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

Abstract

The Government of Malawi (GoM) initiated activities to deliver treatment of common childhood illnesses (suspected pneumonia, fever/suspected malaria, and diarrhea) in the community in 2008. The service providers are Health Surveillance Assistants (HSAs), and they are posted nationwide to serve communities at a ratio of 1 to 1,000 population. The GoM targeted the establishment of 3,452 village health clinics (VHCs) in hard-to-reach areas by 2011. By September of 2011, 3,296 HSAs had received training in integrated case management of childhood illness, and 2,709 VHCs were functional. An assessment has shown that HSAs are able to treat sick children with quality similar to the quality provided in fixed facilities. Monitoring data also suggest that communities are using the sick child services. We summarize factors that have facilitated the scale up of integrated community case management of children in Malawi and address challenges, such as ensuring a steady supply of medicines and supportive supervision.

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

“…However, other research has shown that many iCCM programs have not achieved decreases in mortality and fail to perform on intermediate outcomes. [13][14][15][16] Especially, troubling is the result of a study in which adding pneumonia management to an existing program of diarrhea and malaria community management led to no statistically significant reduction in mortality in a well-controlled randomized controlled trial. 15 Therefore, it is imperative to perform research that assesses the efficacy and acceptability of iCCM programs.…”

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…Currently, governments throughout sub-Saharan Africa are scaling up a variety of CCM and iCCM programs. [4][5][6][7][8][9] During the past three decades, national CCM programs in countries such as Nepal, Pakistan, Honduras, and Senegal have targeted specific (and often single) diseases, with partial CCM coverage in over forty other countries. dition, depending on the child's presentation.…”

“…16,17 African iCCM studies are few, 14,18 and less still have assessed health outputs and outcomes. 5,14,[19][20][21][22][23] National programs in sub-Saharan Africa are new and while early studies are demonstrating implementation feasibility and early positive outcomes 7,8 , more studies are needed to understand implementation in a variety of contexts including use of volunteer CHWs with limited formal education and short iCCM training.…”

First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project’s Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh

“…Although prior evidence exists that community-based maternal, neonatal, and child health programs improve health, [23][24][25][26] most programs have been rural and have had a more vertical focus, [25][26][27][28][29] with limited published information on their implementation strategies. Two successful, comprehensive rural programs that have detailed their implementation strategies are the Rwandan national CHW program, 30,31 and the home-based neonatal care program of SEARCH in central India.…”