Insights from Community Case Management Data in Six Sub-Saharan African Countries

Abstract

There is strong research evidence that community case management (CCM) programs can significantly reduce mortality. There is less evidence, however, on how to implement CCM effectively either from research or regular program data. We analyzed monitoring data from CCM programs supported by the International Rescue Committee (IRC), covering over 2 million treatments provided from 2004 to 2011 in six countries by 12,181 community health workers (CHWs). Our analysis yielded several findings of direct relevance to planners and managers. CCM programs seem to increase access to treatment, although diarrhea coverage remains low. In one country, the size of the catchment area was correlated with use, and increased supervision was temporally and strongly associated with improved quality. Planners should use routine data to guide CCM program planning. Programs should treat all three conditions from the outset. Other priorities should include use of diarrhea treatment and insurance of adequate supervision.

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

“…Regular supervision ensures the quality of iCCM interventions [24–26] and its absence was evident in several respects during the crisis, including observed inconsistencies in treatments and referrals recorded in CHW registers and difficulties reported by CHWs in diagnosing patients without touching them. Alternative means of providing supportive supervision from a distance, such as through cell phone calls, are recommended to overcome barriers to in-person follow-up.…”

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…15 In Asia, Pakistan and Nepal have well-established and studied iCCM programs. 16,17 African iCCM studies are few, 14,18 and less still have assessed health outputs and outcomes. 5,14,[19][20][21][22][23] National programs in sub-Saharan Africa are new and while early studies are demonstrating implementation feasibility and early positive outcomes 7,8 , more studies are needed to understand implementation in a variety of contexts including use of volunteer CHWs with limited formal education and short iCCM training.…”

Routine monitoring systems for integrated community case management programs: Lessons from 18 countries in sub–Saharan Africa

“…In addition, the samples used in most widely available household surveys, such as DHS and MICS, are often representative of the national or regional population, making it difficult for district managers to extract useful information for program monitoring. To better understand the contribution of iCCM and to improve implementation, program implementers, managers and evaluators require real-time, sound data that enables tracking trends over time on factors associated with high coverage, quality and cost-efficiency, such as rates of treatment, supervision and medicine availability [11].…”

“…Table 2 outlines data elements that should be captured monthly at district level to generate a minimal set of indicators and identifies other data elements that are better captured periodically through household or CHW surveys. Capturing the number of treatments by CHWs and comparing against the expected number of episodes for each condition based on local epidemiology and care-seeking practices is especially important to understand program performance and identify issues that require further investigation into causes and formulation of appropriate responses [11]. While our experience shows that the data elements required for numerators can be generated even in extremely resource limited settings such as South Sudan, obtaining up to date and accurate information for the denominators (number of children under five in target areas; number of CHWs trained and deployed) remains difficult and requires strategic investments in health workforce tracking.…”

“…To be effective, approaches must focus on a small set of indicators with agreed targets and actionable responses, regularly engage program managers in critical thinking to identify bottlenecks and root causes and address the organization and behavioral determinants of data quality and use [4,5]. An example dashboard developed by PSI for the iCCM program in South Sudan is available on request from the authors and readers are encouraged to consult the paper from IRC on analysis of routine data from six countries for additional guidance [11]. Further work is needed to increase demand for data, integrate data use into existing review mechanisms, and increase accountability of program managers for timely response.…”