| Integrated Management of Childhood Illness
Integrated Management of Childhood Illness (IMCI) was launched globally by WHO and UNICEF in 1995 in order to reduce childhood mortality and morbidity. An integrated approach, IMCI, focuses on improving the well-being of the whole child and includes both preventive and curative elements at the family, community and health facility levels.
Integrated: The ultimate goal of IMCI is for children under-five to receive holistic, quality care at all levels. Integration is designed to occur across:
- Curative, preventive and development aspects of child care;
- Vertical health programs involving different managers and experts at the country level in implementation committees;
- Disease areas, addressing the main causes of child mortality in one standardized, integrated training package; and
- Locations of health care service, providing for a continuum of care between the formal health system and the home.
Management: Management has both a clinical and public health meaning. The IMCI clinical management focuses on signs and symptoms as the entry point, with cases being "classified" into defined categories of severity based on the presence or absence of a few key signs and symptoms. The classifications enable the primary health care provider to select a management plan rather than make a precise diagnosis, which would often be impossible at the community or peripheral health facility level. Thus, a sick child is "classified" into one of three main categories, highlighted with a color code: Red indicates severe conditions which need urgent referral to an inpatient facility; Yellow indicates situations that can be managed at the health center or community level - often with drugs - but that require definite follow-up; and Green indicates mild conditions which require simple home care. Apart from the clinical management of sick children, many things have to be in place to deliver child care, both in the health system and in the community; these aspects of health care represent the public health meaning of management.
Childhood: IMCI focuses on children under five years of age in order to target those most at risk for illness and death and those with whom a few, life-saving interventions can have the greatest reward in terms of health gains. Originally, the first week of life was excluded from IMCI, but neonates are now being integrated into the IMCI algorithms and this critical age group is being included in community and facility-based interventions for IMCI.
Illness: IMCI focuses on the primary causes of death in children under five: malaria, malnutrition, measles, diarrhea, and pneumonia. Efforts are currently underway to incorporate neonatal health and pediatric AIDS. Some countries and regions have added other high mortality issues based on their national data (ex. Chagas, injuries). IMCI does not seek to cover all areas of pediatric illness, but uses public health priorities to focus on the primary causes of morbidity and mortality. Additionally, and often lost in the acronym, IMCI is not solely focused on the sick child, but includes prevention and promotion in addition to curative care.
- Adapted from the WHO/EMRO website
The IMCI strategy has three components:
1. Improving the skills of health workers - Health worker training is carried out through in-service trainings to the public and private sectors and pre-service trainings in schools of nursing and medicine. The cornerstone of this component is a set of algorithms (flow charts) and guidelines for the integrated care of children presenting with diarrhea, pneumonia, fever, malaria, and/or malnutrition. Color-coded charts classify the condition of the child and direct the health care worker to treatment, urgent referrals to higher level services where needed, and advice and guidance to be given to parents. The charts ensure that danger signs for any of the critical diseases are spotted and the child receives the correct combination of care. The generic algorithms provided by WHO are adapted by each country to reflect local disease prevalence and drug policies. The standard training for health workers is an 11-day course. Several shorter trainings have been developed in tested in different countries.
2. Improving health systems - In addition to improving health worker skills, IMCI focuses on strengthening the health system. This includes ensuring effective drug supply, supervisory systems, health care financing, health information systems, referral, policy, planning, human resource management, and monitoring and evaluation.
3. Improving household and community health practices (also known as Community-IMCI) - IMCI places the individual child and his or her needs at the center of attention and emphasizes that key factors in the child's immediate environment are as important as medical treatment in improving health. C-IMCI focuses on 16 key family practices necessary for the survival and optimal growth of the child. Critical to improving child health are interventions at the family and community level to prevent illness, provide home-based treatment, access health providers when necessary, and promote physical growth and mental development. This involves improving partnerships between health facilities and communities, increasing appropriate and accessible health care and information from community-based providers, integrating promotion of key family practices critical for child health and nutrition, and linking health efforts to those of other sectors such as agriculture and education. Community IMCI may also be referred to as Community Approaches to Child Health. Click here to learn more about Community-IMCI.
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