Reducing the number child deaths in Kenya is a key priority for the Government and its development partners. Despite this, child mortality remains unacceptably high - of every 1,000 children born, 115 will die before their fifth birthday. Whilst the five main causes of death – diarrhoea, pneumonia, malaria, measles and malnutrition, can all be managed in primary health care facilities, quality of care for these conditions is frequently inadequate. Since 1999 the Government has introduced the Integrated Management of Childhood Illness (IMCI) in an attempt to reduce child mortality. The IMCI strategy, developed by WHO and UNICEF, aims to improve the management of childhood illness at the primary health care level. However, implementation of IMCI remains highly inadequate. The three major challenges are: low training coverage; trained health workers not following guidelines; and barriers to access for community members. This policy brief explores these three challenges and looks at why the IMCI strategy is failing to fulfil its potential to improve health care and reduce child mortality in Kenya. Recommendations are outlined for increasing IMCI coverage and implementation.