Integrated Management of Childhood Illness (IMCI)

Rajat Das Gupta

Every day, millions of parents seek health care for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers. Surveys reveal that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised. At first-level health facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave doctors at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources

These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI).
 

What is IMCI?

IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
The strategy includes three main components:

• Improving case management skills of health-care staff
• Improving overall health systems
• Improving family and community health practices.

In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers, and speeds up the referral of severely ill children. In the home setting, it promotes appropriate care seeking behaviours, improved nutrition and preventative care, and the correct implementation of prescribed care.

Why is IMCI better than single-condition approaches?

Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible. IMCI is an integrated strategy, which takes into account the variety of factors that put children at serious risk. It ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition.

How is IMCI implemented?

Introducing and implementing the IMCI strategy in a country is a phased process that requires a great deal of coordination among existing health programmes and services. It involves working closely with local governments and ministries of health to plan and adapt the principles of the approach to local circumstances. The main steps are:

• Adopting an integrated approach to child health and development in the national health policy.
• Adapting the standard IMCI clinical guidelines to the country’s needs, available drugs, policies, and to the local foods and language used by the population.
• Upgrading care in local clinics by training health workers in new methods to examine and treat children, and to effectively counsel parents.
• Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available.
• Strengthening care in hospitals for those children too sick to be treated in an outpatient clinic.
• Developing support mechanisms within communities for preventing disease, for helping families to care for sick children, and for getting children to clinics or hospitals when needed.

IMCI has already been introduced in more than 75 countries around the world.

What has been done to evaluate the IMCI strategy?

CAH has undertaken a Multi-Country Evaluation (MCE) to evaluate the impact, cost and effectiveness of the IMCI strategy. The results of the MCE support planning and advocacy for child health interventions by ministries of health in developing countries, and by national and international partners in development. To date, MCE has been conducted in Brazil, Bangladesh, Peru, Uganda and the United Republic of Tanzania.
The results of the MCE indicate that:

• IMCI improves health worker performance and their quality of care;
• IMCI can reduce under-five mortality and improve nutritional status, if implemented well;
• IMCI is worth the investment, as it costs up to six times less per child correctly managed than current care;
• child survival programmes require more attention to activities that improve family and community behaviour;
• the implementation of child survival interventions needs to be complemented by activities that strengthen system support;
• a significant reduction in under-five mortality will not be attained unless large-scale intervention coverage is achieved.