Perspectives of health care workers and village health volunteers on community-based Integrated Management of Childhood Illness in Madagascar

The Ministry of Health and Family Planning of Madagascar introduced Integrated Management of Childhood Illness (IMCI) strategy in 2006, and community-based IMCI (c-IMCI), in Mahajanga II District in 2007. Following the 2009 political crisis, foreign organisations' suspension of development aid until 2012 significantly affected the implementation of c-IMCI. This study aimed to elucidate the perspectives of village health volunteers (VHVs) and public health officers (PHO) on c-IMCI. Semi-structured in-depth interviews with all VHVs working in three communes and PHOs working at central, district, and health centre levels were conducted in 2013. Textual data, created from transcripts, were translated into English and French. Data management involved analysis of sections of translated transcripts, which were marked, coded, and linked with similar experiences, challenges, and opinions; these were categorised into words and phrases to discover meaningful relationships between emerging themes. From all interviews of 30 VHV in three Mahajanga II communes and 4 PHOs, 3 themes emerged: 1) benefits of c-IMCI to the community and for VHVs, 2) challenges to continue c-IMCI, and 3) motivation to continue c-IMCI. Although all respondents considered c-IMCI as beneficial, they stated it was difficult to continue. The health system and implementation of c-IMCI should be strengthened to enable programme survival beyond the initial phase, especially during times of political instability.