The global health community came together in March 2014 in Accra, Ghana to review the evidence from integrated community case management (iCCM) implementation across sub-Saharan Africa in a symposium hosted by UNICEF. Stakeholders from Ministries of Health, implementing partners and donors shared experiences and learning across different thematic areas; policy, supply chain management, costing and cost effectiveness, quality assurance, human resources and deployment, demand creation and social mobilisation, monitoring and evaluation, innovations, community based newborn health and iCCM in the private sector.
A number of programmes across the different countries had conducted endline surveys in the last few months, and the symposium was intended to bring together and use the data and findings as a starting point for a wide variety of discussions on the lessons learned as well as recommendation for the way forward in iCCM implementation. Despite all the varying approaches, findings and ideas a very clear message from the symposium was that, the delivery of well-packaged prevention and treatment strategies that are integrated in order to address multiple illnesses at community level in the form of iCCM can saves lives and improve quality of care. Many programmes found that the use of diagnostic tools for malaria and pneumonia showed a decrease in treatment for both diseases, suggesting improved quality of treatment and care.
Across all thematic areas, some key lessons were shared, (you can find more information from each of the sessions here) but some of the key learning that came from the symposium more widely is that the Government leadership in the development, implementation and sustainability of the programme is essential. In order to achieve its goals, iCCM must be a national priority, well embedded in national health sector plan, and costed with a clear budget provision.
Another important lesson is that, increased utilisation through the deployment of community health workers to areas of greatest need, the assessment of demand barriers and the continuous implementation of community engagement and mobilisation strategies, iCCM can be cost effective and achieve maximum impact. Implementation has to be at scale for a duration of a year or more, in order to achieve high rates of utilisation. Various programmes found that high supervision rates and providing treatment for all three malaria, pneumonia and diarrhoea increased utilisation while medicine stock outs and fee charging decreased it.
Finally, it became evident that routine monitoring of programmes and their implementation is imperative in assessing the extent to which CHWs are providing timely and appropriate treatment to sick children. Many of the programmes discussed at the symposium had conducted endline surveys without having implemented at scale for longer than two years and this data, while useful in certain aspects, was not fully representative of the iCCM picture and could have potentially shown different impact had they been conducted when programmes had implemented at scale for longer periods of time. Many of the programmes, due to donor requirements and international interest, spent a lot of time and money on conducting mortality impact surveys. During the symposium, it became clear that while mortality evaluations are important, at this stage of the iCCM programme it is more crucial to concentrate on scaling up, ensuring quality of service, increasing demand, assessing costs, and conducting process evaluations which have the potential to provide a large amount of useful information.
Such learning and experience sharing has the potential to improve iCCM programme development, planning, implementation and monitoring, therefore impacting greatly on the quality of care provided. Hearing from different stakeholders, especially Ministries of Health on practical elements filled a critical gap in the roll-out of iCCM across different countries and it is widely recommended that countries continue to talk to and learn from eachother’s experiences, adapting to their context. In this way, it is possible that bottlenecks can be addressed and more children reached.
Malaria Consortium is committed to the sustainability and scale up of iCCM and CHW programmes in Uganda and in many other sub-Saharan African countries including Ethiopia, Mozambique, Nigeria, and South Sudan. The organisation’s work focuses on providing the highest quality of care through these programmes while ensuring they are used as a strategy for wider health system strengthening.