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Analysis Strategic Review of Child Health

Introductory commentary: a strategic review of options for building on lessons learnt from IMCI and iCCM

BMJ 2018; 362 doi: (Published 30 July 2018) Cite this as: BMJ 2018;362:bmj.k3013

Strategic review of child health

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  1. Marian Jacobs, emeritus professor1,
  2. Michael Merson, professor2
  1. 1University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
  2. 2Duke University, Global Health Institute, Durham, North Carolina, USA
  1. Correspondence to Marian Jacobs marian.jacobs{at}

Despite advances in child health over the past 20 years, children are still failing to reach their full health and development. Marian Jacobs and Michael Merson examine what the 2016 strategic review tells about how IMCI and iCCM have contributed to gains in child health, as well as the changes in child health epidemiology, health systems, technology and innovations, and health science

Over the past quarter of a century, child mortality has more than halved.1 Yet in 2016, globally, an estimated 5.6 million children died before reaching their 5th birthday, most from conditions that are readily preventable or treatable with proved, cost effective interventions. Millions of others failed to reach their full healthy growth and development.12 Children need better, more comprehensive care. A third of countries have adopted multisectoral policies to deal with social determinants of child health and promote early childhood development. However, these are rarely institutionalised and fully supported, resulting in fragmented and inadequate services.3

Globally and within countries, a number of strategies have been adopted aiming at reducing child mortality and promoting child health. Two decades ago, Integrated Management of Childhood Illnesses (IMCI) was introduced by the World Health Organization and Unicef as a global strategy to “reach all children” with prevention, diagnosis and treatment for common childhood illnesses.4 IMCI provides guidance in three key areas: health worker training; health systems’ strengthening; and improving family and community practices.5 Since 2010, IMCI has been complemented by Integrated Community Case Management (iCCM), designed to increase access to care for underserved populations, by deploying community health workers to provide diagnosis and management of common illnesses.6 IMCI has been adopted in over 100 countries and iCCM has also been widely accepted, mainly in sub-Saharan Africa. In recent years, other global child health strategies have …

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