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Turning Skeptics into Believers:

Pediatricians in Benin Support Treating the Child, and not Just the Illness

Dr. Julien Gbaguidi is a pediatrician and head of the pediatrics ward at Ouémé Regional Hospital in Benin. Like many doctors, he was skeptical when he heard about a new integrated approach to treating sick children. Now, he proudly proclaims, "If you haven't seen a health worker apply the integrated management of childhood illness approach, just watch me!"

The integrated management of childhood illnesses (IMCI) is an approach that focuses on treating the whole child, and not just an illness. In the past, health workers often treated the symptom the mother complained about when she brought her ill child to a health center. If a child had a fever, the mother received medicine for malaria; a child had diarrhea, the mother was given the treatment only for diarrhea. However, children often suffer from more than one illness at a time, meaning repeated trips to the health center for the mother and child. Through the integrated approach, the child is systematically examined, a proper and thorough diagnosis is made, and all of the child's conditions are treated. The mother also receives extensive counseling about nutrition, as well as illness prevention and care. IMCI, developed by WHO, USAID and UNICEF, involves training health workers in using this new diagnosis and treatment methodology.

In 1999, Benin's Ministry of Health, in response to continuing high rates of infant and child mortality caused principally by malaria, diarrhea and respiratory illnesses, decided to implement IMCI. Through USAID's support, the MOH and its partners adapted training materials for the Beninese context. Health worker trainings began in 2001 in the Ouémé Region of Benin through the USAID-funded Africa Integrated Malaria Initiative (AIMI), implemented by Africare in collaboration with the MOH offices in the Ouémé region. AIMI's goal is to reduce morbidity and mortality among children under five and pregnant women by improving case management of children through the IMCI approach in communities and health facilities, preventing malaria by promoting the use of insecticide-treated nets and improving prevention and treatment of malaria in pregnant women.

Dr. Gbaguidi, who participated in initial orientation sessions on the new approach, said that he and many of his colleagues didn't understand it at first, and he wasn't even interested in attending the sessions. He said he doubted that you could "turn a health worker into a pediatrician with a few days training," and that the training wasn't necessary for doctors who had already learned everything about childhood illnesses.

Despite his skepticism, Dr. Gbaguidi participated in the first IMCI trainings, and then became a clinical instructor and facilitator. Today, he is the first to admit that his doubts were misplaced, and that this new approach makes sense, claiming that "with IMCI, we can really take better care of sick children." He also said that other pediatricians, not only in the Ouémé, but also in other regions of Benin, now believe that IMCI is the most cost-effective and appropriate way of treating sick children. Dr. Gbaguidi has become such an advocate of IMCI that he has successfully convinced the Catholic Church's archdiocese in the Ouémé to finance IMCI training for health workers facilities supported by the Church, an important source of health care in Benin.

Through AIMI, a total of 132 health care workers in the Ouémé region have been trained in the IMCI approach, and trainings will continue until all children in the region, which has a population of just over one million, will benefit from improved services. Initial post-training surveys indicate that the quality of care given by IMCI-trained health workers has drastically improved since the 1999 baseline survey.

Although IMCI is being implemented in several countries in Africa, and throughout the world, Benin is the first country in which the impact is being rigorously measured, not only concerning the quality of care offered in health facilities, but also concerning child mortality. With assistance from the Centers for Disease Control and Prevention (CDC), AIMI has developed and put in place a child mortality surveillance system that has been integrated into Benin's health information system, which means that chances are good that mortality surveillance will continue after the program ends. Nearly 1000 health workers have been trained in implementing the child mortality surveillance system, which is implemented in more than 250 health facilities. This system will be used to demonstrate the bottom-line impact of child survival interventions in the Ouémé.

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