Community case management of childhood illness in sub–Saharan Africa – findings from a cross–sectional survey on policy and implementation

Abstract

BackgroundCommunity case management (CCM) involves training, supporting, and supplying community health workers (CHWs) to assess, classify and manage sick children with limited access to care at health facilities, in their communities. This paper aims to provide an overview of the status in 2013 of CCM policy and implementation in sub–Saharan African countries.MethodsWe undertook a cross–sectional, descriptive, quantitative survey amongst technical officers in Ministries of Health and UNICEF offices in 2013. The survey aim was to describe CCM policy and implementation in 45 countries in sub–Saharan Africa, focusing on: CHW profile, CHW activities, and financing.Results42 countries responded. 35 countries in sub–Saharan Africa reported implementing CCM for diarrhoea, 33 for malaria, 28 for pneumonia, 6 for neonatal sepsis, 31 for malnutrition and 28 for integrated CCM (treatment of 3 conditions: diarrhoea, malaria and pneumonia) – an increase since 2010. In 27 countries, volunteers were providing CCM, compared to 14 countries with paid CHWs. User fees persisted for CCM in 6 countries and mark–ups on commodities in 10 countries. Most countries had a national policy, memo or written guidelines for CCM implementation for diarrhoea, malaria and pneumonia, with 20 countries having this for neonatal sepsis. Most countries plan gradual expansion of CCM but many countries’ plans were dependent on development partners. A large group of countries had no plans for CCM for neonatal sepsis.Conclusion28 countries in sub–Saharan Africa now report implementing CCM for pneumonia, diarrhoea and malaria, or “iCCM”. Most countries have developed some sort of written basis for CCM activities, yet the scale of implementation varies widely, so a focus on implementation is now required, including monitoring and evaluation of performance, quality and impact. There is also scope for expansion for newborn care. Key issues include financing and sustainability (with development partners still providing most funding), gaps in data on CCM activities, and the persistence of user fees and mark–ups in several countries. National health management information systems should also incorporate CCM activities.

Using geographical analysis to identify child health inequality in sub-Saharan Africa

“…Variable immunization coverage in Ethiopia has led to recommendations to address regional variations in service delivery and access to information [66]. We observed that measles and DPT-3 immunization coverage is generally lower in more remote areas of west and central Africa, possibly indicating poor access to services, while the band of high-high coverage in eastern Africa may be related to ease of access to services and cultural acceptance.…”

Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

“…7 uptake of iCCM by national governments in Africa has been rapid, increasing from a total of 7 countries with iCCM policies in 2005 to 28 countries by 2013. [11] The scale-up of community-based delivery platforms, including treatment of the common causes of child deaths, has contributed to the achievement of MDG4 in several countries in Africa, including Malawi and Niger. [12,13] SA embarked on a strategy to re-engineer the primary healthcare (PHC) system in 2011, including the creation of ward-based out reach teams (WBOTs), comprising approximately six CHWs supervised by one nurse.…”

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

“…In 2014, only 27 of 42 sub-Saharan African countries surveyed were providing "complete" iCCM compared with 35 providing CCM for diarrhea and 32 for malaria. 17 A recent meta-analysis showed that one of the most important aspects of scalable interventions with CHWs is community acceptance. 18 Although some studies have demonstrated that iCCM interventions are acceptable to the community, 19,20 others have shown that programs are resisted if CHWs do not provide services of value.…”