UNICEF Perspectives on Integrated Community Case Mangement (iccm) scale up across Africa

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1 UNICEF Perspectives on Integrated Community Case Mangement (iccm) scale up across Africa Valentina Buj, Malaria Health Specialist, UNICEF MMV Access Meeting, Dar Es Salaam 03 June 2011

2 Integrated Community Case Management (iccm) Integrated delivery of ORT, zinc, oral antibiotics, & effective antimalarials (esp. ACTs) Increasing focus on diagnostics (esp RDTs) Evidence demonstrates that CHWs provided with adequate training, supervision, tools, and logistics support, can identify and appropriately treat children with diarrhea, pneumonia, and malaria Source: UNICEF, draft iccm report, 2011

3 Pneumonia, diarrhea and malaria together account for more than half of childhood deaths in the post-neonatal period Prompt and effective treatment for these killers is essential for reducing child mortality and achievement of MDG4. New preventive interventions especially pneumococcal and rotavirus vaccines will help reduce this mortality burden BUT high coverage with these new interventions will take time. Poor and disadvantaged children without easy access to services are most at risk. In most high mortality countries, facilitybased services alone do not provide adequate access to treatment for these major childhood diseases Only 39% of children receive correct treatment for diarrhea Only 27% of children with suspected pneumonia receive an antibiotic Only 34% of children with fever (suspected malaria) receive antimalarial medicines (Source: UNICEF, various publications, )

4 Results expected An integrated strategy can increase the coverage of high quality services to deliver these high impact treatments: Community case management of pneumonia could result in a 70% reduction in mortality in children under five Community case management of malaria can reduce overall and malaria-specific U5 mortality by 40% and 60% respectively, and severe malaria morbidity by 53% ORS and zinc have also been found effective against diarrhea mortality in home and community settings, with ORS estimated to prevent 93% of diarrhea deaths, and zinc estimated to decrease diarrhea mortality by 23%. (Source: CHERG estimates and various peer-reviewed publications)

5 Results Framework GOAL: Under Five Mortality Decreased Strategic Objective: Use of Curative Interventions for Childhood Infection Improved Intermediate Result 1: Access to and Availability of Services Delivering Interventions Increased Intermediate Result 2: Quality of Services Delivering Interventions Increased and Assured Intermediate Result 3: Demand for Interventions and Related Behaviors Increased Intermediate Result 4: Social and Policy Environment to Deliver Interventions Enabled Illustrative Strategies: Map and select communities for CCM Select CHWs Train, supply and deploy CHWs Strengthen link between CHW and health facility Train health facility staff in case management Strengthen drug logistics Procure supplies Illustrative Strategies: Identify core competencies for CHWs and supervisors Conduct competencybased training Provide job aids Conduct competencybased supervision Supervise supervisors Monitor quality Illustrative Strategies: Multi-media, multichannel BCC for illness recognition and prompt appropriate care-seeking Interpersonal communication for home care, adherence, and indications for revisit Community mobilization to demand quality Illustrative Strategies: Demonstrate, present and publish feasibility, effect, cost of CCM Develop CCM inputs (e.g., training package, job aids, register) Advocate for CCM policy and resources Increase community capacity to support CCM

6 Programme Requirements and Phases of iccm 1) Advocacy Planning Coordination and Policy Setting Costing and Financing 2) Pilot/Early Implementation Human Resources Supply chain management Service delivery and referral Communication and social mobilization Supervision and Performance Quality Assurance M&E and Health Information Systems 3) Expansion/Scale-Up Region Yes: % (n) Sub Saharan Africa (40 countries) CCM Policy 85% (34/40) Source: UNICEF, draft iccm report, 2011 Diarrhea Malaria Pneumonia CHW TX Policy 83% (33/40) CCM Policy 77% (30/39) CHW TX Policy 74% (29/39) CCM Policy 70% (28/40) CHW TX Policy 60% (24/40)

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8 UNICEF s Contribution Supporting country implementation through advocating, assisting and investing resources in iccm programs. Capacity Building and ensuring community-based health workers are well supported to provide iccm, including development and dissemination of training materials and other program support tools. Dissemination of good practices by working with governments and non-governmental organizations to document and disseminate experiences from current and emerging CCM programs. Communication and promotion efforts to enhance prevention and treatment of childhood illness especially through iccm Resources and Tools: Caring for the Sick Child in the Community (WHO & UNICEF joint training package) CCM Essentials A Guide for Program Managers (CORE Group, 2010) CCMCentral.com

9 Questions for Round Table Do the medicines that are currently available meet the unique needs for treatment of young children? Are appropriate formulations and dosages reflected in guidelines and on national Essential Medicines Lists? How to improve supply chains and ensure consistent availability of appropriate medicines and basic health supplies? upstream quantification & integrated delivery schedules How to sustainably improve logistics management at the community level? How to support community-workers to undertake good inventory control practices? Good and timely supervision - integrated supervisory checklists &consolidated supervisory visits schedules Pooled transportation resources (both vehicles and budgets) Functioning information systems for data collection? Good communication interventions? How to improve coordination and collaboration among programs and partners? U5 MR Treatment coverage (2009) Diarrhoea ( ) Malaria ( ) Pneumonia ( ) SSA % 23% 34 % Source: UNICEF, draft iccm report, 2011