Declared as one of the Millennium Development Goals, the goal to reduce the under-five mortality rate by two thirds continues to be a high priority for the development community. The progress, however, has been slow in many regions, such as Sub-Saharan Africa where the civil disturbances and the HIV/AIDS epidemic have driven up rates of infant and child mortality in several countries.
Integrated Management of Child Illnesses (IMCI)
Five common illnesses are responsible for the majority of child deaths in developing countries: diarrhea, acute respiratory infections, malaria, measles, and malnutrition or a combination of them. While these conditions would be easily prevented and treated in developed countries, they are often fatal in the developing world. The Integrated Management of Child Illnesses (IMCI) strategy, developed in 1995 by the World Health Organization (WHO) in cooperation with the United Nations Children's Fund (UNICEF), aims at adopting an integrated approach to child health and development of national health policies, focusing on the improvement of health-care staff's case management skills, the overall health system, and family and community health practices.
Importance of Nutrition
Nutrition is equally critical for child health and survival. According to the WHO, the proportion of children under five in the developing world who are malnourished to the point of stunting fell from 39% in 1990 to 30% in 2000. And the UN's Food and Agriculture Organization (FAO) estimates that 17% of people in the developing world were undernourished in 1999-2001, a slight drop from 18% in the mid-1990s. The absolute number of undernourished people, however, rose slightly over that period from 780 to 798 Million. Moreover, inadequate nutrition of mother and child accounts for 9.5% of the global burden of disease.
IMCI in World Bank Policies
IMCI includes preventive and curative interventions, such as improved infant and child nutrition, breastfeeding promotion, immunization, and use of bed nets in areas with malaria. It responds to the needs of caretakers and seeks to improve their satisfaction with child health services. IMCI has three main components:
- To improve family and community practices related to child health and nutrition;
- To strengthen the health system for effective management of childhood illness; and
- To improve health workers' skills.
The IMCI has also been proven to be one of the most cost effective ways to prevent childhood illness. In other words, it is one of the “best buys” in public health for developing countries.
IMCI in World Bank Operations
While some aspects of IMCI have been supported by several Bank projects over the past decade, many of them are pilot efforts, and there is considerable room for scaling up. There is the ample evidence of its cost-effectiveness in reducing child mortality. In Brazil, after receiving IMCI nutrition counseling, mothers were able to recall feeding recommendations and modified their feeding practices. As a result, their children had significantly improved their nutritional status than control groups. In Tanzania, in districts where IMCI is in place, health worker performance has improved, and caretakers are more satisfied with the care that their children received.
Issues for Scaling Up
A recent multi-country evaluation of IMCI suggests that:
- IMCI training for health workers managing children in first-level health facilities can lead to rapid and sustained improvement in health workers' performance.
- Ministries of Health and their partners find it difficult to maintain and expand training coverage beyond a few pilot districts.
- Scaling up IMCI to national scale will require i) stronger management structures at central and district levels; ii) increased funding; iii) coordination with other child health programs and elimination of conflicting regulations; and iv) improvement of supervision at the health-facility level and reduction of staff turnover rates.
- Implementation of IMCI at the household and community levels is essential for improving care-seeking practices health services utilization.