Children at home and in primary health care

WHO/Malin Bring

Ruslan has bronchopneumatic troubles and has been coughing for several days, before coming to the Osakarov district hospital for treatment

WHO/Europe approaches the care of children through the integrated management of childhood illness (IMCI) strategy, which aims to reduce mortality and morbidity from the most common childhood diseases and promotes the healthy growth and development of young children. IMCI is about children at home, as well as reforming health systems at the primary care level: the family doctor and other local health services.

Integrated case management

Central to IMCI is integrated case management for the most important causes of childhood death: acute respiratory infections, diarrhoea, measles, neonatal conditions and malnutrition. This includes a range of preventive and curative interventions to improve practice both in the health facility and at home.

Introduced to the WHO European Region in 1999, IMCI is being implemented in 15 Member States, including those with higher mortality and limited resources. It tackles under-5 mortality, inequities in services (such as differences between rich and poor, rural and urban populations), quality of care and more efficient use of limited resources. Adapted IMCI clinical guidelines help to address such serious problems as common antibiotic abuse, unjustified hospitalizations of children with acute respiratory infections (ARI) and diarrhoeal diseases.

Interventions

The main interventions include:

  • strengthening health care professionals’ skills through clinical training;
  • introducing the strategy into the medical training curriculum;
  • strengthening the quality of essential primary health care services and legislative reforms;
  • improving community and family practices including care for early childhood development; and
  • monitoring and evaluating the quality of care.

WHO/Europe provides support through promoting:

  • adaptation of evidence-based guidelines for primary care, emphasizing essential curative and preventive interventions (immunization, nutritional and growth standards, care for social and cognitive development and counselling mothers), to country needs and their introduction into curricula of pre-service and post-diploma training;
  • a basic package of essential health services for children;
  • the IMCI care for development counselling course; and
  • evaluation of the quality of IMCI integration and identification of organizational barriers (in Armenia, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan).

There is strong evidence of the relationship between nutritional status and psychological development, and the potential of combining interventions that enhance early childhood development and improve child health and nutrition in an integrated model of care. The IMCI care for development counselling course combines both approaches and aims to improve child feeding and psychosocial development.