Integrated Management of Childhood Illness (IMCI) is a WHO/UNICEF developed approach to reduce mortality and morbidity associated with five major childhood illnesses such as diarrhea, ARI, measles, malnutrition and malaria, which account for about 70% of child deaths in developing countries.
Community Based Integrated Management of Childhood Illness (CB-IMCI) program in Nepal developed through the years with preceding programs such as Control of Diarrheal Disease (CDD) program initiated in 1982 and Acute Respiratory (ARI) Program initiated in 1987. Emphasis on community level involvement in Nepal started with ARI strengthening program in 1995 and for CDD in 1996. This program was commonly known as CBAC (Community Based ARI and CDD) program. The IMCI program, with its emphasis on detecting and managing multiple illness in children, was implemented in Nepal in 1997.
Initially there was a great concern over the CB-IMCI program allowing FCHVs to learn to treat pneumonia in children with antibiotics because a majority of the FCHVs could not read or write. A working group of child health professionals recommend further research to test whether FCHVs should treat pneumonia in children with Cotrimoxazole or refer cases of pneumonia to the health facility. An evaluation of this program in the four initial districts, conducted with technical support from WHO in 1997, found that FCHVs are able to deliver quality pneumonia assessment and management in the community. Additionally, in the “treatment” districts twice as many children at risk from pneumonia were identified and treated as compared to the “referral” districts.
In the CB-IMCI implemented districts, there is an increase in detection and treatment of pneumonia and correct management of diarrhea. This increase in coverage is mostly attributed to community health workers and especially the FCHVs treating and managing over half the diarrhea and ARI/pneumonia cases.