Community case management in Nicaragua: lessons in fostering adoption and expanding implementation

George, Asha; Menotti, Elaine P.; Rivera, Dixmer; Marsh, David

doi:10.1093/heapol/czq048

Cited by 30 publications

(20 citation statements)

References 21 publications

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“…In the present case, the intervention area is also endemic for schistosomiasis (Malaria Consortium, unpublished) and is being targeted by a programme for integrated community-case management (iCCM) to treat malaria, pneumonia and diarrhoea [34], [35]. While drug safety recommendations would currently not allow the co-administration of antibiotics with praziquantel for schistosomiasis control [25], there may be ways in which iCCM and its support/supervision system could be harnessed to contribute to trachoma and/or schistosomiasis control.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

Kolaczinski

Robinson²,

Finn³

2011

PLoS Negl Trop Dis

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BackgroundMass drug administration (MDA) of antibiotics is a key component of the so-called “SAFE” strategy for trachoma control, while MDA of anthelminthics provides the cornerstone for control of a number of other neglected tropical diseases (NTDs). Simultaneous delivery of two or more of these drugs, renowned as “integrated NTD control,” is being promoted to reduce costs and expand intervention coverage. A cost analysis was conducted alongside an MDA campaign in a remote trachoma endemic area, to inform budgeting for NTD control in South Sudan.Methods and FindingsA first round of antibiotic MDA was conducted in the highly trachoma endemic county of Mayom, Unity state, from June to August 2010. A core team of seven staff delivered the intervention, including recruitment and training of 44 supervisors and 542 community drug distributors. Using an ingredients approach, financial and economic costs were captured from the provider perspective in a detailed costing database. Overall, 123,760 individuals were treated for trachoma, resulting in an estimated treatment coverage of 94%. The economic cost per person treated was USD 1.53, excluding the cost of the antibiotic azithromycin. Ninety four per cent of the delivery costs were recurrent costs, with personnel and travel/transport costs taking up the largest share.ConclusionsIn a remote setting and for the initial round, MDA of antibiotics was considerably more expensive than USD 0.5 per person treated, an estimate frequently quoted to advocate for integrated NTD control. Drug delivery costs in South Sudan are unlikely to decrease substantially during subsequent MDA rounds, as the major cost drivers were recurrent costs. MDA campaigns for delivery of one or more drugs in South Sudan should thus be budgeted at around USD 1.5 per person treated, at least until further costing data for delivery of other NTD drugs, singly or in combination, are available.

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Section: Discussionmentioning

confidence: 99%

The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

Kolaczinski

Robinson²,

Finn³

2011

PLoS Negl Trop Dis

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“…Finally, all this takes place with a particular context (for example, the particular role of the state, within a specific cultures and the current economic situation), which along with the policy content formed the three apices of the triangle around the actors. This model, or variants of it, continues to be used in resource poor contexts for analysis of health policy [30-32]. In our analysis, too, particular attention was paid to the complex inter-relationships between the actors (forming the centre of the triangle) and the context, processes and content.…”

Section: Methodsmentioning

confidence: 99%

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Taegtmeyer

Martineau

Namwebya³

et al. 2011

BMC Public Health

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BackgroundKenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle).MethodsQualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred.ResultsThe scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach.ConclusionThe introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact.

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“…Many countries are starting to implement CCM on a large scale. However, there is insufficient attention in the literature to implementation factors that lead to successful scale-up of CCM programs 4. This study addresses one key factor in the implementation of CCM, namely perceptions about the program among community-based health workers, their supervisors, and senior district managers.…”

Section: Introductionmentioning

confidence: 99%

“…Clinicians and professional medical associations have objected to the delegation of clinical tasks to lay health workers in several program areas, including human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) 4,11–14. In addition, there is a history of resistance to programs using community-based health workers (CBHWs), and the public health community has debated the role of CBHW cadres for decades, particularly whether these workers should provide curative services 13,15.…”

Section: Introductionmentioning

confidence: 99%

Health Workers' and Managers' Perceptions of the Integrated Community Case Management Program for Childhood Illness in Malawi: The Importance of Expanding Access to Child Health Services

Callaghan-Koru¹,

Hyder²,

George³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Community case management (CCM) is a promising task-shifting strategy for expanding treatment of childhood illness that is increasingly adopted by low-income countries. Its success depends in part on how the strategy is perceived by those responsible for its implementation. This study uses qualitative methods to explore health workers' and managers' perceptions about CCM provided by health surveillance assistants (HSAs) during the program's first year in Malawi. Managers and HSAs agreed that CCM contributed beneficially by expanding access to the underserved and reducing caseloads at health facilities. Managers differed among themselves in their endorsements of CCM, most offered constrained endorsement, and a few had stronger justifications for CCM. In addition, HSAs uniformly wanted continued expansion of their clinical role, while managers preferred to view CCM as a limited mandate. The HSAs also reported motivating factors and frustrations related to system constraints and community pressures related to CCM. The impact of CCM on motivation and workload of HSAs is noted and deserves further attention.

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Community case management in Nicaragua: lessons in fostering adoption and expanding implementation

Cited by 30 publications

References 21 publications

The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Health Workers' and Managers' Perceptions of the Integrated Community Case Management Program for Childhood Illness in Malawi: The Importance of Expanding Access to Child Health Services

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