In 1992, the World Health Organization (WHO) and UNICEF developed a strategy for children's health care, known as Integrated care for childhood illnesses (IMCI). This strategy was designed as an integral approach to improve children's health in the world (1). The IMCI provides unified health care instead of separate management of diseases affecting children under five. Moreover, this approach also focuses on the reduction of morbidity and mortality rates associated with the most common diseases in childhood. The strategy is divided into three components: organizational, clinical, and community. The IMCI approach has introduced several ways to mitigate infant risks in several action fronts.
According to the WHO, about 68 million children around the world will die before reaching five years by 2030 (2). Most of these deaths are caused by one of the following diseases or a combination of them: acute respiratory infection (ARI), acute diarrheal disease (ADD), measles, malaria and malnutrition (1, 3). The 70% of such cases occur in low-income countries. Moreover, starting from the fact that the IMCI was created in line with the Millennium Development Goal (MDG) number four, which indicated the need to reduce by two-thirds the infant mortality by 2015, the correct application of the strategy would allow the reduction of the expected morbidity and mortality in the upcoming years (4).
On the other hand, and considering Alma-Ata's statement, the conceptual framework of IMCI is close to Primary Health Care (PHC). Specifically, in several countries of the Americas region, where the strategy was introduced, there has been a "Primary Health Care for children" (PHC) (5). Additionally, the IMCI focuses on the first contact of children with the health system, thus, it promotes health access and quality for this population group (6). Similarly to the development of PHC, the IMCI has been deployed attending the specific needs and capacities of each country in the region (5).
Since 2004, more than 100 countries, including Colombia, have adopted the components of the IMCI. Specifically, the clinical component for the evaluation, treatment and prevention of sick children, as well as, counseling to caregivers was mainly implemented (7). When the strategy was introduced at Colombia, it was based on the right of every child to be treated with quality and warmth. It adopted a risk identification approach, of total integration, and was aimed at responding to the main causes of morbidity and mortality of children in the country (7). Despite all efforts of the Health Ministry to implement the strategy in all country's departments, the main challenge was poor adherence by trained professionals in this strategy (6).
If the factors that influenced the implementation of the IMCI strategy had been considered in the country, it would have increased the probability of reducing the infant mortality rate from 19.5 deaths per 1,000 live births in 1998, to 6.5 deaths in 2015. However, in 2013, there were 11.6 deaths per 1,000 live births (6.7). Since its introduction in low-income countries, the IMCI strategy has shown positive results in reducing infant mortality. Unfortunately, factors such as the availability of medications, enough technical equipment and permanent training for health professionals have not been studied in the Colombian context. Figure 1 illustrates the factors and benefits related to the implementation of the strategy in the global context, with reference to PHC (8).
Moreover, Kiplagat (2014) mentioned that in Tanzania factors such as personal training, monitoring, and vocation, lead to improve health care and improve adherence to treatments by families and infants (8). It was also stated that the availability of medications, vaccines, the correct financing, and leadership by administrators can lead to the improvement of the quality of children's care (8). On the other hand, Rowe (2012) asserted that the presence of enough equipment, essential medicines, supervision visits and the duration of training not only determine the performance of health workers, but also the level of coverage of the intervention (9). Therefore, by gathering the basic minimums to offer a correct strategy, better health care for children under 5 years of age could be achieved. Similarly, the strategy offers integrated management for childhood predominant illnesses, by achieving a reduction in infant mortality and morbidity (10). Nevertheless, several international studies have shown that it is not carried out and it is presumed to be that the understanding of the motivations could improve health care (11).
Although, the impact of the strategy has not been documented given the lack of national coverage (12), it has been identified a decrease in the infant mortality rate that seems to be related to the inclusion of the strategy in 2004 (13). Moreover, there is no clarity about what factors determine the applicability of the IMCI at Colombia. In 2011, a document published by Universidad Nacional defined the care conditions provided from the clinical component of the strategy. Nevertheless, the factors related to its applicability were not identified. Thus, in 2016, the Universidad de los Andes in agreement with the Pan American Health Organization and the Health Ministry carried out an assessment of the integrated health care received by children under five by practitioners formed in the clinical component of the strategy between 2012 and 2014.
The IMCI provides children's health monitoring through promotional, preventive and therapeutic approaches, as well as interactions with the child, the family, health services and other social sectors. Therefore, this work proposes an integrated care that involves general information, identification, evaluation, classification, treatment, and counseling to children and their caregivers in the most prevalent pathologies of childhood (14). Moreover, framed in the clinical component of the strategy, this work is also aimed at identifying the related factors to IMCI at 18 Colombian cities.