Millions of parents seek health care for their sick children everyday. They take them to hospitals, health centres, pharmacists, doctors and traditional healers. Despite the treatment, surveys reveal that many sick children are not properly assessed and treated by these healthcare providers. In many cases, parents are poorly advised.

According to World Health Organization (WHO), at first-level health-care facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave health workers at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources. These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI).

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IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

According to a report by Jonathon L Simon and his colleagues, one of the key recommendations of the child health strategic review was a call for WHO and UNICEF to bring together existing guidance packages for new-borns and children below 5 years into one set of flexible, adaptable and user-friendly tools. The review also called for an approach that dealt with child health and development during the first 18 years of life. The life course approach considers “childhood” as defined by the UN Declaration on the Rights of the Child (ages 0-18 years) and calls for a continuum of support and care where inputs at each age become the basis for improving the health and wellbeing at each subsequent age. This call for the redesign of the child health guidance within the context of this life course approach and the sustainable development goals is based on several identified factors that create changes and require a continued focus on child survival while also broadening the concept of global child health.

The change from millennium development goals to sustainable development goals has extended the programme. In addition to the reduction of the mortality of young children, it now examines the social determinants of ill health and improved wellbeing.

Changes in the timing and causes of child deaths suggest that greater attention should be paid to the first year of life. Focus on the first day, week and month of life is key as this is when most deaths occur.

Advances in clinical sciences and biomedical technology create opportunities to improve existing guidance. The introduction of new vaccines and antibiotics has changed the epidemiology, prevention and treatment of several conditions. Old and new conditions and technologies would benefit from an updated review to ensure that they reflect the most recent scientific evidence. For example, research is underway to strengthen clinical recommendations for identification of children with signs of pneumonia who are likely to benefit from antibiotics.

Developing WHO technical guidelines to meet the sustainable development goals is challenging given the breadth of problems reflected in the 17 goals, with a broad definition of health being a core component of many of them. WHO and UNICEF envisaged a child health redesign project to deal with these challenges through consultation with policy makers, programme managers, scientists, implementation partners and civil society in all regions. This process has identified priority areas on which WHO and UNICEF will focus. There is general agreement that the emphasis should expand beyond survival of children under 5.

To conclude, L Simon believes that countries ascribe great importance to WHO guidance. Thus, the need to adopt state of the art thinking and science is both a huge responsibility and an opportunity for WHO. This is an exciting opportunity to refresh the world’s child health knowledge and, more importantly, use this information to accelerate the improvements in child health and development required to meet the 2030 sustainable development goals.