Pneumonia, diarrhea, malaria, measles and malnutrition account for over 70% of the 11.5 million deaths and 80-90% of sick child consultations in developing countries. These conditions often occur in combinations requiring a holistic approach of assessment, treatment and caretaker counseling. The Integrated management of Childhood Illness (IMCI) strategy has been developed to address these needs. Ethiopia contributed immensely to the development of IMCI and officially adopted it in 1997. Progress in terms of training and geographic expansion has been limited. This analytical review has been made to identify ways to strengthen and sustain IMCI implementation. Data were collected from published and unpublished information sources relevant to the IMCI strategy in Ethiopia and through key informant interviews with representatives of Federal Ministry of Health and its partners. The rationale for IMCI in Ethiopia, past, present and planned IMCI activities, related policies and strategies, strengths and weaknesses, and priorities have been analyzed and recommendations developed. The review identified that most of the childhood deaths and 40% of all disability-adjusted life years lost are associated with pneumonia, diarrhea, malaria, measles and malnutrition. IMCI has, thus, been adopted in 1997 as the main strategy for improving child health and included in the Health Sector Development Programme of the country. Three regions have piloted the strategy and their experience used to develop plans for expansion to other regions and also to initiate IMCI activities related to family and community practices. Much has been learnt from the pilot phase and from the country's involvement in the initial development of the strategy. There are critical gaps that need to be addressed for the IMCI strategy to exert the desired impact on child health in Ethiopia. The HIV/AIDS algorithm should be validated and included in the IMCI guidelines. There is a need for scaling-up training activities and carry out follow-up after training in 4-6 weeks. A standardized checklist needs to be developed and integrated into existing supervision protocols and this be used to supervise IMCI implementing facilities regularly. Strategies to train and involve lower level health cadres in IMCI implementation and modify the standard IMCI course to suit senior physicians and programme managers are required. Standard recording and reporting tools need to be developed and IMCI classifications harmonized with current MOH guidelines. Essential IMCI drugs should be available to health facilities. Interventions need to be identified and tools developed to support the IMCI implementation at community and family level. Continued advocacy for IMCI is required to secure support from all stakeholders. Planning for IMCI should set clear milestones and take into consideration central and regional capacities and ways to strengthen them. Operations research is required to guide policy development and planning for IMCI implementation. It should be included as an essential activity in strategic and annual plans for IMCI implementation in Ethiopia.