Evolution of IMCI in the Eastern Mediterranean Region: from sick to healthy child approach

In the Eastern Mediterranean Region, the IMCI (Integrated Management of Childhood Illness) strategy was introduced in 1996 to reduce under-five mortality and has since evolved to encompass both the sick and the healthy child.

The evolution of IMCI in the Region reflects the characteristics of its countries. In fact, the Region is characterized by a distinct socioeconomic, cultural, and epidemiological diversity.

In the Region, more than one million children under the age of 5 still die every year, one death every 30 seconds. Most of these deaths are preventable through existing, effective interventions included in IMCI.

While in some countries under-5 mortality reduction is a priority, in others where downward mortality trends have been substantial in the past decades, child health care needs to go beyond survival and take up the challenge of addressing newly emerging issues, e.g. injuries, and child development.

This challenge has brought about a change in the way of thinking at regional level. The foundation of “child health”—as opposed to only “child survival”— is seen as a requisite for a child care strategy in any country, whether the priority is to reduce deaths, reduce child vulnerability to illness or promote healthy growth and development. Interventions need to improve the quality of children’s life.

The new concept wants to address the child as a whole and emphasize the importance of a more holistic approach contributing to building stronger children rather than just waiting for them to get sick in order to treat them.

Much attention has been given in the Region to the health system, to support the delivery of quality child health services. Many medical and some paramedical schools in the Region have started a process to incorporate IMCI elements into their teaching (see pre-service education).

Both approaches, i.e. addressing the healthy and sick child, have to go hand in hand, if sustainable and persisting achievements over time are to be made.

With this understanding, IMCI has since evolved gradually in the Region to encompass both illness and healthy growth and development of children, especially in most recent years.

It has therefore been re-named “Integrated Management of Child Health” in the Eastern Mediterranean Region, to better reflect its original objectives, which go beyond illness, and underline its emphasis also on prevention and health promotion. The acronym “IMCI” has to date been retained as this is how it has been widely known worldwide.