Five countries are participating in the MCE. Sites were chosen based on the basis of a number of specific factors, including the level of child mortality, the probability of strong IMCI implementation, and the availability of partners both to support implementation and to carry out the evaluation studies. An MCE team visited each prospective site at least once.
Feasibility assessments for the evaluation were carried out at 12 sites. The evaluation is under way in five countries:
In Tanzania, the baseline health household survey was completed in August 1999, and the health facility survey in August–September 2000. Both included assessments of costs. Additional cost data at national and district levels were collected in July 2000. A follow-up survey was carried out in July/August 2002. Demographic surveillance of under-five mortality was completed in 2003. Final results are now being analysed and prepared for publication.
In Bangladesh, data collection for both the household and the health-facility surveys, including cost data, was completed in November 2000. Randomization of health facilities to IMCI and comparison groups was completed in January 2001. Implementation of IMCI in the intervention areas began in November 2001 with the training of health workers in IMCI case management. Facility-based IMCI was fully implemented by March 2002, and community-IMCI activities were initiated in November 2002. The Government of Bangladesh is at present developing a plan for large-scale implementation of the three components of IMCI.
In Peru, the Instituto de Salud del Niño and the Ministry of Health have conducted a nationwide analysis of secondary data collected on health and related variables from all 25 districts of the country to assess the impact of IMCI. It includes a mixed (retrospective and prospective) ecological analysis of IMCI impact. Data sources include the 1996 and 2000 DHS surveys, official vital statistics, and Ministry of Health data on provision, utilization and coverage of health services.
In Uganda, USAID supported the Johns Hopkins University in carrying out an evaluation together with the Makerere University Institute of Public Health and the Ministry of Health. Baseline data were collected in 2000 from household and health facilities in 10 districts at varying stages of IMCI implementation. Follow-up health-facility surveys were carried out in 2001 and in 2002, and follow-up household surveys in 2001 and 2002. The investigators and the MCE central team are now analysing and preparing those data for publication.
In 2002, a health facility survey was carried out in four states in North-East Brazil (Bahia, Ceará, Paraíba and Pernambuco) in IMCI and comparison municipalities. The 2002 meeting of MCE technical advisers and investigators was hosted in Brazil, in Ceará state. Current activities include reinforcement of training and supervision in 23 municipalities with IMCI, and data analyses on determinants of IMCI implementation at municipal level, and on the effect of IMCI on process and impact indicators using secondary data.