MSH Presents Best Practices at 2014 Integrated Community Case Management (iCCM) Evidence Review Symposium

MSH Presents Best Practices at 2014 Integrated Community Case Management (iCCM) Evidence Review Symposium

 {Photo credit: MSH.}MSH representatives attend the iCCM Symposium. From left to right: Jean Fidele Ilunga Mubay (DRC Ministry of Health), David Collins, Pascaline Hareimana (MSH/Burundi), Papy Luntadila (MSH/DRC), Ciro Franco, Jane Briggs, Naia Embeke Narcisse (MSH/DRC), Colin Gilmartin, Zina Jarrah, Uzaib Saya.Photo credit: MSH.

In the absence of effective treatment and access to quality health services, diarrhea, malaria, and pneumonia remain the leading causes of child mortality in sub-Saharan Africa and cause nearly 44 percent of deaths worldwide in children under five years old. To improve access to life-saving treatment among children, many African countries have begun implementing and scaling-up integrated community case management (iCCM), a strategy that focuses on the delivery of timely and low-cost interventions at the community level by community health workers.

Understanding the potential impact and the importance of iCCM as an effective means to reduce child mortality, more than 400 researchers, donors, government, implementers, and partners representing 35 sub-Saharan African countries convened on March 3-5 in Accra, Ghana for the 2014 Integrated Community Case Management (iCCM) Evidence Review Symposium.

The objectives of the Symposium were to review the current state of the art and evidence of iCCM implementation and to assist African countries to integrate and take action on key iCCM findings presented during the evidence symposium. Among those in attendance were 10 Management Sciences for Health (MSH) representatives from Burundi, the Democratic Republic of the Congo, and the United States.

Serving as the thematic leads for Costing and Financing at the Symposium, David Collins (Senior Principal Technical Advisor) and Zina Jarrah (Technical Adviser) of MSH presented alongside Emmanuelle Daviud of the South African Medical Research Council and Eric Swedberg of Save the Children on a panel focused on using costing and cost-effectiveness to make informed policy decisions. Recognizing the importance of the financial and economic aspects of iCCM program design and evaluation, David Collins, who served as the panel moderator, asked the audience, “If you want to scale up [iCCM programs] how much will it cost?”

Despite the evidence of iCCM in several African countries, many have yet to implement or expand iCCM, partly due to a lack of evidence around the cost-effectiveness of iCCM programs. Zina Jarrah, who presented on iCCM costing in five African countries (Cameroon, the Democratic Republic of the Congo, Sierra Leone, South Sudan, and Zambia), emphasized that having an understanding of the costs and cost-drivers is important for countries which seek to maximize the use of scarce resources.

According to Jarrah, contextual factors (e.g. supervision costs, trainings, prices of medicines, etc.) can have a significant impact on the overall cost of iCCM programs. Said Jarrah: "iCCM programs should be well-utilized in order to improve cost-effectiveness."

Dr. Ciro Franco, MSH Senior Principal Technical Adviser for maternal, newborn, and child health, also presented at the Symposium on a panel entitled “Supervision and Performance Quality Assurance.” According to Dr. Franco, to improve the quality of iCCM care, the supervision of community health workers (CHWs) is essential. In particular, improving the link between health centers and CHWs and establishing ongoing supervision of CHWs can improve their performance.

Presenting on the iCCM supervision strategy of the USAID-funded Benin BASICS project, Dr. Franco noted that after six months of ongoing methods of supervision (e.g. CHW group supervision and individual on-site coaching), CHWs reported higher rates of appropriate treatment. In addition, CHW supervisors (e.g. nurses, health center supervisors) became increasingly involved an interested in CHW tasks. Said Dr. Franco: "CHWs are capable of performing [iCCM] tasks when there is appropriate and ongoing follow-up."

[Dr. Ciro Franco, Senior Principal Technical Advisor for MNCH, presenting on a panel - Supervision and Performance Quality Assurance. Dr. Franco discussed various supervision strategies that the MSH-ledBenin BASICS project used to improve the quality of iCCM services.] {Photo credit: Colin Gilmartin/MSH.}Dr. Ciro Franco, Senior Principal Technical Advisor for MNCH, presenting on a panel - Supervision and Performance Quality Assurance. Dr. Franco discussed various supervision strategies that the MSH-ledBenin BASICS project used to improve the quality of iCCM services.Photo credit: Colin Gilmartin/MSH.

In addition to the lessons from MSH-led presentations, there were several key takeaways from the Symposium.

  1. Government leadership and political will is essential for ensuring the success of iCCM programs. iCCM programs must be integrated in national health systems and should be embedded as national health sector plans, with a clear budget line.
  2. While there is no single model for supervising or managing CHWs, high supervision rates can increase the quality, utilization and motivation of CHWs.
  3. In terms of the utilization of iCCM programs, stockouts of essential medicines are a deterrent in patients seeking care from CHWs. Providing combined treatment for malaria, pneumonia, and diarrhea increases the utilization of treatment for each illness.
  4. iCCM programs should be reviewed and evaluated to ensure best practices for implementation and scale-up.

Learn more about the 2014 iCCM Symposium

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