Improving Quality: Care for Children under 5
Ensuring Quality Care for Children under 5
Ensuring high-quality care for children under five is essential for reducing preventable deaths and promoting healthy early childhood development. Since its introduction in 1995 by the World Health Organization (WHO), the Integrated Management of Childhood Illness (IMCI) has served as a cornerstone strategy for improving child survival. IMCI was designed to reduce mortality, illness, and disability, and to promote healthy growth and development by targeting the five major causes of under-five deaths: pneumonia, diarrhea, malaria, measles, and malnutrition.
Nearly three decades later, IMCI continues to be a vital approach, especially in resource-limited settings. However, there have been significant evolutions in both the technical content and delivery of IMCI, including updated guidelines, integration with community-level care, and the inclusion of emerging child health priorities such as early childhood development and non-communicable diseases.
This section focuses on improving the quality of care for children under five through strengthened IMCI implementation and service delivery in primary healthcare settings. High-quality care includes timely and accurate assessment, diagnosis, and treatment, respectful communication with caregivers, and continuity of care through follow-up and community engagement.
By embedding quality into all components of child health services, local governments can ensure that healthcare providers are equipped with the tools, skills, and systems they need to detect, treat, and prevent life-threatening conditions in young children – ultimately contributing to the reduction of under-five mortality and achieving Sustainable Development Goal (SDG) targets for child health.
What Are the Benefits of Delivering Quality IMCI Care?
Strengthens Provider Skills in Case Management
Quality IMCI care equips healthcare providers with practical, evidence-based skills to assess, classify, and treat the most common and deadly childhood illnesses such as pneumonia, diarrhea, malaria, measles, and malnutrition. It enhances decision-making and improves the accuracy of diagnoses at the primary care level.
Improves Service Delivery at Health Facilities
Implementing IMCI strengthens the capacity of service delivery points (SDPs) by standardizing protocols, ensuring availability of essential medicines and equipment, and promoting supportive supervision. This leads to more efficient, timely, and child-friendly health services.
Increases Care-Seeking and Trust in Health Systems
When caregivers experience reliable, respectful, and effective care, they are more likely to seek care early and consistently for their children. Quality IMCI care fosters trust in health facilities and encourages routine use of child health services.
Reduces Child Morbidity and Mortality
By addressing the major causes of under-five deaths with a holistic and preventive approach, quality IMCI significantly contributes to reducing child mortality. Early identification, appropriate treatment, and caregiver education help prevent complications and improve long-term child health outcomes.
How to Implement
Steps for Providing Quality Care for Children under 5:
1. Understand and Apply the Core Steps of IMCI
Use the WHO and UNICEF IMCI guidelines to identify, classify, treat, and monitor childhood illness. The key steps are:
- Assess and Classify the Child (Pages 1–7): Evaluate signs and symptoms to classify illness severity and identify appropriate treatment.
- Treat the Child (Pages 8–14): Provide necessary medications, refer for advanced care if needed, ensure immunization, and train caregivers in home care.
- Counsel the Caregiver (Pages 15–19): Offer guidance on feeding, breastfeeding techniques, thermal care for low birth weight babies, and home management.
- Provide Follow-up Care (Pages 20–24): Follow up for critical illness, clinical infections, or suspected bacterial/viral infections.
2. Assess and Strengthen Quality through Supervision and Data
- Conduct routine monitoring and use supportive supervision tools to ensure IMCI protocols are followed. Use the WHO M&E checklist to review:
- Facility infrastructure.
- Staff training and case management.
- Quality of data and recording.
- Infection prevention practices.
- Availability of job aids and supplies.
- Track progress through data collection and review meetings to identify gaps and improve service delivery.
3. Build Capacity of Service Providers and CHWs
Success in IMCI implementation depends on strong intersectoral coordination, regular reviews of guidelines, and continuous improvement of service quality through practical training and supervision.
Ensure that service providers and community health workers (CHWs) are properly trained and mentored:
- Adopt national or county-level IMCI guidelines.
- Align clinical protocols with local epidemiological and food supply contexts.
- Deliver regular training and refresher sessions.
Conduct mentorship and supportive supervisory visits to reinforce skills.
Resources for Training:
Key Indicators
- Proportion of primary health care centers with at least 60% of staff trained and coached on IMCI.
- Proportion of community-based health workers who have been trained in IMCI.
- Proportion of sick children under the age of 5 years who are diagnosed correctly and given the correct doses of drugs/antibiotics.
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Quality of Care
Looking for practical guidance on delivering MNCH services? Visit the MNCH Service Delivery Toolkit for step-by-step instructions on Care for Children under 5.
Tips
- Conduct regular supportive supervision by trained staff to assess the quality of care and share actionable feedback.
- Strengthen data review and feedback mechanisms at the facility level by ensuring the timely availability of data and building staff capacity to interpret and use the information.
Challenges
- Weak primary health care systems and poor inter- and intra-facility referral mechanisms.
- Limited capacity of facility staff at primary health care centers to implement the IMCI strategy effectively.
- Lack of skilled personnel for supportive supervision of IMCI activities.
- Inadequate funding to support supervision, training, and capacity-building programs.
- Absence of strong political commitment and local government leadership to reinforce IMCI guidelines and implementation.
Key Resources
- Training Manual for participants. WHO 2019
- IMCI in-service training: Module 1. WHO 1997
- Supportive Supervision Checklist for IMCI. Medbox
- Management of the Sick Young Infant Aged Up to 2 Months. WHO & UNICEF 2019
- MNCAH Data Portal. WHO
