Academic journal article Bulletin of the World Health Organization

Integrated Management of Childhood Illness: A Summary of First Experiences

Academic journal article Bulletin of the World Health Organization

Integrated Management of Childhood Illness: A Summary of First Experiences

Article excerpt

Voir page 592 le resume en francais. En la pagina 593 figura un resumen en espanol.

Introduction

The strategy of Integrated Management of Childhood Illness (IMCI) is aimed at reducing child mortality and morbidity in developing countries. It combines improved management of common childhood illnesses (e.g. pneumonia, diarrhoea, malaria, measles, ear problems, and anaemia) with proper nutrition and immunization. In 1995, guidelines for the integrated management of childhood illnesses at first-level facilities(a) were finalized in a collaborative effort, which was led by WHO and supported by a programme of research (1). WHO and UNICEF promoted a training course based on these guidelines in 1996, which was targeted at health workers in first-level facilities (2), and issued a joint statement on IMCI in July 1997 (3).

Following this training effort, a broad strategy was developed to encompass both preventive and curative interventions for promoting child health and development. The three components of these interventions were as follows:

- improving the skills of health workers;

- improving the health system to support IMCI; and

- improving family and community practices.

IMCI implementation in a country proceeds in three phases. In the first phase are activities for the introduction of IMCI, which leads to a decision by the ministry of health on whether to move forward with further preparations and planning. The second phase is for early implementation, in which each country adapts the generic IMCI clinical guidelines to its own epidemiological and cultural characteristics and begins implementation in a limited number of areas (e.g. districts). This experience is carefully documented and analysed. The third phase, which is focused on expansion, draws on the experience gained during early implementation to introduce a broad range of IMCI activities and increase access to them. Fig. 1 shows the countries engaged in IMCI and their phase of implementation (as of December 1998).

[Figure 1 ILLUSTRATION OMITTED]

This article, which draws on information from a number of sources, describes the experiences of several countries in implementing IMCI as well as WHO's recommendations that evolved from these experiences. WHO has documented the process of IMCI implementation in six countries -- Indonesia, Nepal, Peru, Philippines, Uganda, and the United Republic of Tanzania (4). This involved completing detailed forms by WHO staff and consultants together with country personnel, in collaboration with UNICEF and other partners, which were used as the basis for interviews and document reviews. The results and preliminary conclusions reported here have been reviewed by WHO staff at all levels, as well as with country personnel implementing IMCI, to ensure that they are complete and correct. The experiences of additional countries are included where possible, drawing on reports from the staff in the ministry of health and other institutions implementing IMCI, and on presentations made at the First Global Review and Coordination Meeting on Integrated Management of Childhood Illness (5).

This retrospective summary attempts to give an accurate report based on what was learned and the changes effected during the early period of IMCI implementation covered by this documentation effort (1995-97). When the first plans for implementation at country level were made 4 years ago (1995), it was not possible to anticipate the changes that would be made to the strategy as a result of what was learned during IMCI's progressive implementation in the countries and regular reviews by ministries of health. For example, the third component in the strategy (improving family and community practices) has recently been defined more clearly in terms of focus and approaches, but -- despite ongoing programmes in most countries -- there is very limited experience about how best to coordinate these activities within a broader IMCI strategy. …

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