The Integrated Management of Neonatal and Childhood Illness (IMNCI) is a comprehensive strategy developed by WHO and UNICEF to address the major causes of illness and mortality in children under five. By integrating preventive and curative measures, IMNCI aims to reduce child mortality and improve overall child health. The approach includes systematic assessment, classification, and management of common childhood illnesses, training healthcare workers, strengthening health systems, and engaging communities in child health care. IMNCI emphasizes the importance of holistic, evidence-based interventions to ensure effective and sustainable improvements in child health outcomes.

1. IMNCI APPROACH

3. Inadequacies in Health system – For Pediatric Rx
Health worker skills:
◦ Incomplete examinations and counselling.
◦ Poor communication between health workers and parents.
◦ Irrational use of drugs.
Health system issues:
- Access to health services is difficult
- Non availability of appropriate drugs and vaccines
Community and family practices:
◦ Delayed care seeking
◦ Poor knowledge of when to return to a health facility
◦ Seeking assistance from unqualified providers
◦ Poor adherence to health worker advice and treatment

4. Integrated Management of Childhood Illness (IMCI)
World Health Organization (WHO), UNICEF & other International Partner came
out with a new strategy Known as Integrated Management of Childhood Illness
(IMCI) in 1995.
The strategy emphasises on integrated approach for treating the sick children.
Emphasizes on improving the family and community practices as well as care
provided by the health system for better care of child.

5. Components of IMCI:
The IMCI strategy includes three important components :
 Integrated management of childhood illness.
 Health system strengthening.
Community IMCI or promotion of key family and community practices
IMCI strategy are most effective when all three component are implemented
simultaneously.

6. Why Integrated Approach?
Five conditions : Pneumonia, Diarrhoea, Measles, Malaria and Malnutrition are major
cause of Death.
3 out of 4 children seeking health care in developing countries suffers from one of these
condition.
Children likely to be suffering from more than one condition.
 Often combination of these conditions leads to fatal result.
Such children often need combined therapy for successful treatment.

7. Advantages of Integrated Approach
Speeds up the urgent treatment and treatment seeking practices.
Prompt recognition of serious condition, hence prompt referral.
Involves parents in effective care of baby at home.
Involves prevention of diseases by active immunization, Improved nutrition and
Exclusive Breastfeeding practices.
Highly cost effective.
It avoids wastages of resources by using most appropriate medicines and
treatment.

8. IMCI Process:
Source: IMCI; Student’s Handbook, WHO

9. IMCI case management at first level health facility, referral level, and home

10. Difference between IMCI and IMNCI
Features: WHO – UNICEF IMCI IMNCI
Coverage of 0 to 6 days
(early newborn period)
No Yes
Basic Health Care Module NO Yes
Home visit by the provider
for newborn and Young
Infant
No Yes
Training
Training Home based Care No Yes
Training days for newborn
and young infants
2 out of 11 days 4 out of 11 days

11. IMNCI Package:
Care of Newborns and Young Infants (infants under 2 months):
◦ Keeping the child warm
◦ Initiation of breastfeeding immediately after birth and
counselling for exclusive breastfeeding and non-use of pre
lacteal feeds
◦ Cord, skin and eye care
◦ Recognition of illness in newborn , management and/or
referral
◦ Immunization

12. IMNCI Package
Home visits in the postnatal period:
Home visits by health workers (ANMs, AWWs, ASHAs ).
Three home visits are to be provided to every newborn:
First visit on the day of birth (day 1).
Next two visit on day 3 and day 7.
For low birth weight babies, 3 more visits: on Day 14, 21 and 28.
care of mothers during the post-partum period.

13. Care of Infants (2 months to 5 years)
◦ Management of diarrhoea, acute respiratory infections (pneumonia),
malaria, measles, acute ear infection, malnutrition and anaemia.
◦ Recognition of illness / at risk conditions and management/referral.
◦ Prevention and management of Iron and Vitamin A deficiency.
◦ Feeding Counselling for all children below 2 years
◦ Feeding Counselling for malnourished children between 2 to 5 years.
◦ Immunization.
◦ The health workers in the community (ANM, AWW, ASHA ) or
◦ Providers at the facility (PHC/CHC/FRU).

14. Components of IMNCI:
Training:
IMNCI is skill based training based on a participatory approach
combining classroom sessions with hands-on clinical sessions in
both facility and community setting.
◦ Two categories of training are included:
One for medical officers
A second for front-line functionaries including ANM’s and Anganwadi Workers (AWW’s).

15. Improvements to the health system.
The essential elements include:
◦ Ensuring availability of health workers / providers at all levels
◦ Ensuring availability of the essential drugs.
◦ Improve referral to identified referral facility.
◦ Referral mechanism to ensure hassle free transfer to higher level of care
when needed.
◦ Awareness of Health worker for when and where to refer a sick child.

16. Improvements to the health system
◦ The staff at appropriate health facilities must identify and acknowledge the referral slips and
give priority care to the sick children.
◦ Functioning referral centres, especially where healthcare systems are weak need to be
reinforced or private/public partnerships established
◦ Ensuring supervision and monitoring through follow up visits by trained supervisors
◦ On-the-job supportive supervision

17. Improvement of Family and Community Practices:
( Community IMNCI)
Counselling of families and creating awareness among Communities .
This includes:
◦ Promoting healthy behaviours such as breastfeeding, illness recognition,
early care seeking etc.
◦ IEC campaigns for awareness generation.
◦ Counselling of care givers
◦ During Home Visits - identification of sickness and focused BCC for
improving newborn and child care practices.
Collaboration/coordination with other Departments, PRIs, Self Help Groups
etc:

18. Management Algorithm:

19. The IMNCI Process for Children < 2 Months of Age

21. Then proceed for………
Diarrhoea.
Feeding Problem or Malnutrition.
Immunization Status.
Other Problems.

22. The IMNCI case management Process: for children 2 months to 5 years of Age

24. Then proceed for……
Main Symptoms
◦ Cough or Difficult Breathing
◦ Diarrhoea
◦ Fever
◦ Ear Problems
Malnutrition
Anaemia
Immunization Status
Other Problems

25. F- IMNCI: (facility based IMNCI)
What?
Facility Based Care for severely ill children is complementary to primary
care for providing a continuum of care for severely ill children.
 Integration of existing IMNCI package and the Facility Based Care package
in to one package.
WHY?
Majority of the health facilities (24x7 PHCs, FRUs, CHCs and District
hospitals) do not have trained paediatricians.
F-IMNCI training will help in skill building of the medical officers and staff
nurses posted in these health facilities to provide IMNCI care.

26. Focus on Skill Development
50% of training time is spent on building skills by “hands-on training”
involving actual case management and counselling.
Remaining 50% in classroom for building theoretical understanding of
essential health intervention.
Training at two levels:
◦ In service training for the existing staff.
◦ Pre-Service Training– For including F-IMNCI in the pre-service teaching of
doctors and nurses.
Personnel to be Trained:
There are 2 types of trainings under F-IMNCI:
PRE-TRAINING STATUS PACKAGE TO BE USED DURATION
IMNCI not trained F-IMNCI complete
package
11 days
IMNCI trained Facility based care
package of F-IMNCI
5 days

27. Training of Trainers:
◦ Faculty from the departments of Paediatrics and community medicine of the
medical colleges.
◦ The trainers at district level include all the paediatricians in the district.
◦ The TOT for State and District facilitators will be facilitated by National F-IMNCI
facilitators.
Facilitator to trainees ratio:
◦ Participant to facilitator ratio of 1:4-6 (one trainer to 4 – 6 participants).
Training Institutions:
◦ The Departments of Pediatrics and Preventive & Social Medicine in each college.
Pre-service Training:
◦ Include training on F-IMNCI for the undergraduate students and intern. Also for
Nursing students.

28. C - IMNCI: Community and Household
IMNCI:
Community IMNCI is basically Component 3 of the IMCI
Package.
It aims at improving family and community practices by for
improving child survival, growth and development.
Strengthen the linkage between health services and
communities
To improve selected family and community practices and to
support and strengthen community-based activities.

30. Key family practices:
16 key family practices identified Under Four Broad Heading:
The promotion of growth and development of the child:
◦ Exclusive Breastfeeding for six months. Good quality complementary foods after six
months. Continue breastfeeding for two years or longer.
◦ Ensure enough micronutrients – such as vitamin A, iron and zinc – in diet or through
supplements.
◦ Promote mental and social development by responding to a child’s needs for care
and by playing, talking and providing a stimulating environment.

31. Disease prevention:
◦ Dispose of all faeces safely, wash hands after defecation, before preparing meals and
before feeding children
◦ Protect children in malaria endemic areas, by ensuring that they sleep under
Insecticide - treated bed nets.
◦ Provide appropriate care for HIV/AIDS affected people, especially orphans, and Take
action to prevent further HIV infections.

32. Appropriate care at home:
◦ Continue to feed and offer more fluids, including breast milk to children when they
are sick
◦ Appropriate home treatment for infections.
◦ Protect children from injury and accident and provide treatment when necessary
◦ Prevent child abuse and neglect, and take action when it does occur
◦ Involve fathers in the care of their children and in the reproductive health of the
family
.

33. Care-seeking outside the home:
◦ Recognize when sick children need treatment outside the home and seek care from appropriate
providers
◦ Complete a full course of immunization before first birthday
◦ Follow the health provider’s advice on treatment, follow-up and referral
◦ Ensure that every pregnant woman has adequate antenatal care, and seeks care at the time of delivery
and afterwards

34. IMNCI +
The objectives of the newborn and child health strategy are:
◦ Increase coverage of skilled care at birth for newborns in conjunction with maternal care
◦ Implement a newborn and child health package of preventive, promotive and curative
interventions using a comprehensive IMNCI approach
At the level of all
◦ Sub-centres
◦ Primary health centers
◦ Community health centers
◦ First referral units
.

35. At the household level in rural and poor peri urban settings in at least 125 districts (through
AWWs / ASHAs)
◦ Implement the medium-term strategic plan for the UIP (Universal Immunization Program)
◦ Strengthen and augment existing services in areas where IMNCI is yet to be implemented

36. Why IMNCI ‘Plus’
RCH 2 NEW BORN and CHILD HEALTH PACKAGE:

37. “IMNCI +”
Inpatient care component for facilities to ensure effective care of
sick neonates and children who require hospitalization.
IMNCI approach includes counselling for immunization, but the
implementation of immunization in India cannot be adequately
done by the IMNCI contacts alone.
Therefore, a comprehensive immunization plan will be required.