[The integrated management of childhood illness: Haiti's example]

Child health in developing countries is a public health priority both at the national and international level. The World Health Organization, UNICEF and other technical partners have developed The Integrated Management of Childhood Illness (IMCI) strategy to reduce child mortality and improve child health and development through a holistic approach. By the end of 2002, 109 countries among which 17 in the region of the Americas and Caribbean had adopted and implemented this strategy,. In this region, Haiti presents the highest mortality rate for under-fives. Every year, more than 138,000 children die of diseases such as malaria, pneumonia, diarrhea, measles and perinatal complications. Malnutrition contributes to a high percentage of these deaths. It is recognised that the mortality due to these diseases can be prevented. To fight this burden, Haiti officially adopted the IMCI strategy in 1997. The objectives of this paper are, after a general overview of the IMCI strategy, to describe Haiti's child health and analyse the achievements of the first steps of implementing the IMCI strategy in Haiti. The methodology used was a standardised literature review and a qualitative survey based on semi-structured interviews of national and local health authorities involved in the implementation of the IMCI strategy in Haiti. Main results show a limited impact of the first and second phase of implementation in the country. The key factors for this have been limited economical and human resources. A unequal distribution of existing resources between the different IMCI strategy components especially community and family practices, has limited adequate coverage. Isolated actions in favour of child health as well as a lack of co-ordinated interventions between the various actors have been among the barriers for an adequate implementation of this strategy. We recognise that the approach used here is not a formal evaluation on the implementation of IMCI in Haiti. Nevertheless, we hope this article will contribute to draw the attention of national and international public health decision-makers on the difficulties of implementing this strategy in Haiti and in this way, improve child health in the country.