up and improving the delivery of evidence based hospital care for children in Kenya and elsewhere.