Our Story
IMAI is one of the WHO sets of integrated service delivery tools. These integrated management standards - IMCI, IMPAC and IMAI- were developed as packages of evidence-based guidelines, educational materials and job aids. All aimed at health workers in low resource settings. IMAI is the adult equivalent of IMCI. The IMAI Alliance (formerly the IMAI-IMCI Alliance) concentrates on supporting Ministry of Health and the WHO regional and country offices in the adaptation and implementation of the IMAI tools globally. The current focus area has been in the WHO SEARO region in providing technical support for the clinical care of COVID-19 and other severe acute respiratory infections.
The WHO integrated service delivery tools, together with immunization services, cover the range of primary health care services at routine facilities in low resource settings. Each set of tools address community, health centre, and district hospital care.
Integrated Management of Adolescent and Adult Illness (IMAI) is an integrated approach to adolescent and adult health. It reduces death, illness and disability among adolescents and adults, while improving their overall wellbeing. It is a multi-pronged comprehensive approach to health care, which strengthens health services, systems and communities by empowering health care providers, lay people and communities in resource poor settings.
Integrated Management of Childhood Illness (IMCI) is an integrated approach to child health that focuses on the overall well-being of the child. It reduces illness, disability and death, and improves growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families, communities, health centres (IMCI chart booklet and IMCI distance learning curricula) and hospitals (IMCI pocket book).
Integrated Management of Pregnancy and Childhood (IMPAC) is an integrated approach to maternal and newborn care. It addresses factors crucial for access to skilled care before, during and after pregnancy and childbirth. The IMPAC PCPNC addresses the health centre; the IMPAC PCPNC the hospital
History of IMAI:
IMAI grew out of the WHO Stop TB program Practical Approach to Lung Health, which incorporated the management of adult pneumonia, asthma and COPD with that for TB.
HIV/ART: IMAI first-level (health centre) training and mentoring program started with 3 guideline modules- Acute Care, Chronic HIV Care with Antiretroviral Therapy and Prevention and Palliative Care - which were used as the basis for a participatory clinical training program which included skill stations, cases presented by facilitators and by expert-patient trainers (EPTs), and clinical practice sessions. EPTs were people living with HIV/AIDS trained to simulate clinical cases) who proved very effective in helping to train health workers.
This WHO IMAI HIV training program was scaled up to all districts in Uganda in 2004-2005 then adapted and implemented through WHO AFRO in 35 countries to support the scale up of chronic HIV care and antiretroviral therapy. Uganda is one of the pioneer countries that successfully decentralized HIV services to district hospitals and health centres, using IMAI-supported approaches. ,
Although the chronic HIV care/ART module is now out of date given the substantial changes in management of HIV care and ART, Acute Care (for adolescents and adults) and Palliative care have remained highly relevant for subsequent work on COVID-19 and NCDs. The PowerPoint training materials for district hospital clinicians to support hospital HIV care including opportunistic infections and ART was expanded over the following years into the WHO IMAI District Clinician Manual, in response to their request for an equivalent manual to the pocket book for hospital care for children.
Case management of epidemic-prone diseases - The need to support the management of severely ill patients outside of an ICU with severe influenza and other epidemic-prone diseases presenting with severe respiratory distress and septic shock contributed to the completion of the WHO IMAI District Clinician Manual and the Quick Check+ training program. These tools were used to support case management in the influenza H1N1 pandemic in 2009, in the Ebola outbreaks in Uganda and West Africa (2014-2016), for pandemic preparedness in Nepal (2016-2019), and the SEARO SARI tools adapted and used to support case management of COVID-19.
Emergencies and severe illness - Using a participatory, case-based approach, health workers from all cadres of the district hospital clinical team (clinicians-doctors and nurses; managers; and auxiliary staff) are trained in triage, emergency assessment and treatment (Quick Check), the management of severely ill patients with severe respiratory distress and septic shock, and infection prevention and control for the clinician. Later a module on the clinician’s role in disease surveillance and response was added (Quick Check+).
Non-communicable Diseases (NCDs) - Based on the WHO IMAI experience in chronic and integrated HIV care, the Alliance was asked to collaborate in the development of the IMAI-PEN (WHO package of essential non-communicable disease interventions) guideline modules, a longitudinal patient monitoring system, and training programme. After field-testing and an adaptation workshop, these tools became the national curricula for first level health facilities in Uganda- both health centres and hospital outpatients. IMAI-PEN tools operationalizes WHO PEN and Global HEARTS+.
Currently, the IMAI Alliance is focusing on support for the COVID-19 clinical care in the WHO SEARO region.
