Since 2001, IMCI has started its journey in Bangladesh. Now it has got a definitive shape and momentum. Doctors and paramedics of 174 Upozilla health complexes has already been trained in IMCI. By 2010 all upazilla health complex will be brought under the umbrella of IMCI training programme. These training programmes are arranged and funded by DGHS, WHO, UNICEF, ICDDR,B. This is an eleven days extensive training programme conducted in different medical colleges , Institute of Child and Mother Health, Shishu Hospital and ICDDR,B.

Each year more than 10 million children in low-and middle-income countries die before they reach their fifth birthday. Seven in ten of these deaths are due to just five preventable and treatable conditions: pneumonia, diarrhoea, malaria, measles, and malnutrition. Often these occur in simultaneously.

Every day, millions of parents seek healthcare for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers.

Surveys reveal that many sick children are not properly assessed and treated by these healthcare providers, and that their parents are poorly advised.

At first-level health facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave doctors at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources.

These factors make quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called Integrated Management of Childhood Illness (IMCI).

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 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

What does IMCI strive to do?
In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers, and speeds up the referral of severely ill children. In the home setting, it promotes appropriate care seeking behaviours, improved nutrition and preventative care, and the correct implementation of prescribed care.

Why IMCI better then single condition approach ?
Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible. IMCI is an integrated strategy, which takes into account the variety of factors that put children at serious risk. It ensures the combined treatment of the major childhood illnesses, emphasising prevention of disease through immunisation and improved nutrition.

How does IMCI accomplish these goals?
Introducing and implementing the IMCI strategy in a country is a phased process that requires a great deal of coordination among existing health programs and services.

The main steps involve:

• Adopting an integrated approach to child health and development in the national health policy.
• Adapting the standard IMCI clinical guidelines to the country's needs, available drugs, policies, and to the local foods and language used by the population.
• Upgrading care in local clinics by training health workers in new methods to examine and treat children, and to effectively counsel parents.
• Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available.
• Strengthening care in hospitals for those children too sick to be treated in an outpatient clinic.
• Developing support mechanisms within communities for preventing disease, for helping families to care for sick children, and for getting children to clinics or hospitals when needed.

The writer is an Associate Professor of Department of Pediatrics at Community Based Medical College, Mymensingh. [E mail: [email protected]]