Integrating the management of childhood illness

Second, how well IMCI can work depends upon the strength of the health system responsible for its implementation. Despite the important steps toward reality in the field taken by the Bangladesh and Tanzania projects, information available in other IMCI and MCE documents suggests that implementing IMCI effectively in other countries will not be easy. Certainly, titular progress so far has been striking: by the end of 2002, almost all developing-country governments had officially subscribed to IMCI, and nearly half of them claimed to have begun expanding at least two of its three principal components throughout their countries.1' But the MCE's effort to find suitable field sites suggests that such figures are considerably less impressive than they might seem. As the MCE team reported, "selection of countries for the MCE was more challenging and time-consuming than expected".6 The main problem was in finding countries where IMCI was being implemented actively enough to support a reasonable anticipation of measurable change.7 In most countries pledging allegiance to IMCI, weakness in the basic health system was preventing more than nominal execution.