administered time sheet was completed by staff members. The exit poll collected information on socio-economic characteristics, reason for visit, services received, travel time, payments, perceptions, etc. More detailed data were collected from randomly selected households, covering both socioeconomic and demographic characteristics, health, and health care seeking behavior. A second round of data collection is planned, but has been delayed due to slower than expected implementation of decentralization.

## _Source_

Angeles, G., J. F. Stewart, R. Gaete, D. Mancini, A. Trujillo, and C. I. Fowler. 1999. "Health Care Decentralization in Paraguay: Evaluation of Impact on Cost, Efficiency, Basic Quality, and Equity. Baseline Report." MEASURE Evaluation Technical Report Series No. 4. Carolina Population Center, University of North Carolina at Chapel Hill.

# _WHO Multi-Country Evaluation of IMCI_

There is a considerable history of facility surveys in the WHO. Originally, health facility instruments focused on issues relating to child mortality and morbidity, and survey instruments were often disease specific (i.e., designed to evaluate specific programs or projects), e.g., ARI (acute respiratory infection), diarrhea. The principal interest lay in assessing quality (typically process focused assessment, though also measurement of input/structure - e.g., drug availability, staffing), and effect of quality on household behavior and health outcomes. Hence facility surveys were typically accompanied by exit polls and/or household surveys (coverage surveys).

Recently, integrated surveys have been designed and implemented. An important element of this work is carried out in the context of multi-country evaluations (MCE) of the Integrated Management of Childhood Illnesses (IMCI), and is implemented by different institutions (John Hopkins, CDC, etc.), under coordination by WHO. 73 Integrated instruments for costs and quality have been developed and implemented (or are being implemented) in Bangladesh, Tanzania, and Uganda. The purpose of the MCEs is to (i) document the effects of IMCI interventions on health workers performance, health systems and family behaviors; (ii) determine whether and to what extent, the IMCI strategy as a whole has a measurable impact on health outcomes (reducing under five morbidity and mortality); (iii) describe the cost of IMCI implementation at national, district and health facility levels; (iv) increase the sustainability of IMCI and other child health strategies by providing a basis for the improvement of implementation; and (v) support planning and advocacy for childhood interventions by ministries of health in developing countries and national and international partners in development. Worldwide there are 30 countries at different stages of implementation of IMCI among which Uganda, Peru, Bangladesh and Tanzania will participate in the MCE.

## _Source_

> 73 The Integrated Management of Childhood Illnesses (IMCI) Strategy was developed by WHO and UNICEF to address five leading causes of childhood mortality, namely: malaria, pneumonia, diarrhea, measles and malnutrition. The three main components addressed by the strategy are: improved case management, improved health systems and improved family and comrnunity practices.

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