The three phases of IMCI implementation

The introduction of IMCI (Integrated Management of Childhood Illness) in a country follows three phases:

Introduction;

Early implementation; and

Expansion

Introduction

The “Introduction phase” is mainly about enabling the ministry of health and its partners to make an informed decision about IMCI as a suitable strategy in the country context.

It is characterized by country assessment and orientation meetings on IMCI of senior officers of the ministry of health, representatives of academia, international and bilateral organizations, civil society and nongovernmental organizations.

This phase results in the formal endorsement of IMCI as a national strategy by the concerned ministry of health authorities.

An IMCI management and coordination structure is then officially set up.

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Early implementation

The “Early implementation phase” is a major undertaking to gain experience in implementing the adapted IMCI in limited areas in the country.

It is often a lengthy process, because it aims at reaching a consensus among the main stakeholders. However, it plays a key role in establishing the foundations for IMCI in the country and for active partnerships with the scientific community.

This phase includes:

the participation of selected staff in IMCI activities in other countries, to build capacity for adaptation and training; the adaptation of the IMCI guidelines and training materials to the local setting by ad hoc IMCI committees and resource persons—bringing together leading public health and clinical professionals; andbuilding district capacity for planning and implementation.

This work is followed by the selection of a few districts according to agreed upon criteria, preparation of district plans, preparation of these districts and health facilities (health system component) before training starts, capacity-building and implementation with close monitoring.

This phase is thoroughly documented and ends with a major review to identify lessons learnt and plan for wider implementation in the country.

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Expansion

The “Expansion phase" marks the beginning of large-scale implementation in the country, broadens the range of activities and includes also expansion in scope of the strategy, while maintaining quality.

Compared with the previous phases, the pace of progress is usually much faster, depending on the human and financial resources available at central and district level.

This phase relies very much on the work done in the earlier phases, and on the interest and support that these have generated.

Thanks to the IMCI decentralized implementation approach, implementation may move in parallel in several areas of the country at the same time.

This phase should be reviewed periodically.

Competing priorities for funding and human resources have in recent years contributed to diverting resources to areas other than child health, hampering efforts to increase IMCI coverage in some countries. 

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