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Jennifer Bryce, EdD, Cesar G. Victora, MD, PhD, Jean-Pierre Habicht, MD, J. Patrick Vaughan, MD and Robert E. Black, MD

At the time this article was written, Jennifer Bryce was with the Department of Child and Adolescent Health and Development of the World Health Organization, Geneva, Switzerland. Cesar G. Victora is with the Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. Jean-Pierre Habicht is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. J. Patrick Vaughan is with the London School of Hygiene and Tropical Medicine, London, England. Robert E. Black is with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

Correspondence: Requests for reprints should be sent to Jennifer Bryce, EdD, 2081 Danby Rd, Ithaca, NY 14850 (e-mail: jbrycedanby{at}aol.com).

The Multi-Country Evaluation of the Integrated Management of Childhood Illness (IMCI) includes studies of the effectiveness, cost, and impact of the IMCI strategy in Bangladesh, Brazil, Peru, Tanzania, and Uganda.

Seven questions were addressed when the evaluation was designed: who would be in charge, through what mechanisms IMCI could affect child health, whether the focus would be efficacy or effectiveness, what indicators would be measured, what types of inference would be made, how costs would be incorporated, and what elements would constitute the plan of analysis.

We describe how these questions were answered, the challenges encountered in implementing the evaluation, and the 5 study designs. The methodological insights gained can improve future evaluations of public health programs.

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