Integrated Management of Childhood Illness (IMCI) Implementation in the Western Pacific Region
Child deaths remain unacceptably high. In 2009, around 527 000 children in the Western Pacific Region died before their fifth birthday from preventable and treatable diseases. Of these deaths, 97% occurred in six countries, namely, Cambodia, China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam. At least 65% of all child deaths in the Region are caused by neonatal causes, pneumonia, diarrhoea and measles. Undernutrition is a contributor to a high proportion of deaths. An increasing proportion of deaths in children under-five occur in the neonatal period and are due to infections (such as sepsis, respiratory infections, diarrhoeal disease and tetanus), complications of pregnancy and childbirth (birth asphyxia and prematurity) and congenital anomalies. In the six countries with the highest mortality in the Region, the proportion of all child deaths that occur in the neonatal period ranges from 28% to 50%.
The Integrated Management of Childhood Illness (IMCI) strategy was first introduced in the Western Pacific Region in the mid 1990s. It became a key approach for delivering interventions that prevent and treat the most common causes of mortality in children, and is a central element of the WHO/UNICEF Regional Child Survival Strategy. By 2009, IMCI had been implemented in 14 countries in the Region.
IMCI has been demonstrated to improve the efficiency and quality of child health services and to reduce child mortality. It recognizes that children often have more than one problem at the same time and that undernutrition is a factor in many child deaths. All need to be addressed in order to maximize impact on mortality. The strategy includes standard case management guidelines to improve the skills of health workers, as well as approaches for improving family and community health practices, and for strengthening health systems.
Implementing IMCI requires that a number of elements of child health programmes are addressed, including planning and policy development, financing, health systems, skilled human resources at all levels of care, health promotion and behavior change, and community-based care. For this reason, IMCI has resulted in better integration of child health programming both within ministries of health, and between ministries of health, donors and other partners. Importantly, the IMCI strategy has been responsive to changes in available data and field research, and has been flexible enough to allow case management guidelines, and approaches to implementation, to be updated as new data become available.
This IMCI Information Package describes progress with IMCI in the Western Pacific Region through the end of 2009. The current status of implementation as well as lessons learnt and remaining challenges are presented. The package consists of eight parts, each describing a different element of the IMCI strategy. It is hoped that this information is useful to all those who are beginning or further expanding IMCI.
Shin Young-soo, MD, Ph.D
WHO Regional Director for the Western Pacific
1 - IMCI and child survival
2 - Status of IMCI implementation in the Western Pacific Region
3 - IMCI training course for first-level health workers (In-service training)
4 - IMCI pre-service education for health workers
5 - Community IMCI
6 - IMCI at the referral level: "Hospital IMCI"
7 - IMCI and health systems strengthening
8 - IMCI monitoring and evaluation