Community Case Management of Childhood Illnesses: Policy and Implementation in Countdown to 2015 Countries/ Gestion Communautaire Des Cas De Maladies Infantiles: Politique et Mise En Oeuvre Dans Les Pays Compte a Rebours Vers 2015/ Gestion Comunitaria De Casos De Enfermedades Infantiles: Planes De Accion Y Puesta En Practica En Los Paises De la Iniciativa «Cuenta Atras Para 2015»
de Sousa, Alexandra, Tiedje, Kathryn E., Recht, Judith, Bjelic, Ivana, Hamer, Davidson H., Bulletin of the World Health Organization
The community case management (CCM) of childhood illnesses--defined here as the community-level provision to children of curative treatments for diarrhoea, pneumonia, malaria and/or neonatal infections by community health workers (CHWs)--is a strategy with the potential to accelerate progress towards meeting Millennium Development Goal 4 (i.e. the reduction of child mortality by two thirds between 1990 and 2015). (1) Unless their current rates of decline in child mortality accelerate, most African countries will not achieve such a reduction until 2065. (2) A major constraint is the weakness of national health systems, (3,4) especially the shortage of human resources. CCM could increase the number of care providers at the community level. Task shifting has been used in low-resource settings since the late 1960s. After the Alma-Ata declaration in 1978, attention turned to primaryhealth-care services. (5) The allocation of tasks to the least costly health worker has since often been applied effectively at the community level. (6) Compared with other approaches to health care, the provision of services at the community level is likely to reach not only more people but also the populations most in need, thus improving equity. (7-10)
Although the mortality rate in children under the age of 5 years has declined by 28% since 1990, (11,12) infectious diseases still contribute to 68% of deaths among such children.(13) Of the 5.9 million children under 5 who die of infectious diseases each year, about 3.6 million are neonates.(14) The major causes of deaths among children under 5 are pneumonia (18%), diarrhoea (15%), malaria (8%) and neonatal infections, including sepsis (6%). (15) Each of these killers has, however, at least one proven effective treatment: artemisinin-based combination therapy (ACT) for malaria; low-osmolarity oral rehydration solutions (ORS) and zinc for diarrhoea; and antibiotics for pneumonia and neonatal infections. If coverage of these interventions were universal, with community-based delivery of half of the interventions, it has been estimated that the annual number of deaths among children under 5 would fall by 63%. (2,16) The greatest improvements would probably be seen in sub-Saharan Africa, where pneumonia, diarrhoea and malaria account for more than half of all childhood deaths.(13) If such interventions are to be delivered well, however, there have to be good national policies, including effective CCM policies.
In 2010, to identify gaps in CCM policies and understand the current status of CCM implementation, we conducted a survey on the CCM of malaria, pneumonia, diarrhoea and neonatal infections in the 68 countries prioritized by the Countdown to 2015 initiative in 2008 (list available at: http://www.countdown2015mnch.org/reports-publications/ 2010country-profiles/2008-country-profiles) (17); together, these Countdown priority countries account for about 97% of maternal, neonatal and child deaths worldwide each year. To our knowledge, this was the first comprehensive survey on the CCM of childhood illnesses since a survey of the CCM of pneumonia in 57 African or Asian countries in 2008. (18) The results presented here provide a basis for future advocacy work, resource mobilization, programme support and evidence generation.
A 26-item questionnaire on the CCM of malaria, pneumonia, diarrhoea and neonatal infections was pre-tested in Pakistan and Senegal and then distributed, in 2009 or 2010, to the relevant policy-makers and implementers in the 68 Countdown priority countries. The questionnaire addressed the status of CCM policies, implementation and plans; the concerns of the CCM implementers and policy-makers; CHW activities, training manuals, lengths of training; referral policies and remuneration; and drug policies and availability. In an attempt to enhance the quality of the data collected, the questionnaire included multiple questions on the same topic and was sent to two, three or four individuals in each country. …