Steps in Integrated Case Management

The IMCI integrated case management process consists of a number of steps that should be taken by a health-care provider to ensure effective case management.

STEP 1. ASESS

When a child or young infant is brought to a clinic, a health-care provider uses good communication skills to ask the mother about the child's problems and makes an assessment of the child's condition. The health worker checks first for general danger signs, which would indicate any life-threatening condition. In young infant the health worker checks for signs of very severe disease and local bacterial infection. Then the health worker asks specific questions about the most common conditions affecting a child's health. If the answers are positive, he or she examines the child appropriately. An essential part of the assessment is checking the child's nutrition and immunization status. The assessment includes checking the child for other health problems.

STEP 2. CLASSIFY

Based on the results of the assessment a health-care provider classifies a child's illnesses using a specially developed color-coded triage system. Because many children have more than one condition, each condition is classified according to whether it requires:

STEP 3. IDENTIFY TREATMENT

After classifying all the conditions present, a health-care provider identifies specific treatments for the sick child or the sick young infant.

• If a child requires urgent referral (pink classification), essential treatment to be given before referral is identified.
• If a child needs  specific treatment  (yellow classification), a treatment plan is developed, and the drugs to be administered at the clinic are identified. The content of the advice to be given to the mother is decided on.
• If no serious conditions have been found (green classification), the mother should be correctly advised on the appropriate actions to be taken for care of the child at home.

STEP 4. TREAT

After identifying appropriate treatment, a health-care provider carries out the necessary procedures relevant to the child's conditions. The health worker:

• gives pre-referral treatment for sick children being referred;
• gives the first dose of relevant drugs to the children who are in need of specific treatment, and teaches the mother how to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at home;
• provides advice on the home management of sick children at home;
• if needed, asks the mother or other caregiver to return with the child for follow-up on a specific date.

STEP 5. COUNSEL

If the follow-up care is indicated the health-care provider teaches the mother when to return to the clinic, the health worker also teaches the mother how to recognize signs indicating that the child should be brought back to the clinic immediately.

When indicated, a health-care provider assesses feeding, including breastfeeding practice, and provides counseling to solve any feeding problems found. This also includes counseling the mother about her own health.

STEP 6. FOLLOW-UP

Some children need to be seen more than once for a current episode of illness. The IMCI case management process helps to identify those children who require additional follow-up visits. When such children are brought back to the clinic, a health-care provider gives appropriate follow-up care, as indicated in IMCI guidelines, and if necessary, reassess the child for any new problems.