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Can integrated community management of childhood diseases improve care in the context of rapid urbanisation?

31 March 2016

According to World Health Organization (WHO) figures, 5.9 million children under the age of five died in 2015 – that is 16,000 every day. Africa continues to be the most affected continent and many child deaths are caused by malaria, pneumonia and diarrhoea. A promising strategy to improve access to essential health services consists of training selected community members in the skills required to diagnose, treat and refer children suffering from these three diseases, reducing the burden on health facilities and bringing services to the doorstep of those most in need. This approach is known as integrated community case management (iCCM) and has been successfully adopted by Malaria Consortium through a range of projects and countries.

There is plenty of evidence that iCCM is effective in improving health services and reducing childhood deaths in hard to reach, underserved rural areas. However, given the rapid urbanisation in many countries, more evidence is needed to determine whether iCCM is a viable strategy to reach poor and underserved populations in more urban settings. To help answer this question, Malaria Consortium conducted a community-based participatory evaluation in Wakiso district, Uganda, an area close to the country’s capital Kampala and which has been undergoing rapid urbanisation.

The study collected data from 84 caregivers of children under five and 14 community members who had been trained in iCCM and had been providing services to the local communities for several months. Study participants reported that the main benefit of iCCM was timely access to diagnosis and treatment of common childhood diseases. Trained community members were seen as better first points of contact than private clinics and traditional healers. They also praised the fact that iCCM services were offered free of charge. The trained community members were generally judged to be capable of carrying out their duties and that the services they provided were being used by the community. It was recommended that the process of selecting those community members trained in iCCM should be more participatory to ensure the service is perceived as community owned. Participants also pointed out that while iCCM was an effective strategy to refer serious cases to nearby health facilities, lack of transport and stock outs of drugs at facilities continued to be a major constraint.

The study concluded that iCCM may be a useful strategy to improve access to health services even in dynamic, urbanised settings. However, more research is required to determine the best approach to address the specific health needs of populations in areas undergoing urbanisation. Continued investment is also required to strengthen referral systems and supply chains and ensure people referred to health facilities by trained community members receive the care they need.

An article summarising the study results in more detail will soon be submitted to a peer-reviewed journal. The study was funded by COMDIS-HSD, a Research Programme Consortium funded by the UK government and led by the Nuffield Centre for International Health and Development at the University of Leeds. The writing of the article has also been supported by the Programme Partnership Arrangement from the UK government.

Keywords: Surveillance, monitoring and evaluation | Community delivery

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