Stakeholders' Perceptions of Integrated Community Case Management by Community Health Workers: A Post-Intervention Qualitative Study

Abstract

BackgroundIntegrated community case management (iCCM) involves delivery of simple medicines to children with pneumonia, diarrhea and/or malaria by community health workers (CHWs). Between 2010 and 2012, an iCCM intervention trial was implemented by Healthy Child Uganda. This study used qualitative tools to assess whether project stakeholders perceived that iCCM improved access to care for children under five years of age.MethodsThe intervention involved training and equipping 196 CHWs in 98 study villages in one sub-county in Uganda in iCCM. During the eight-month intervention, CHWs assessed sick children, provided antimalarials (coartem) for fever, antibiotics (amoxicillin) for cough and fast breathing, oral rehydration salts/zinc for diarrhea, and referred very sick children to health facilities. In order to examine community perceptions and acceptability of iCCM, post-intervention focus groups and key respondent interviews involving caregivers, health workers, CHWs and local leaders were carried out by experienced facilitators using semi-structured interview guides. Data were analyzed using thematic analysis techniques.ResultsRespondents reported increased access to health care for children as a result of iCCM. Access was reportedly closer to home, available more hours in a day, and the availability of CHWs was perceived as more reliable. CHW care was reported to be trustworthy and caring. Families reported saving money especially due to reduced transportation costs, and less time away from home. Respondents also perceived better health outcomes. Linkages between health facilities and communities were reportedly improved by the iCCM intervention due to the presence of trained CHWs in the community.ConclusionsiCCM delivered by CHWs may improve access to health care and is acceptable to families. Policymakers should continue to seek opportunities to implement and support iCCM, particularly in remote communities where there are health worker shortages.

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

“…This is in line with many other studies that have shown the acceptability of community case management of disease starting with diarrhea and malaria [51][52][53] and more recent research on iCCM including pneumonia care. 19,20 This is likely because the CHWs in this program have been providing services which are considered valuable to the community. 21 Previous work has demonstrated the availability of drugs as an exceedingly important component of iCCM interventions.…”

“…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. 21 This is important because iCCM programs, which have low utilization and likely low acceptance of services are the least costeffective, do not lead to decreases in mortality, and may decrease demand for biomedical health care, leading the most marginalized to seek care from ineffective providers.…”

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

“…(ii) Household surveys As described by Buchner and colleagues 37 a household survey of mothers of young children was conducted in November 2012 in 15 randomly selected households per village. The tool was translated into the local language, back-translated, and field-tested prior to data collection.…”

“…The tool was translated into the local language, back-translated, and field-tested prior to data collection. 37 Trained research assistants not involved in the study intervention administered surveys verbally. Treatment was determined 'appropriate' if the mother reported that the child received, in age-appropriate dosage, artemether-lumefantrine (Coartem ) for fever, an antibiotic for cough and rapid breathing, and ORS and zinc for diarrhoea.…”

“…Questionnaires surveyed impressions of iCCM: access to care, perceived confidence in CHW services, satisfaction with quality of care, referral, patient encounters, supervision and drug supply. 37 FGDs and KIIs were conducted following at least seven months of iCCM intervention coupled with mobile phone deployment. Participants were caregivers, CHWs, health centre staff, local leaders and government health officials.…”