Integrated management of childhood illness

What is Integrated Management of Childhood Illness (IMCI)?

IMCI is an integrated approach that focuses on the health and well-being of the child. IMCI aims to reduce preventable mortality, minimize illness and disability, and promote healthy growth and development of children under five years of age. IMCI includes both preventive and curative elements that can be implemented by families, in communities and in health facilities.

The strategy includes three main components:

• Improving case management skills of healthcare providers;
• Improving health systems to provide quality care;
• Improving family and community health practices for health, growth and development.

In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major conditions that affect a young child, strengthens the counselling of caretakers, and speeds up the referral of severely ill newborns and children. In the home setting, it promotes appropriate care seeking behaviours, improved nutrition and support for early childhood development, prevention of illness, and correct implementation and adherence to treatment.

Why is IMCI better than single-condition approaches?

IMCI considers each child that is brought to a health service in a holistic way. The clinical algorithms take into account the variety of conditions that may affect a newborn or child and put them at risk of preventable mortality or impaired growth and development. By facilitating an integrated assessment and combined treatment of conditions, IMCI focuses on effective case management and prevention of disease, and contributes to healthy growth and development, including through immunization and nutritional and developmental counselling.

What are the key requirements for IMCI implementation?

Implementation of the IMCI strategy requires a great deal of coordination among health programmes and services at national and sub-national (or district) levels. It involves working closely with and within ministries of health, local governments, and communities to plan for implementation based on the local context. Examples of key requirements are:

• The adoption of a national policy and standards on an integrated approach to child health and development.
• Regular review and updating of IMCI clinical guidelines with adaptation to the country’s epidemiology, medicines and commodities, relevant policies, and local foods and language used by the population.
• Improving quality of care in primary health facilities by training, mentoring and support supervision of health workers in integrated assessment, treatment and effective counseling of caregivers.
• Ensuring availability of the essential medicines, laboratory tests and key equipment for prevention and case management.
• Strengthening referral pathways and improving quality of care in hospitals for management of severely ill children referred from the outpatient clinics.
• Empowering families and communities to prevent disease, seek timely care from qualified health care providers for illness, provide adequate home care for sick children, and support children’s healthy growth and development. 

What has been the impact of IMCI?

Since the introduction of IMCI in the mid 1990’s, over 100 countries have adopted and implemented the strategy, either in part or all of its three components. Evidence suggests that if fully implemented, IMCI contributes to reduction in child mortality. A Cochrane review by Gera et al in 2016 found that the strategy was associated with a 15% reduction in child mortality when activities were implemented at scale in health facilities and communities.

Over the years, programme reviews have shown that IMCI implementation is influenced by different political, epidemiological, and social contexts. Three major determinants of effective implementation coverage are:

• political leadership to ensure an enabling environment;
• strengthened health systems based on empowered, recognized, motivated, supplied, and supported frontline health workers; and
• empowered communities that can hold systems accountable and utilize IMCI services.

To achieve the Sustainable Development Goal target 3.2 of reducing child mortality to at least 25 or less deaths per 1000 live birth by 2030, it is paramount that key components of IMCI are implemented at scale, especially in countries with a high burden of preventable childhood mortality.

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