Community Case Management of Childhood Illness in Nicaragua: Transforming Health Systems in Underserved Rural Areas

Abstract

While social factors broadly determine health outcomes, strategic health workforce innovations such as community case management (CCM) can redress social inequalities in access to health care. Community case management enables trained health workers to assess children, diagnose common childhood infections, administer medicines, and monitor life-saving treatment in the poor, remote communities where they reside. This article reports on research that combined focus group discussions and key informant interviews to examine the perceptions of multiple stakeholders, with monitoring data, in order to assess programmatic results, limitations, and lessons learned in implementing CCM in Nicaragua. We found that CCM increases the use of curative services by poor children with pneumonia, diarrhea, or dysentery by five to six-fold over facility-based services. Apart from dramatically increasing geographic access to treatment for underserved groups, our qualitative research suggests that Nicaragua's CCM model also addresses the managerial challenges and social relations that underpin good quality of care, care-giver knowledge and awareness, and community mobilization, all health system-strengthening factors that are central to equitably and effectively improving child health. While our findings are promising, we suggest areas for further operational research to strengthen CCM program learning and functioning.

How female community health workers navigate work challenges and why there are still gaps in their performance: a look at female community health workers in maternal and child health in two Indian districts through a reciprocal determinism framework

“…ASHAs employed empathetic communication when talking to women. CHWs are readily accepted when close relationships are forged with the community based on trust and empathy [12, 22, 37–39]. Similarly, support from their families in household chores enabled them to undertake many activities while involvement of their husbands enabled them to indirectly influence the men in the community.…”

Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

“…Programmes targeted at attracting health professionals to severely under-resourced settings have achieved varying degree of success [9][10][11]. Particularly in the post-conflict reconstruction, heavy spending without proper needs assessment leads to less effective outcomes [12].…”

“…Motivating health professionals for placement in underserved settings is broadly determined by the level of understanding of the community concerned [10,13,14], the cultural norms, and organizational determinants such as good human resources management [15]. In post-conflict situations, deterioration of the health system as a whole, social tensions between the confronting groups and the destroyed economy are additional challenges [1,9,16].…”

Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study

“…And the fact that this long delay 1 of 2 days did not vary significantly from seeking care at the community or at the facility levels, nor within perceived severity groups at illness onset warrants the need to reinforce the community–based Integrated Management of Childhood Illness (C–IMCI) strategy that improves case management skills of health workers, strengthens the health care system, and addresses family and community practices. The opportunity with C–IMCI to consult a health worker at any time of the day or night, 7 days per week facilitates prompt treatment–seeking and case management [39–41]. …”