A Health Systems Approach to Integrated Community Case Management of Childhood Illness: Methods and Tools

Abstract

Integrated community case management (iCCM) of childhood illness is an increasingly popular strategy to expand life-saving health services to underserved communities. However, community health approaches vary widely across countries and do not always distribute resources evenly across local health systems. We present a harmonized framework, developed through interagency consultation and review, which supports the design of CCM by using a systems approach. To verify that the framework produces results, we also suggest a list of complementary indicators, including nine global metrics, and a menu of 39 country-specific measures. When used by program managers and evaluators, we propose that the framework and indicators can facilitate the design, implementation, and evaluation of community case management.

Scaling Up Integrated Community Case Management of Childhood Illness: Update from Malawi

“…In this approach, monitoring program implementation and outputs is an essential pre-requisite to attribute any changes in coverage and/or mortality to the CCM program. The MOH and partners are working to strengthen the availability and reliability of CCM indicators, many analogous to the proposed CCM Benchmark indicators,23 at the district level. An emphasis on better information at the district level through routine monitoring and special exercises, such as telephone surveys among iCCM-trained HSAs to assess drug supplies, frequency and content of supervision, and use of services,16 will provide additional information about the strength of CCM implementation and allow program managers to identify ongoing weaknesses for improvements.…”

Health systems supports for community case management of childhood illness: lessons from an assessment of early implementation in Malawi

“…The initial supervision strategy in the Malawi CCM program of adding CCM supervision to the workload of busy facility-based clinicians, which is common in other programs [43,46,47], may be an unrealistic approach for regular and sustained supervision in many settings. Although CCM programs are often implemented in environments with constrained resources, planning for resources to implement effective supervision strategies is essential for scale-up [24]. Supervision initiatives that include training for supervisors in quality assurance, problem solving and coaching may improve performance and motivation [48-51].…”

“…CBHWs providing CCM services often have no previous clinical experience, are trained for short periods of time, have low levels of education, and are posted in isolated settings [18-22]. As a result, supportive supervision, including observation of case management and corrective feedback, and effective job aids, are considered particularly important for ensuring high quality care by CBHWs [23,24]. Disruptions in supplies of essential drugs prevent CBHWs from providing life saving treatments, and can also damage the credibility of CCM programs and CBHWs among community members [10,25].…”

Routine monitoring systems for integrated community case management programs: Lessons from 18 countries in sub–Saharan Africa

“…The selection and definition of indicators should be informed by global recommendations and the underlying structure and capacity of the health information system [13,14]. Table 2 outlines data elements that should be captured monthly at district level to generate a minimal set of indicators and identifies other data elements that are better captured periodically through household or CHW surveys.…”