Health providers' perceptions about the Integrated Management of Childhood Illness (IMCI) in Lahej governorate, Yemen, were explored in a qualitative analysis of 12 in-depth interviews in 2007. The following themes emerged: appreciation of clinical aspects of IMCI but unclear about community IMCI; IMCI working better in peripheral than central health facilities; inflexible rules; lack of integration of services; poor supervision; multiple roles for one person; success of immunization; basic equipment and drug supplies deficient; conflicting views about health committees and community participation; and solutions for community health problems. After 4 years of IMCI experience in Yemen, the gaps identified would endanger the positive influence of IMCI unless action is undertaken at different levels.