About Integrated Management of Childhood Illness (IMCI)

Objectives and Goals Components Content Current Situation Regional Accomplishments About the "Healthy Children: Goal 2002" Initiative Projects

Background Integrated Management of Childhood Illness (IMCI) is a strategy formulated by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), presented in 1996 as the principal strategy to improve child health. It focuses on the care of children under five, not only in terms of their overall health status but also on the diseases that may occasionally affect them. Thus, it reduces missed opportunities for early detection and treatment of diseases that can escape the notice of both parents and health workers, with the consequent risk of the illness becoming worse and complications arising. In addition, IMCI incorporates a strong component of prevention and health promotion as an integral part of care. Thus, among other benefits, it helps increase vaccination coverage and improve knowledge and home-care practices for children under five, subsequently contributing to growth and healthy development. IMCI implementation involves the participation of the community, the health-service sector and the family. This is carried out in three ways: 1. Improving the performance of health workers for in the prevention and treatment of childhood diseases. 2. Improving the organization and operation of health services so they provide quality care. 3. Improving family and community care practices. IMCI is a strategy that integrates all available measures for disease prevention and health problems during childhood, for their early detection and effective treatment, and for promoting healthy habits within the family and community. IMCI can be applied by both health workers and other people responsible for the care of boys and girls under five years of age, i.e. their parents and those who care for them. IMCI offers the knowledge and abilities to sequentially evaluate and integrate the status of child health and, in this way, detect the diseases or problems frequently affecting it according to the epidemiological patterns of the respective location. Based

on this evaluation, IMCI gives clear instructions on disease classification and problems, establishing the treatment that should be administered for each one. The strategy also provides instructions on how to control the progress of treatment, in order to identify the need for applying prevention measures as well as how to inform and educate parents on disease prevention and child health promotion. On this basis, IMCI is currently regarded as the most efficient strategy for reducing the burden of disease and disability among the population in this age group. It main goal is to contribute to healthy growth and development during the first five years of life. Objectives and Goals IMCI has three objectives: 1. Reducing infant mortality. 2. Reducing the incidence and seriousness of illnesses and health problems that affect boys and girls. 3. Improving growth and development during the first five years of a child's life. In the Region of the Americas, PAHO has proposed a specific goal for the implementation and strengthening of the IMCI strategy. The Healthy Children: Goal 2002 initiative was launched in 1999 (summary in Spanish). It proposes to reduce the number of deaths of children under five in the American hemisphere by 100,000 during the period 1999-2002. Content In its initial version, the central focus of the IMCI strategy was a basic set of communicable diseases and the nutritional status of children under five. Progressively, however, the strategy has been being expanded and is currently finalizing the preparation of complementary symptoms encompassing the majority of health problems and diseases that affect children under five years of age. Thus, IMCI includes the following: 2 months to 4 years Non-specific signs of serious illness. Cough or difficulty breathing. Diarrhea: o Dehydration. o Persistent diarrhea. 1 week to 2 months Nonspecific Signs of serious disease. Diarrea: o Dehydration. o Persistent diarrhea. o Dysentery. Feeding problems or low

Dysentery. weight.

Fever: Malaria. Measlies. Malnutrition and anemia.

o o

Vaccination status.

Vaccination status.

The following constitute additional areas of relevance during different implementation phases:

Perinatal/neonatal. Asma and broncho-obstructive syndrome. Child development. Oral health. Neglect, child abuse, and accidents. Diabetes and obesity.

Components The implementation of the IMCI strategy has three components: 1. Improving the performance of health workers when tending to children under five and their families (health-worker component). 2. Improving the organization and overall functioning of health-care services so that they offer efficient, good-quality care (health-service component). 3. Improving knowledge on best practices for the care of boys and girls at home and in the community (community component). With regard to improving the performance of health workers, IMCI offers a number of practical tools, including

Modules for the evaluation, classification and treatment of children under five, and training materials on these modules. Guides for health-care workers to provide support in effective IMCI application. Training materials on how to improve communications with parents during their child's evaluation, diagnosis and treatment, telling them how to deal with problems and promoting practices for healthy growth and development.

With regard to improving the organization and overall functioning of health services, IMCI also has made available practical toolkit including

Guidelines for evaluating the care provided to children under five in primary health-care services and in hospitals.

Training materials on how to develop local plans for IMCI implementation, follow-up and evaluation. Training courses to improve the availability of attention and medications needed for IMCI application. Protocols for operational and epidemiological research related to IMCI. Guidelines to evaluation the results of applying IMCI.

With regard to improving knowledge and practices on the part of parents and others who care for children under five, IMCI has made various practical tools available, including

Sixteen key family practices for healthy growth and development. Guide for developing community IMCI projects. Guide on evaluating the care of children under five in primary health-care facilities and hospitals.

Current Situation The Pan American Health Organization estimates that approximately half a million boys and girls die every year before ever having reached their fifth birthday. It is estimated that approximately 27% of these deaths are due to infectious diseases and nutritional disorders, which annually represent more than 150,000 deaths of children under five in the American hemisphere. Among these, respiratory diseasesmainly pneumoniaand diarrheal diseases are the leading causes of mortality. The available information on disease during the first five years of life also shows that infectious diseases and nutritional disorders continue to be the main reason for loss of health. Consequently, these emerge as the main determinants governing boys' and girls' chances for healthy growth and development from birth to the age of five. The majority of infectious diseases that continue to affect child health and are responsible for more than 150,000 annual deaths in the American hemisphere, can be prevented or effectively treated through the application of simple, low-cost interventions. However, thousands of families still do not have access to these interventions or lack the knowledge and skills that would enable them to apply such interventions both at home and within the community. Taking this situation into account, WHO and UNICEF worked together during the early 1990s to design a strategy to integrate all interventions for prevention, treatment and health promotion that might help reduce mortality and morbidity in childhood and promote better conditions for child health and development during the first five years of life: IMCI Integrated Management of Childhood Illness. Regional Accomplishments By the end of 2001, 17 Latin American and Caribbean countries had adopted and

implemented the IMCI strategy for Integrated Management of Childhood Illness. Children in these countries make up 52% of the total hemispheric population under five years of age, and 75% of annual deaths occur among this group. Other countries have also participated in IMCI implementation by contributing care models already in existence, taking part in designing and incorporating new components, and analyzing the contribution that IMCI can make to pre-existing mechanisms that deal with health-care issues affecting children. All the countries adhered to the Healthy Children: Goal 2002 initiative, launched on 1 December 1999. Ten of them launched national and local initiatives of their own to promote institutional and community participation to speed up the decline in mortality through enforcement of the IMCI strategy. All the countries that adopted the IMCI strategy have prepared plans to focus on implementation in specific areas and with the most vulnerable population groups, taking as their basis the levels of infant mortality. Plan implementation has shown notable progress in staff training for health-service workers, enabling them to apply the procedures established by IMCI for the care of children under five. The number of trained staff has increased thanks to regional, national and local training mechanisms, with the result that more than 40,000 people have received training in IMCI application. Projects

With the support of the American Red Cross: Empowering Local Communities to Improve Child Health in Ten Latin American Countries: Technical-Cooperation Project Regional Community IMCI Project: Profiles of Nine Local Projects in Bolivia, Ecuador, and Peru, with the Support of the American Red Cross (in Spanish) With the support of the Catholic Medical Missionary Board: Tapping the UntappedUnleashing the Power of Faith-Based Organizations to Scale Up the Integrated Management of Childhood Illness (IMCI) Strategy in Central America and the Caribbean