IMCI’s Not Working

The World Health Organization’s Integrated Management of Childhood Illness (IMCI) strategy is one of the cornerstones of global health. It’s meant to reduce child mortality by improving their medical care, teaching parents about how to care for sick kids, and improving health systems. It’s an evidence-based diagnostic strategy, based on identifying the illnesses most likely to kill children in the developing world. Providers love it, parents see a visible increase in the quality of care that their children get, and providing IMCI training is cost effective and sustainable. It’s been incorporated in continuing medical education and medical school programs around the world.

A recent study by the Gates Foundation, published in the Lancet, found that it’s not working in Bangladesh. The intermediate steps are in place – mothers are breastfeeding more, and taking their children to the doctor more often. Fewer children are stunted. But child mortality is not decreasing. Regions where the IMCI strategy show approximate the same reduction in mortality rates as the regions where IMCI is not being used.

Since Bangladesh is the only country where IMCI-implementing areas are being compared to the areas that are not implementing IMCI, this is pretty depressing. This is the only case-control study we have, and it’s not good news.

In my own opinion, this isn’t a crushing blow to IMCI. It’s still a good way to improve medical care – the study proves that IMCI does improve the quality of children’s medical care. The gap occurs after that – just improving medical care to kids doesn’t reduce mortality as expected.