Community based health delivery systems
Three quarters of deaths in children under five are caused by malaria, pneumonia, diarrhoea and newborn conditions; more than a third of these deaths are linked to malnutrition. It is often the case, that access to quality health care is 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 appropriate treatment.
Working with the community to tackle these challenges of access to treatment has become a major focus for many governments around the world. Many governments in sub-Saharan Africa are working to train selected community members in the skills required to diagnose, treat and, in serious cases, refer young children suffering from these three diseases. 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, centres around the idea that the most common childhood killers can be readily diagnosed and treated by people within the community, including those with limited education and medical training.
Research has shown that integrated community case management (iCCM), diagnosing and treating diarrhoea, pneumonia and malaria in children under five at community level, as well as identifying and referring sick newborns has the potential to decrease childhood mortality from these three diseases by 60 percent. In a joint statement released in 2012 by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF), it is stated that appropriately trained community health workers (CHWs), who are supported, supervised and provided with a continuous supply of medicines and equipment can identify and appropriately treat children with diarrhoea, pneumonia and malaria.
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 CHWs 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, 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 through our CIDA - iCCM project (2009-2013). We have been building on this work in Uganda and Mozambique since 2010 through our inSCALE project, which is looking at innovations to address some of the key issues affecting community based health delivery.