The way forward for integrated community case management programmes: A summary of lessons learned to date and future priorities

Young, Mark; Sharkey, Alyssa; Aboubaker, Samira; Kasungami, Dyness; Swedberg, Eric; Ross, Kerry

doi:10.7189/jogh.04.020303

Cited by 12 publications

(14 citation statements)

References 14 publications

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“…The service delivery for iCCM typically depends on lay, often volunteer, community health workers (CHWs) selected and trained to render the service in their communities [4]. Successful and sustainable iCCM services depend on appropriate selection, training, supervision and support to these CHWs [8-10]. However, there are challenges related to engagement and sustaining of volunteer health workers.…”

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confidence: 99%

“…These challenges have resulted in varied rates of performance and retention among these workers with an attrition range of 3% to 77% documented in a variety of community health delivery programmes [12-14]. Attrition of CHWs negatively affects access to, and utilisation of iCCM services [11,12]; and improvement in utilisation of services has been shown to be dependent on effective demand creation and social mobilisation [8,15].…”

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confidence: 99%

“…Evidence has shown that social mobilisation is one of the key features of successful public health programmes [16,17]. However, the need to continue to assess and address the demand barriers for iCCM through behaviour change, community engagement and social mobilisation activities was identified at an international symposium in 2014 on lessons and priorities for iCCM [8].…”

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confidence: 99%

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Community engagement and mobilisation of local resources to support integrated Community Case Management of childhood illnesses in Niger State, Nigeria

Alegbeleye

Dada²,

Oresanya³

et al. 2019

Journal of Global Health

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Background Despite strong evidence of integrated community case management (iCCM) of childhood illnesses being a proven intervention for reducing childhood morbidity and mortality, sustainability remains a challenge in most settings. Community ownership and contribution are important factors in sustainability. The purpose of this study was to document the process and scale achieved for community engagement and mobilisation to foster ownership, service uptake and sustainability of iCCM activities. Methods A review of data collected by the RAcE project was conducted to describe the scale and achievement of leveraging community resources to support the community-oriented resource persons (CORPs). The Rapid Access Expansion (RAcE)-supported iCCM programme in Niger state (2014-2017), aimed at improving coverage of case management services for malaria, pneumonia, and diarrhoea, among children aged 2–59 months. Resources donated were documented and costed based on the market value of goods and services at the time of donation. These monetary valuations were validated at community dialogue meetings. Descriptive statistics were used to summarise quantitative variables. The mean of the number of CORPs in active service and the percentages of the mobilised resources received by CORPs were calculated. Results The community engagement activities included 143 engagement and advocacy visits, and meetings, 300 community dialogues, reactivation of 60 ward development committees, and 3000 radio messages in support of iCCM. 79.5% of 1659 trained CORPs were still in active iCCM service at the end of the project. We estimated the costs of all support provided by the community to CORPs in cash and kind as US$ 123 062. Types of support included cash; building materials; farming support; fuel for motorcycles, and transport fares. Conclusions The achievements of community engagement, mobilisation, and the resources leveraged, demonstrated acceptability of the project to the beneficiaries and their willingness to contribute to uninterrupted service provision by CORPs.

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Community engagement and mobilisation of local resources to support integrated Community Case Management of childhood illnesses in Niger State, Nigeria

Alegbeleye

Dada²,

Oresanya³

et al. 2019

Journal of Global Health

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“…4 However, little is known about the effectiveness of the strategy in reducing under-five mortality when implemented at scale by governments and partners. There is a large and growing body of research focusing on iCCM implementation and intermediate outcomes, 11 including the iCCM policy adoption process, 12 the extent and challenges of implementing iCCM in low- and middle-income countries, 9 the quality of care provided by health-care workers trained in iCCM, 13 , 14 and the health system supports needed to implement iCCM effectively. 15 …”

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confidence: 99%

Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design

Amouzou¹,

Kanyuka²,

Hazel³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.

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“…Communities defined as hard-to-reach due to their limited access to a health facility typically employ an iCCM strategy. For iCCM interventions, routine data are vital to assess program performance and identify areas for improvement [13,14,18,19]. However, iCCM data face several data quality problems, both due to challenges specific to CHWs and because adding another level to the reporting system creates more opportunities for errors.…”

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iCCM data quality: an approach to assessing iCCM reporting systems and data quality in 5 African countries

Davis

Zalisk

Herrera

et al. 2019

Journal of Global Health

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Background Ensuring the quality of health service data is critical for data-driven decision-making. Data quality assessments (DQAs) are used to determine if data are of sufficient quality to support their intended use. However, guidance on how to conduct DQAs specifically for community-based interventions, such as integrated community case management (iCCM) programs, is limited. As part of the World Health Organization’s (WHO) Rapid Access Expansion (RAcE) Programme, ICF conducted DQAs in a unique effort to characterize the quality of community health worker-generated data and to use DQA findings to strengthen reporting systems and decision-making. Methods We present our experience implementing assessments using standardized DQA tools in the six RAcE project sites in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria. We describe the process used to create the RAcE DQA tools, adapt the tools to country contexts, and develop the iCCM DQA Toolkit, which enables countries to carry out regular and rapid DQAs. We provide examples of how we used results to generate recommendations. Results The DQA tools were customized for each RAcE project to assess the iCCM data reporting system, trace iCCM indicators through this system, and to ensure that DQAs were efficient and generated useful recommendations. This experience led to creation of an iCCM DQA Toolkit comprised of simplified versions of RAcE DQA tools and a guidance document. It includes system assessment questions that elicit actionable responses and a simplified data tracing tool focused on one treatment indicator for each iCCM focus illness: diarrhea, malaria, and pneumonia. The toolkit is intended for use at the national or sub-national level for periodic data quality checks. Conclusions The iCCM DQA Toolkit was designed to be easily tailored to different data reporting system structures because iCCM data reporting tools and data flow vary substantially. The toolkit enables countries to identify points in the reporting system where data quality is compromised and areas of the reporting system that require strengthening, so that countries can make informed adjustments that improve data quality, strengthen reporting systems, and inform decision-making.

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The way forward for integrated community case management programmes: A summary of lessons learned to date and future priorities

Cited by 12 publications

References 14 publications

Community engagement and mobilisation of local resources to support integrated Community Case Management of childhood illnesses in Niger State, Nigeria

Community engagement and mobilisation of local resources to support integrated Community Case Management of childhood illnesses in Niger State, Nigeria

Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design

iCCM data quality: an approach to assessing iCCM reporting systems and data quality in 5 African countries

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