The analytic review of the Integrated Management of Childhood Illness strategy
The overall decline in child mortality observed over recent years has been a factor in the shift of attention from child survival to other health priorities by the international community. However, growing evidence suggests that certain indicators of child health and development have reached a plateau and some are declining.
Many children are dying from lack of access to proven, inexpensive interventions and more than 9/10 of these deaths are in the world's poorest countries. Today, 62% to 80% do not receive oral rehydration therapy needed for diarrhea ; 60% do not receive appropriate antibiotic treatment for pneumonia; 61% are not exclusively breastfed during the crucial first months of life; 45% do not receive vitamin A supplementation; and 46% do not have clean delivery by a skilled attendant at birth .
To determine how IMCI could better contribute to improved child health outcomes, DFID, UNICEF, USAID, and WHO/CAH joined efforts to conduct an analytic review of the strategy. The review examined assumptions made when conceiving the strategy in 1996, as well as management, organization and policy issues, the three components of the strategy and their content, possible linkages with other child health related programmes and strategies, the implementation process, partnership, and the amount and flow of financial resources made available for child health and IMCI in countries and at international level. As a basis for future partnerships in research, development, and implementation, a broad consultative process was established to ensure that the full range of experience and evidence related to child health was taken into account and to build consensus about any revision of the strategy.
To answer the analytic review questions, the following mix of activities were conducted in 2002 and early 2003 including: desk review, visits by interagency teams to Egypt, Indonesia, Kazakhstan, Mali, Peru and Zambia, and key informant interviews at country and global levels.
The findings drew attention to the lack of comprehensive child health policies in countries, the competing health priorities, the difficulties encountered by ministries of health in directing interventions towards the most needed populations, and the fragmentation among governments and partners. The findings also confirmed the importance of a strong health system to support child health interventions such as IMCI, the recognition of IMCI case management guidelines as evidence-based standards for child health care, the evidence that training in IMCI case management effectively improves the quality of care delivered to sick children, the wide acceptance of the household and community practices promoted in IMCI, the limited investments made to date in IMCI and the underexploited partnerships with the private sector and civil society.
After reviewing and endorsing the findings, DFID, UNICEF, USAID, and WHO/CAH formulated and agreed upon a set of recommendations during the AR Steering Committee meeting held at DFID offices in London, on 1st and 2nd October 2003. After this meeting a final report was prepared and cleared by the four organizations.
 An average 62% ORT use rate in diarrhoea episodes during 1995-2000 was reported in 2001 State of the World's Children, UNICEF, and an unpublished synthesis of DHS data up through 2003 shows a 66% average ORT use rate in countries with DHS data.
 How many children deaths can we prevent this year? Lancet 2003, vol 362, pages 65-71.