Implementing integrated community case management during conflict in Yemen

Abstract

Background The conflict in Yemen has devastated the health system, with only 51% of health facilities classified as fully functional and 19.7 million people lacking access to health care. To address the urgent need for primary health care services in rural communities, Save the Children launched an iCCM program in Lahj and Taiz Governorates. A qualitative study was conducted to document the challenges to iCCM service delivery and to aid in developing strategies for overcoming service delivery bottlenecks in conflict-affected rural areas. Methods Qualitative data were collected in Aden City, Lahj Governorate, and Taiz Governorate. Twenty-three IDIs and six FGDs were conducted with iCCM stakeholders at all levels. Results Key findings included: 1) Policy, coordination, and funding were challenged by the fact that iCCM was not integrated into the national health system and was implemented as a short-term emergency program. 2) Villages that received services from a CHW who was based in a different community experienced reduced access to services, especially during times of heightened conflict and insecurity, when CHWs could not travel. 3) Supervision, supply chain, and monitoring were all challenges that were exacerbated by difficulties in travel due to the conflict. Potential solutions to these included the use of mobile technology for supervision and data collection and pre-positioning of buffer stocks in locations closer to CHWs. 4) Travel was seen as the primary threat to the safety of CHWs and supervisors. Measures taken to reduce the risk included limiting travel during periods of heightened insecurity, safety training for CHWs, and use of mobile technology for communication. Conclusions CHWs were able to provide iCCM services in a challenging and insecure context. The challenges in delivery of services were related to both a weak health system and the conflict. Several adaptations to service delivery to overcome the bottlenecks have been identified and should be considered for future community health programs. The closure of the program in Taiz after only 14 months of implementation is a stark illustration of the failure of the current model of short-term humanitarian funding to address long-term needs in protracted emergencies.

Community-based surveillance in internally displaced people’s camps and urban settings during a complex emergency in Yemen in 2020

“…All suspected and confirmed cases were recorded in the generic line lists of routine surveillance, and the cases reported through CBS were not specified. The challenges reported in Yemen were previously documented during the implementation of the integrated community case management in 2017 and are similar to those in other developing countries that attempted CBS implementation [ 15 , 25 , 29 ]. The cost of setting set up a CBS system to support routine surveillance is usually huge, exceeding 1000,000 USD for the purchase of motorbikes, organisation of trainings, purchase of mobile phones and other items, excluding a monthly running costs that may exceed 100,000 USD in a country such as Sierra Leone [ 14 ].…”

“…This may have led to fear of the households that neighbours and other people in the streets would hear their conversation with GCHVs. The implementation of CBS in urban areas such as Al-Mukalla city is usually a challenge, requiring better coordination and an extensive education of communities, as demonstrated in Kenya and Yemen during the implementation of integrated community case management program in 2017 [ 23 , 25 ].…”

“…However, in Yemen, proper assessments were not performed because the project was implemented as part of an emergency response rather than as routine surveillance. The community and local authorities perceptions regarding CBS, reasons of low reporting of cases to the health facilities, proper calculation of resources and supplies needed, sustainability and other aspects should be considered before the implementation of CBS [ 25 , 28 ].…”

Examining the evidence for best practice guidelines in supportive supervision of lay health care providers in humanitarian emergencies: A systematic scoping review

“…Eight articles clearly described the supervisory parameters used including the type of supervision (peer, group, individual, etc. ), whereas the supervision format was unclear in the remaining three articles [ 42 , 43 , 47 ]. More than half of the included research defined the goals of supervision [ 14 , 32 , 41 , 44 , 49 , 50 ].…”

Evidence on Child Nutrition Recommendations and Challenges in Crisis Settings: A Scoping Review

“…As such, community-led selection is an important mechanism to identify the right persons to understand those community contexts, needs and priorities [ 59 ]. Furthermore, integrating nutrition interventions during emergency situations into the national health service plan can strengthen the effectiveness and sustainability of the program implementation [ 59 , 61 ]. This does not mean that communities need to rely on themselves alone without adhering to the official health standards.…”