Why was Integrated Management of Childhood Illness (IMCI) created?

Why IMCI Was Created

IMCI was created to reduce childhood mortality and morbidity in developing countries by systematically addressing the five major causes of death in children under 5 years—pneumonia, diarrhea, malaria, measles, and malnutrition—which together account for 70% of deaths in resource-poor settings. 1, 2

The Core Problem IMCI Addresses

• More than 7.5 million children younger than age five in low- and middle-income countries were dying annually when IMCI was developed, with pneumonia alone causing approximately one-fifth of all deaths in this age group. 1, 3

• The strategy emerged from successful experiences with individual interventions like immunization, oral rehydration therapy, acute respiratory infection management, and improved infant feeding, but these were operating as separate "vertical" programs that wasted resources and duplicated efforts. 4

Strategic Design for Resource-Limited Settings

IMCI was specifically designed for first-level health facilities in low-resource settings where doctors, nurses, and nonphysician clinicians work with limited diagnostic capacity. 1

• The WHO developed standardized clinical algorithms using simple signs (like tachypnea and chest indrawing) that non-specialist providers could reliably assess without laboratory tests or radiography. 2

• The strategy prioritizes high sensitivity over specificity to avoid missing life-threatening cases and enable rapid empirical treatment in settings where diagnostic delays could be fatal. 2

Three-Pillar Approach

IMCI was built on three essential components working together: 4, 5

1. Improving case management skills of health personnel through standardized training
2. Strengthening health systems including drug supply, supervision, and referral capacity
3. Improving family and community practices through counseling and home-based care

Proven Impact

• IMCI implementation over two decades has contributed to global child pneumonia mortality reductions exceeding 30%. 1, 2

• A meta-analysis of nine community trials demonstrated a 42% reduction in pneumonia mortality (95% CI 22-57%) in children under 1 month, and 36% reductions in older age groups. 2

Replacing Fragmented Programs

IMCI consolidates or complements separate disease control programs, creating a scientifically sound link between community-level management and referral center care while reducing resource wastage. 2, 4

• The strategy provides integrated treatment and prevention for multiple conditions simultaneously, rather than addressing each illness in isolation. 4, 6

• It creates practical algorithms for situations when referral is impossible, offering the best possible options in resource-constrained circumstances. 4

Beyond Treatment Alone

IMCI extends beyond illness management to include critical preventive interventions: 4

• Immunization delivery
• Nutritional counseling and improved infant feeding practices including breastfeeding
• Early home care and appropriate care-seeking behavior
• Correct implementation of prescribed home treatments

By 2002, IMCI had been introduced in more than 80 countries, with 19 having scaled up implementation nationally, fundamentally reshaping how child health services are delivered in resource-limited settings. 4