all sites, standard methods were adapted to
measure the MCE indicators and to collect the data
needed to support cost-effectiveness analysis.
Depending on the evaluation at each site, data
were collected at household, community, district
and national levels.
tools developed for the MCE may be useful to
others interested in evaluating child health
programmes. These generic tools are available from
of Child and Adolescent Health and Development.
important characteristic of the MCE is the use of
a stepwise design. The number and nature of steps
were tailored to each site, but in general the
following steps were included:
strength of IMCI implementation (training
coverage, geographical spread, etc.) and
health-system characteristics (accessibility,
utilization rates, etc.) were assessed at
necessary, a baseline survey of mortality,
nutrition and coverage of key interventions
was carried out.
surveys were performed, to compare the quality
of care provided by IMCI-trained and other
health workers. Information on health facility
costs was also collected.
were obtained on health systems support for
IMCI (drugs, supervision, etc.) and on the
coverage of community and household
interventions – either from specially
designed household surveys or from secondary
sources. Costs at national, district and
household level were also ascertained.
results from the previous steps, a decision
was made about whether IMCI implementation is
sufficiently strong that an impact on
mortality and nutrition is likely.
including costs, continued to be monitored for
two or more years, to allow sufficient time
for an impact on mortality to be
household survey investigated whether coverage
with key child-survival interventions was
adequate, and whether child nutritional status
improved. Costs at the household level were
in mortality were assessed by a demographic
survey or from results of mortality
of late 2005, the evaluation ended in Tanzania,
where all eight of the above steps were completed.
In Brazil, Peru and Uganda, the evaluation was
stopped at step 5 because there was evidence that
IMCI implementation in the whole study area was
not sufficient to reach a measurable impact on
child survival and nutrition. Nevertheless, in
Brazil and Peru there were smaller areas with
stronger implementation, and exploratory impact
analyses were carried out using secondary data
In Bangladesh, the study is under way, currently
in phase 6.
information on the design of the MCE, the sampling
methods, and the impact model used to define the
key indicators is available in the "MCE