Integrated Management of Childhood Illness (IMCI) was adopted by the Ministry of Health Zanzibar as one of the strategy for improving child survival in the direction to the reduction of child mortality and also as the main national strategy to reach the child-related objectives of the Millennium Development Goals and MKUZA II targets. The purpose of this study was to assess the healthcare workers knowledge, attitudes and practices in the implementation of IMCI strategy to address Childhood Illnesses in the First Level Health Facilities at Wete District in North Region, Pemba. The Study adopted a case study design. The study consisted 50 respondents which comprised of eight (08) health care prescribers, forty (40) caregivers of sick children and two selected (02) DHMT officers. The sampling procedures used to select these respondents were simple random and purposive. For the purpose of receiving further information, documentary review of MoH documents and the underfives registers from daily used registers with the availability of all information treatment inclusive and the review of supervisory/comments books within study areas were also covered. The study came up with various findings; health care workers are found to have a good knowledge of IMCI strategy with positive attitudes toward the IMCI strategy and commented it is a better approach in managing common childhood illnesses. Also is observed that there is malpractice in assessment of IMCI indicators attributed by ineffective supportive supervision. In the context of health care services reveals that there is good hope through the strong political will, government and partner’s collaboration to improve and sustain health system strengthening in particular availability of essential drugs and other supplies. However, the bottlenecks observed are: weak supportive supervision, poor adherence of the standard treatment guideline and misuse/overuse of antibiotics. Also outlines lack of pre-referral treatment for urgent referral, shortage of the essential drugs, poor counseling and advice to the caregivers and lack of sound referral system. The study recommends that DHMT to support the health care provider’s so as they can be more conversant with IMCI approach. Also there should be a well organized mechanism to ensure training coverage increased, provided with supportive supervision and sufficient distribution of all essential requirements.