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About inSCALE

The inSCALE project ran from 2010 to 2016. See our About upSCALE page for the latest information.

inSCALE Project

Innovations at Scale for Community Access and Lasting Effects (inSCALE), is a research project in Uganda and Mozambique looking at community based health delivery, known as integrated community case management or iCCM.

The project is funded by the Bill & Melinda Gates Foundation and led by Malaria Consortium, in collaboration with the London School of Hygiene and Tropical Medicine and University College London’s Institute for Global Health. For more information on the inSCALE project team, click here.

Several low income countries across Africa and Asia are scaling-up iCCM through their health systems as a way of increasing access to quality care in rural areas where health infrastructure is weak or non-existing. Mozambique and Uganda are among these countries.  However, the community health workers (CHWs) providing iCCM, have limited access to supervision from formal health authorities, lack motivation, and are affected by the low availability and usage of community health data, all of which hamper the effective progression of the programmes.

The aim of the inSCALE project is to demonstrate that government led iCCM in Uganda and Mozambique can be rapidly expanded without compromising on quality of care, if innovative solutions can be found for these critical limitations. Once feasible and acceptable solutions are identified, these can be used to increase the coverage of iCCM and improve its quality so that more children under five have prompt access to appropriate treatment for malaria, pneumonia and diarrhoea.

As a result inSCALE has been working since 2010 to:

  • Identify best practices in implementing iCCM at sub-national levels in Uganda and Mozambique, and identify innovations in iCCM with potential to increase coverage and improve the quality of iCCM through better performance and retention of CHWs
  • Assess the feasibility of identified innovations and their acceptability among community members, CHWs, facility-based health workers, sub-national and national health authorities
  • Evaluate innovations with the potential to increase coverage of iCCM and improve its quality through better CHW performance and retention
  • Cost the innovations which demonstrate effectiveness in improving iCCM coverage and quality through better CHW performance and retention and investigate the potential for economies of scale and scope
  • Promote implementation spread of iCCM by collaborating with ministries of health, sub-national health authorities and stakeholders, to share experiences and findings that improve coverage of iCCM and improve its quality.

Through the initial stages of the inSCALE project, two different innovations were identified as a potential means to address motivation, performance and retention of CHWs; one innovation uses mobile phone technology and the other is community engagement based using village health clubs. Both interventions have been trialled in Uganda, whereas in Mozambique the focus of inSCALE has been on mobile phone technology only.