Integrated management of childhood illness: a summary of first experiences

Abstract

The strategy of Integrated Management of Childhood Illness (IMCI) aims to reduce child mortality and morbidity in developing countries by combining improved management of common childhood illnesses with proper nutrition and immunization. The strategy includes interventions to improve the skills of health workers, the health system, and family and community practices. This article describes the experience of the first countries to adopt and implement the IMCI interventions, the clinical guidelines dealing with the major causes of morbidity and mortality in children, and the training package on these guidelines for health workers in first-level health facilities. The most relevant lessons learned and how these lessons have served as a basis for developing a broader IMCI strategy are described.

PIP: This article delineates the experience of the first countries to adopt and implement the Integrated Management of Childhood Illness (IMCI) strategy in reducing child mortality and morbidity through the combination of improved management of common childhood illnesses and proper nutrition and immunization. The strategy includes intervention schemes involving improving the skills of health workers, the health systems, and the family and community practices. IMCI implementation proceeds in three phases. The first phase involves activities for the introduction of IMCI, in which clinical guidelines involving the review of child health policies and reorganization of services and interventions are discussed. The second phase is the initial implementation, in which each country adapts the generic IMCI clinical guidelines to suit its own epidemiological and cultural characteristics and begins implementing them in a limited number of districts. The third phase involves expanding of IMCI through increasing access to its programs and broadening the range of its interventions. In this phase, problems identified during the early implementation are addressed, priorities are identified, and strategies for expanding access while maintaining quality are developed. The introduction of the IMCI strategy helped develop and update national policies in the management of sick children. The implementation of IMCI brings together a broader range of programs and national medical expertise relating to child health. The program serves as a catalyst for the identification of substantial weaknesses in public health systems.