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Integrated management of childhood illness: challenges from the community.


 Following an integrated approach to the management of childhood illnesses provides an opportunity to increase the effectiveness of the delivery of primary health care services through the efficient use of case management interventions. However, the potential impact of this approach to morbidity and mortality depends ultimately upon its use, and various constraints to use exist. There are constraints that are characteristics of the services themselves (such as long waiting lines); there are constrains within households (ideational, psychological, and socioeconomic); and there are constraints within communities (systems of transportation as well as geographic and social barriers). Unfortunately, inadequate theory exists to facilitate efforts to overcome the constraints which require behavioral and social change. This is due, in part, to the low priority placed by societies on the development of applied social science, as contrasted with biomedical science. Whereas the main factors that affect the utilization of health resources are well known, the relative importance of these factors in different conditions and situations (and their mechanisms of interaction) are not understood. Therefore, strategies which work in one context fail in another. This situation will continue until efforts are made to develop more systematic approaches to these experiences. However, the main challenge is to apply existing research tools and techniques and develop new ones which will permit the measurement and analysis of social and behavioral variables in a way that contributes to our understanding of them. The successful institutionalization of integrated management of childhood illness will also require the adaptation of generic guidelines to local communities. This process depends upon information on community beliefs and practices as well as on ways to use such information. Current techniques, such as rapid assessment procedures and focused ethnographic studies, must be further refined to meet this challenge.
