Three quarters of deaths in children under five are caused by pneumonia, diarrhoea, malaria and newborn conditions; more than a third of these deaths are linked to malnutrition. In many cases, the deaths could have been avoided if the child had received the appropriate treatment quickly enough. But access to quality health care is often hardest in areas where the need is greatest. In many rural areas, distance and poverty mean a sick child may not get to the nearest health facility in time to receive life-saving treatment.
Working with the community to address the challenges of access to quality healthcare has become a major focus for many governments around the world. Many countries in sub-Saharan Africa have adopted policies to train selected community members in the skills required to diagnose, treat and, in serious cases, refer young children suffering from these conditions. This brings essential health care for the most vulnerable right to their doorstep – bringing skills to the community, reducing the burden on overstretched health facilities and, most importantly of all, saving lives by saving time.
This approach, known as integrated community case management (or iCCM), is based on the evidence that the most common childhood killers can be readily and safely diagnosed and treated by people within the community, including those with limited education and medical training.
iCCM can only be effective as part of a wider health systems strengthening approach; for this reason implementing governments need to ensure appropriate policies are in place and that community health workers are well-trained and equipped, supported by the formal health system and motivated in order to provide high quality care.
Malaria Consortium has supported ministries of health to train and equip community health workers in iCCM in Mozambique, Nigeria, South Sudan, Uganda and Zambia to diagnose and treat the three common childhood illnesses or refer sick newborns and severe cases to the nearest health facility. We have been building on this work in Uganda and Mozambique since 2010, looking at innovations to address some of the key issues affecting community based health delivery. In South Sudan, we have integrated nutrition into our iCCM programmes, allowing community health workers to address undernutrition as well as common childhood illnesses. In 2015, we expanded our iCCM work to Myanmar, which has the highest child mortality rate in Southeast Asia.
In addition to iCCM, we also work with communities to improve health-seeking behaviours and to change attitudes and perceptions through community dialogues, health clubs and behaviour change initiatives. These strategies have been found to be highly effective in motivating rural communities to identify and address common health challenges that they face on a daily basis.
We also work with communities to improve delivery and uptake of drugs, such as for seasonal malaria chemoprevention and mass drug administration for neglected tropical diseases. Despite these drugs being highly effective and affordable when administered, resistance and misconceptions from the community can often pose a challenge to achieving coverage. By sensitising people to these strategies through dialogues, health clubs, outreach to religious leaders, town criers and mass media, we are able to reach the most vulnerable and remote populations more effectively. Lastly, we help facilitate the distribution of long lasting insecticide treated mosquito nets to remote communities and follow up with villagers to ensure proper usage and sufficient coverage.