Background: Uganda adopted the Integrated Management of Childhood Illness (IMCI) Strategy in 1995 as one of the key strategies for reducing mortality and morbidity in children less than five years of age, however, IMCI faced various challenges including high costs. To address the challenges, the Ministry of Health of Uganda undertook a decision to explore two alternative IMCI distance learning models between 2017 and 2018. To assess the process, outcomes and cost of two alternative IMCI distance-learning models i.e., the WHO generic Distance Learning (DL) and Short, Interrupted Course (SIC), an evaluation was undertaken in order to guide the roll out of IMCI training. This paper describes the results of the evaluation of the implementation research.

Methods: We used multiple approaches: (i) Desk Review (ii) Key Informant Interviews and Focus Group Discussions (iii) Observation of case management and health facility support for both DL and SIC models. We conducted a desk review which included extracting data on cost of training, as well as data on health care provider knowledge before, during and at the end of the course and 18 months later. Direct observations of health care providers (HCPs) managing sick children were conducted 18 months after the courses to determine knowledge retention. We compared performance of HCP trained using these alternative approaches with the performance of HCP using the standard 11-day IMCI course in Tanzania.

Results: Both DL and SIC were implemented in 2 districts each and had high and similar skills retention 18 months later. The average skills score changed from 74% to 71% (p=0.6545) in DL and from 72% to 73% (p=0.8841) in SIC at 18 months after initial training. After adjusting for gender and professional cadre, participants in SIC had a 0.44 %: 95% CI (-8.0,8.9) higher score compared to DL participants, but this was not statistically significant. The programmatic and government cost of training per HCP was cheaper by 40% for DL compared to SIC across all levels of health care delivery.

Conclusion: DL and SIC were successfully used to build skills and knowledge of HCPs at the end of the course and participants showed significant knowledge retention 18 months later. These two models could be harnessed in scaling up IMCI training for all cadres of HCPs in the country.