63. Integrated Management of the Sick Child


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Gideon Mendel/Corbis

The vast majority of the nearly 11 million deaths annually of children under five are caused by only a few diseases and occur in the poorest families in the poorest countries. Moreover, many of the children who die have overlapping clinical symptoms and suffer from malnutrition. An integrated approach to case management, the Integrated Management of Childhood Illness (IMCI), was heralded in the mid–1990s to address these childhood diseases and to increase the likelihood that a child's nutritional needs would be addressed.

Key aspects of IMCI involved raising health worker performance by combining curative care with preventive measures; improving health systems and delivery mechanisms; and enhancing family and community practices around home treatment and care seeking. In most developing countries, however, these interventions failed to reach or have an effect on those portions of the population in greatest need. Obstacles to successful implementation of the IMCI strategy were attributed to lack of funding, staff turnover, low use of public sector health care, and shortages of drug supplies?constraints common in most health services in low–income countries.

Success or failure of the IMCI strategy is also dependent on community–level intervention. In most developing countries, utilization of appropriate health services is unlikely to be achieved without strong family and household–level interventions. Thus, the challenges facing developing countries are to develop first–level facilities staffed by well–trained health workers, while simultaneously developing the health system capacity and improving outreach to families and communities. Despite the fact that IMCI has only partly lived up to initial expectations, an integrated approach as well as significant investment in communities, facilities, and worker training should continue to characterize child survival strategies in the future. Increasing the coverage of IMCI could result in a more than 60 percent reduction in child mortality and help countries to make progress on the child mortality Millennium Development Goal.