The Implementation of Integrated Management of Childhood Illness ...

5. Discussion
The results of this study show that half of all attendees to the five health facilities
in the Monkey Bay health zone were children. The largest number of patients fell
within the 1-4 year age group. Around 84% of all classifications in under-fives are
directly dealt with in the IMCI guidelines indicating that the IMCI approach is
appropriate in these settings. The most common classification is malaria, which was
given to over half of attending under-fives. Respiratory tract infections accounted for
roughly a third of all classifications and diarrhoea was 5%. The drug inventories
revealed that IMCI-recommended oral drugs were mostly available while
intramuscular antibiotics were often out of stock.
a. Health Facility Attendancee
The total attendance to the five health facilities during the research period was
just less than nine thousand patients. Since patients were only recorded in the
Outpatient Registers during office hours, this is an underestimate of the total
number of attendees.
In 1987 the World Bank adverted the introduction of user fees for health care in
developing countries with the aim of improving efficiency, increase coverage and
quality and reduce frivolous demands in the health care system (52). On the
contrary, numerous studies have shown that user fees are not an efficient means of
raising revenues for the health care system, they have a much more devestating
impact on the poor than the rich, they do not improve the quality or coverage of
health care and they prolong the time which passes from the onset of disease until
health care is sought (52). In areas where user fees have been introduced, attendance
to health care facilities has decreased 30-50% (53, 54). Therefore, it was interesting to
examine whether there was a relative difference in attendance between CHAM
facilities, that charge user fees for their services, and the government facilities that
offer care free of charge. The results from outpatient departments in the Monkey Bay
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