WHAT IS IMCI? IMCI is an integrated approach to child health that focuses on the well-being of the whole child.

IMCI aims to reduce death, illness and disability and to promote improved growth and development among children under five years of age. IMCI include curative and preventive elements that are implemented by families and communities and by health facilities. Development of a strategy of Integrated Management of Childhood Illness (IMCI) was started by WHO and UNICEF in 1992. Its main objective was reduction of the mortality and morbidity associated with the major causes of childhood illness. Every year, about 10 million children die before reaching their fifth birthday. Over 70% of these deaths, the vast majority occurring in the developing world are due to acute respiratory infections, diarrheal diseases, malaria, measles and malnutrition, often in combination. It was decided to initially focus on improving care at the first level health facilities where millions of children arrive sick each day, most of them with one or more of the major causes of illness and death.

OBJECTIVES OF IMCI Name of Office: FHO, NCDPC y Reduce death and frequency and severity of illness and disability y Contribute to improved growth and development

WHAT ARE THE FOCUS OF IMCI? Name of Office: FHO, NCDPC y Improving case management skills of health workers y Improving over-all health systems y Improving family and community health practices

WHAT ARE THE STEPS IN THE IMCI CASE MANAGEMENT PROCESS? Name of Office: FHO, NCDPC 1. ASSESS a child by checking first for danger signs (or possible bacterial infection in a young infant), asking questions about common conditions, examining the child, and checking nutrition and immunization status. Assessment includes checking the child for other health problems.

2. CLASSIFY a childs illnesses using a color-coded triage system. Because many children have more than one condition, each illness is classified according to whether it requires: urgent pre-referral treatment and referral (red), or specific medical treatment and advice (yellow), or - simple advice on home management (green) 3. IDENTIFY specific treatments for the child. If a child requires urgent referral, give essential treatment before the patient is transferred. If a child needs treatment at home, develop an integrated treatment plan for the child and give the first dose of drugs in the clinic. If a child should be immunized, give immunizations. 4. Provide practical TREATMENT instructions, including teaching the caretaker how to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at home. Ask the caretaker to return for follow-up on a specific date, and teach her how to recognize signs that indicate the child should return immediately to the health facility. 5. Assess feeding, including assessment of breastfeeding practices, and COUNSEL to solve any feeding problems found. Then counsel the mother about her own health. 6. When a child is brought back to the clinic as requested, GIVE FOLLOW-UP CARE and, if necessary, reassess the child for new problems.

WHAT IS THE BASIS FOR CLASSIFYING THE CHILDS ILLNESS? Name of Office: FHO, NCDPC The childs illness is classified based on a color-coded triage system: PINK - indicates urgent hospital referral or admission YELLOW - indicates initiation of specific outpatient treatment GREEN - indicates supportive home care

WHAT IS THE EXTENT OF IMCI IMPLEMENTATION? Name of Office: FHO, NCDPC IMCI is implemented in 70% of all health facilities nationwide. IMCI is also integrated in the Nursing, Midwifery and Medical Pre- Service Education. The attached lists/addresses of DOH Centers for Development (CHDs) in 17 regions can provide technical assistance in IMCI training. The lists also include the Nursing and Midwifery Schools designated as Training Institution for IMCI Pre-Service.

WHY AN INTEGRATED APPROACH? Name of Office: FHO, NCDPC Ten million children die each year and majority of these deaths are caused by 5 preventable and treatable conditions namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood illness are caused by these five conditions Most children have more than one illness at one time. This overlap means that a single diagnosis may not be possible or appropriate.

PRINCIPLES OF THE IMCI CASE MANAGEMENT GUIDELINES Name of Office: FHO, NCDPC y All sick children aged up to 5 years are examined for general danger signs and all sick young infants are examined for very severe disease. These signs indicate immediate referral or admission to hospital y The children and infants are then assessed for main symptoms. For older children, the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For young children, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional and immunization and deworming status and other problems y Only a limited number of clinical signs are used y A combination of individual signs leads to a childs classification within one or more symptom groups rather than a diagnosis. y IMCI management procedures use limited number of essential drugs and encourage active participation of caretakers in the treatment of children y Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI

WHAT ARE THE BENEFITS OF THE IMCI STRATEGY? Name of Office: FHO, NCDPC 1. Addresses major child health problems because it systematically address the most important causes of children illness and death 2. Responds to demands 3. Promotes prevention as well as cure because IMCI emphasizes important preventive interventions such as immunization and breastfeeding 4. Is cost-effective- most cost-effective interventions in low and middle income countries (World Bank)

5. Promotes cost-saving 6. Improves equity IMCI improves inequity in global health care