Using the RE‐AIM framework to evaluate the implementation of integrated community case management in Kenya

Abstract

Aim: To evaluate an integrated community case management programme for sick children aged 2 to 59 months in western Kenya using the Research, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods: This was a prospective observational research project conducted betweenDecember 2013 and February 2016. Outcome variables were measured before, during and at end of implementation using a series of surveys as well as by looking at routine service statistics.Results: A total of 2604 community health workers were trained in 245 community units.The average post-training knowledge level (73.5%) and retention rates (89.7) of trained community health workers was high. At the end of study, there was an increase in the proportion of children who received appropriate treatment for diarrhoea (49.2%), pneumonia (19.5%), malaria (16.4%) and vitamin A (51.5%) from baseline. Community health workers were able to assess, classify and treat sick children with a similar quality as that provided by facility-based healthcare workers (>85% concordance).Conclusion: Based on the RE-AIM metrics, our results demonstrate promising practical approaches and outcomes of a large-scale implementation of integrated community case management in western Kenya. The findings have important implications for future design and expansion of the programme in Kenya.When community health workers are trained, supervised and supported, they are able to have adequate knowledge, skills and competency to provide quality services including treatment of sick children Mechanisms of performance review and clinical accreditation of skills after basic training are needed in order to produce and maintain competency among community health workers. Availability of commodities for community health workers coupled with strong health facility-community linkages are crucial to success.

Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study

“…However, there are a number of challenges in the widespread adoption and scale up. These challenges include lack of formalized recognition within health care systems including lack of remuneration, standardized training, supervision, quality assurance and meaningful participation in decision-making [31, 46, 55–57]. Based on reports from several African settings, mentor mothers have first-hand knowledge of HIV, strong ties to communities, and can gain the trust of other mothers in their communities, making them particularly suited for community-based interventions [19].…”

Effects of an expanded Uber-like transport system on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homa Bay, Kenya

“…Prior to launching the mAccess project, the investigators on this project had worked with the local community members and the county health management team and launched a mobile phone-enhanced integrated community case management (iCCM) of pneumonia, malaria, diarrhoea and vitamin A supplementation in children aged 2–59 months in Homa Bay County 16. The team trained ~90 County and subcounty healthcare workers to be trainers of trainers in iCCM and CMNH, and further trained a total of 2604 CHWs and 251 community health extension workers in 245 community units across eight subcounties ensuring 100% coverage of the county with essential community child-based interventions 17. Unfortunately, pregnant and postpartum women were not covered by these services and there was a need to address this population while leveraging the existing structures that had been set up.…”

Implementation research for maternal, newborn and child health

“…Four of the studies examined the effect of interventions on community health worker (CHW) performance. Three papers specifically looked at the delivery of integrated community case management (iCCM) of childhood illnesses by CHWs in rural Haryana, India , and in Homa Bay County, Western Kenya ; one study looked at an intervention to enhance supportive supervision of lady health workers (LHWs) on iCCM of childhood pneumonia and diarrhoea in Badin District, Pakistan . Another study tested an mHealth intervention to improve knowledge and skills related to MNCH care of accredited social health activists (ASHA) in Bharuch and Narmada districts of Gujarat, India .…”

“…the health worker motivation strategy in Nepal outlined in Baral et al., 2018) . Box 1 provides an example of how two projects have been scaled up (an example of iCCM in Kenya and in community‐based services for pneumonia in Pakistan ).…”