of Childhood illness
Why is IMCI better than single-condition
• Children are often suffering from more than one condition
• This overlap means that a single diagnosis may not be
possible or appropriate and treatment may be complicated by
the need to combine therapy for several conditions
• An integrated approach to managing sick children is,
therefore, indicated as is the need for child health programs
to go beyond single diseases
“Looking to The Child as a Whole (Health of a child) ”.
Health Delivery System
Health Care Providers
THQ / DHQ: They typically have 40-60 beds and
appropriate support services
including x-ray, laboratory and surgery facilities. The
staff includes at least three
specialists: an obstetrician & gynecologist, a pediatrician
and a general surgeon.
RHC: Pop: 50,000 to 100,000 , 10-20 beds, with
about 30 staff including 2 M.Os, 1 WMO, 1
dental surgeon & a no: of paramedics.
, x-ray, laboratory and minor surgery facilities.
These do not include delivery and emergency
BHUs staff of 10 ( a male doctor, a LHV or a FHT,
a Male Medical Technician or/and a dispenser, a
trained or unqualified midwife (dai), a sanitary
inspector, a vaccinator, and 2-3 support staff
(guard, sweeper, gardener, etc.). They are
required to offer first level curative, MCH, family
planning and preventive services .
Rural Health Centers
DHQ: 1Million to 1.5m
THQ: 100,000 – 300,000
Primary care facilities:
(MCH, BHU, RHC)
Referral level care facilities:
MCH ,Family planning ,
& Curative, prev: services
5,000 – 10,000
Tertiary care facilities:
IMCI Case Management
Need to Refer
Counsel & Follow-up
The strategy includes
1. Improving case management skills of
health-care staff. (Improvement of health worker skills)
2. Improving overall health
3. Improving family and
community health practices
(in relation to child health)
IMCI Component 1: Improves Health Worker
Case management guidelines
Training of health providers (Doctors , Medical Assistants & Nurses)
who look after sick infants and children up
to 5 years (pre-service and in-service)
Follow-up after training
IMNCI HEALTH SYSTEM COMPONENT:
Strengthening health systems is one of the three
key elements of the IMCI strategy to ensure
universal access to services of high quality.
IMCI packages essential interventions and
strengthens service delivery in primary care settings
with a focus on conditions of significant public
IMCI Component 2:
Improves Health Systems
Objectives of field visits to BHU & RHC:
To identify the health services available at the health facility.
A. Health work force.
B. Technologies available at the health facilities.
C. Availability of drugs and supplies.
D. Monitoring & Supervision
E. Health information system.
F. Referral pathways and system.
To identify barriers against coverage for child health
Gaps in capacity of health care delivery.
Inadequate/ ineffective human resources.
Inadequate financial resources to support cost-effective health
programs like IMNCI.
Poor referral system and quality of care.
Inadequate knowledge and practices of caretakers.
What progress may be made in improving health
systems for child health?
• Leadership and governance in key policy areas in
• Health financing system.
• Improving the capacity of the health work force.
• Filling the gap in health care delivery to the needy
IMCI Component 3:
Improves Family and Community Practices
(Household & Community base Component)
To improve the knowledge, attitude and practices of families
--greatest impact on child survival , growth & Development
Objectives For Household Surveys:
To prevent common childhood illness including
malnutrition, injuries and neglect at the household and
To improve the household and community response to
childhood illness and the quality of care provided at home.
To improve appropriate and timely care seeking behaviour
when children need additional assistance outside the home.
To increase compliance to recommended treatment and
advice from trained care providers.
To promote a supportive and enabling environment at the
household and community level for children’s survival,
growth, and development.
Improves Family and Community Practices
Cont. feeding during illness.
Regular growth monitoring.
Early care seeking.
Compliance to provider advice
Home care of sick children
Recognition of severe illness
IMCI Component 3: Improves Family and
Proper waste disposal.
Use of Nets
TT for pregnant ladies.
Proper nutrition for pregnant ladies.
Volunteers were trained on Key Family practices and communication skills
LHWs, Female Health
Technicians (FHTs) and TBAs.
Provides MCH, family
planning services .
Each LHW has established a
“Health House” in her home
and also reaches the doorsteps
of the people to serves as the
first level of health services
for the rural and peri -urban
women and children.
LHWs maintain records for all the
households in their catchment areas
and actively follow up each family
every month, especially the
defaulters for immunization or
dropouts for family planning and to
persuade families to adopt healthier