Table 3.

Key findings of the included studies in the scoping review, 2018–2019

THEMES	KEY CHALLENGES	EFFECT ON HCW DELIVERING IMCI PROGRAM
Leadership and Governance	Poor dynamics (lack of planning and coordination between policy makers to HCW implementers) and ineffective decentralization. Other child health programs (such as Expanded Program of Immunization, Tuberculosis, Nutrition and Malaria control) were prioritized and not harmonized to the IMCI program. Donors shifted their interests to ICCM (Integrated community case management program) and neglected the IMCI program. Absence of IMCI institutionalization (i.e. no specific budget allocation) at district and PHC-levels affected its prioritization and rollout.	HCWs had unclear roles and uncertainty on the expected tasks for IMCI program implementation. HCWs had difficulty synchronizing some tasks in PHC-facilities. HCWs lack support to continue the IMCI program. HCWs felt that they were losing time due to administrative burdens and required reports.
Resources for IMCI Implementation	Inadequate supply of essential medicines, IMCI wall charts and booklets, lack of basic equipment and transport for referrals. Shortage of trained HCWs at PHC-facilities. Lack of enabling and supportive health facility structures.	HCWs were dissatisfied with the working conditions because they lacked adequate supplies to do their job. Trained HCWs were burned-out because of too many tasks to perform. HCWs cannot render some vital IMCI services, such as counseling of caretakers.
Training, Mentoring and Supervision	Long duration and high cost of IMCI training, insufficient follow-up after training, and unavailability of refresher courses. Low number of skilled IMCI training facilitators and lack of appropriate training sites. No standard IMCI-specific supervision and lack of motivation of supervisors. Lack of funding for follow-up after training and inadequate job aids.	HCWs needed to leave their workplace in long days, creating problems of lack of personnel to manage the PHC-facilities. HCWs who were not trained on IMCI inhibit scale-up in some LMICs. HCWs compliance to IMCI algorithm was uneven and often led to incorrect classification even after IMCI trainings. HCWs who are meant to do supervision and monitoring cannot perform their duties.
Quality of Care	IMCI child health assessment protocols were not consistent and comprehensive. Length of time needed for IMCI consultations and overall poor working conditions for HCWs	HCWs struggled to understand and consistently implement IMCI leading to misclassification and missed referrals. HCWs often failed to do nutritional assessments such as searching for signs of malnutrition, and providing caretakers with advice on feeding practices was usually omitted.