Evidence shows that effective and sustainable interventions in disease management at the community level targeting diarrhoea, pneumonia and malaria greatly improve health outcomes for children under five in sub-Saharan African countries where progress on the reduction of child mortality and morbidity is lagging.

However these interventions need the support of strong institutional health systems, and these are often too weak and fragmented to enable the scaling-up of essential child health interventions. In response to this need, several African countries are currently investing in community health workers (CHWs) to deliver life saving treatment to young children. Issues of high attrition and low performance among CHWs create challenges for implementing governments, which are attempting to scale up community based care.

Mozambique and Uganda were selected for implementation as both countries have demonstrated the ability for regional influence and a willingness to make a firm commitment to community based care as a way of reducing mortality and morbidity in children under five. The Ugandan Ministry of Health has, for example, pioneered a nationwide programme for home-based management of fever, demonstrating to the international community what can be achieved through community-based programming at scale and its impact on the disease burden. The APE (agentes polivalentes elimentares, or community health workers) programme in Mozambique has been in existence for over 30 years. APEs were regarded as one of the key community level actors who could help extend primary healthcare to rural communities. After the ruptures caused by the civil war, the programme is now being revitalised and community based care of children with diarrhoea, pneumonia and malaria through APEs is now part of the national Public Health Strategy.

You can watch specially produced films highlighting the need for community based agents in Uganda and the challenges they face as they try to provide villages with access to diagnostics and treatment for main childhood illnesses. For more information, click here.