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Community case management: IRC’s experience and considerations for scale up
- 1. COMMUNITY CASE MANAGEMENT IRC’S EXPERIENCE AND CONSIDERATIONS FOR SCALE UP
- 5. Map of six countries
- 6. Population to CBD 300 CBDs to Supervisor 20 Supervisors to Officer 15 Officers to Manager 5 Managers to Coordinator 3
- 14. Reductions in child mortality
- 15. Lessons learned
- 21. Region 1,000,000 people Cost USD per year Initial training (3,333 CBDs) 133,333 Refresher training/6 months 186,666 Refresher training/1 year 93,333 Supervision costs (20 USD/month/supervisor) 40,000
- 22. Supervision: go beyond the greed for numbers
Editor's Notes
- Strategy to deliver life-saving curative interventions at community level for the conditions that cause the most child deaths
- IRC is actually implementing CCM in six different countries: Sierra Leone, Ivory Coast, South Sudan, Ethiopia, Uganda and Rwanda.
- This graph shows how the population covered with community case management increases over time in IRC program. We started in October 2004 and at the moment almost 2,5 million people live in a village where a community health worker is treating fever, diarrhea and ARI among children under five. As we can see, the country that is contributing the most to the scale up is Rwanda.
- This graph shows the number of treatments delivered over time. The fluctuations are mainly due to seasonality, stock out of drugs, policy change for malaria treatment. When we look at the single contribution of each condition to the total of treatments we can see that the gross of the treatments is represented by treatment of fever, although we see how the treatment mix is becoming more balanced over time.
- Data entry. Validation included in entry
- Reporting module. Can generate standard reports, run independent reports, and generate charts
- GIS module. Can look at indicators over time and space. This map is the coverage of all of the health facilities in sierra leone by primary symptom.
- Avoid shortcuts in CBD selection. Scale up is the art of increasing coverage without sacrificing quality. In CBD selection, rapid scale up often implies district-level selection of CBDs, use of the existing volunteer network and literacy as a pre-condition. Example of Uganda.
- Don’t overstretch CHVs. Here the art is balancing the task shifting trend with the need to ensure technical performance, retention levels and the training costs. Example of workload in Rwanda and Uganda.
- Better to start off integrated. In this graph we see the proportion of the treatments that are for fever, diarrhea or ARI by country. When we started in Rwanda the National Malaria Control Program was implementing home based treatment of fever. Rwanda introduced diarrhea and pneumonia later on. For Sierra Leone and Southern Sudan, IRC was able to start off integrated. The Rwanda program still suffers from the sequential introduction of the three conditions, and has an unbalanced treatment mix, that is not likely to reflect the proportional morbidity of each condition. IRC introduced the three conditions simultaneously in Sierra Leone and Southern Sudan, and the treatment mix is more balanced.
- No NGO can scale up alone. A consortium called Kabeho Mwana, or “the living child” was formed between CONCERN, World Relief and IRC and is actually covering 20% of the country’s population. The consortium has given us credibility as key government partners in child survival, has allowed us to optimize manpower, to achieve geographical overage and cross-institutional learning. In this sense, IRC is trying to partner with other implementing agencies in other countries, we have partnered with CARE in Sierra Leone and would be willing to do the same anywhere where we work. But the other main lesson learned is that nobody can scale like the government can and the Rwanda case is a clear example. That opens the ground to what donors could do ; in order to apply for a USAID child survival grant in Rwanda we had to create the consortium, so instead of funding isolated experiences in different countries donors could consolidate government and NGOs’ efforts, sit at the same table per country and come up with a plan to achieve scale. It seems that Canadian CIDA is oriented to do so in a place like Uganda through UNICEF and NGOs with presence and experience in community health like Malaria Consortium and IRC.