An Assessment of Public Health Effectiveness of Approaches to Promote Key Family & Community Behaviors for Child Survival

The proposed four-year randomized study will attempt to test the hypothesis that community-based child health interventions in conjunction with facility-based IMCI will improve child care practices, nutritional status and child survival. The objectives of this research are:

1. To measure the effectiveness of the community-based interventions in improving selected child care practices in the community.
2. To measure the effectiveness of the community-based interventions in improving child nutritional status and in reducing child morbidity and mortality.
3. To document the process of implementation of community-based interventions at scale to promote selected key family and community practices related to child health.
4. To undertake cost-effectiveness analysis of the interventions.

Integrated Management of Childhood Illness (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF to reduce childhood mortality and morbidity and to contribute to improved growth and development of children under-5 years of age Experience suggests that a purely facility based strategy will not reach the significant portion of the population that does not have access to or choose not to use a health facility. Links between the service providers and families at household levels is essential in order to ensure that families have the knowledge, skills and ability to provide appropriate preventative and curative care to their children. However, globally, actual evidence of effectiveness of community-based IMCI interventions implemented at scale is meager.

C-IMCI in Bangladesh will be implemented by GoB in partnership with NGOs and also through active participation of different community groups, civil societies, and the private sector.

Both GoB and UNICEF/Bangladesh have agreed that an evaluation of the C-IMCI implementation by GoB, as proposed here, would be very opportune and useful in providing the evidence and analysis of lessons that will guide further scale-up in the country.

A cluster-randomized design will be used for this evaluation. Fourteen Upazilas where facility-based IMCI is already in place will be selected, and 7 upazillas will be randomly allocated to C-IMCI intervention and 7 to comparison. Community-based IMCI in the intervention upazillas will be implemented by GoB through the district health system while in the comparison upazillas existing services will continue, including facility-based IMCI.