1) An integrated community case management (iCCM) program in South Sudan was able to continue providing services during an acute emergency situation caused by conflict in 2014. Some community-based distributors were displaced themselves but continued treating people in their new locations using remaining drug supplies. 2) There was high demand for iCCM services from displaced community members as health facilities closed. While funding did not increase to meet higher needs, donors allowed the program to continue using existing funds. 3) The iCCM model proved resilient during the crisis and indicators returned to pre-crisis levels within a few months. However, implementing agencies did not have a systematic strategy for responding to emergencies or accommodating increased demand. With proper planning

1. 1
From Harm to Home | Rescue.org
Naoko Kozuki, MSPH, PhD
@nkozuki
CORE Group Conference
Sept 2017
Integrated Community Case Management
in an Acute Emergency:
Case study from South Sudan

3. What is the role of iCCM in emergencies?
• Disease burden high, health
care access low
• Strong community health
platforms may strengthen
resilience when crises occur
• Limited learning from
previous experiences using
CHWs in emergencies
 IRC / UNICEF case
study of iCCM in acute
emergency
The role of iCCM in emergencies

4. • Conflict outbreak in late 2013
- 1.4 million displaced internally
- half million to other countries
• Conflict entered Payinjiar
County in early 2014
- Internal displacement doubled
estimated population from
~40,000 to ~80,000
• Classified as Phase 3 (crisis) /
Phase 4 (emergency) levels of
food insecurity / malnutrition
throughout 2014
Context – South Sudan, 2014

5. • Retrospective mixed methods case study
• Data collection in mid-2015
• Qualitative
- 20 key informant interviews and 13 focus
group discussions
- Community-based distributors (CBD), CBD
supervisors, caregivers, community
leaders, MoH officials, program staff,
policymakers
• Quantitative
- Analysis of routine monitoring data of iCCM
program
Methods

6. Key Results

7. • Many CBDs displaced themselves, but some
continued providing care with whatever
supply they could take with them
• “We were with new people where we ended up and we
continued giving our services as CBDs. Those new people also
appreciated our services. They didn’t want us to return
home…The community where we ended up when we were
displaced knew we were CBDs because we told them. They
knew what that meant; they had CBDs before.” - CBD
Sustained service

8. • High demand for service
- Displaced CBDs and CBD supervisors occasionally
tracked down by home community members to notify
them when it was safe for them to return
- Caregivers unwilling to risk insecure journey to the MoH
health facility and/or arriving at an ill- or non-equipped
facility
• “The [referral facility] has been closed, the health
workers all left, they did not want to be on the front
lines.” - Caregiver
• Increased CBD drug stockout in areas with large influx of
displaced persons
Sustained service

9. -
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Averagenumberofcontacts
perunder-fivechildperyear
CBD, host population only CBD, host pop and IDPs Health facility
Utilization - # of contacts per child per year

10. 0
1
2
3
4
5
6
7
8
Presumptivemalariatreatmentsperunder-fivechildperyear
CHW, U5 in host
population as
denominator
CHW, U5 in host + IDP
popualtion as
denominator
Expected fever
incidence
Health facility
Treatment rate – presumptive malaria

11. • CBD supervisors attempted to continue
supervision
- Utilized networks to track down displaced CBDs
and to assess the security situation prior to making
supervisory visits
- Several CBDs and community leaders validated
the claim of sustained supervision
Supervision

12. • One donor requested to stop iCCM spending,
potentially as political move to pressure government
- The IRC used unrestricted private funds to fill gap for
2-3 months
• Another donor flexible – allowed iCCM programming
to continue, trusting implementing partners’
judgment
• No increase in funding despite increased demand
- “Funding did not significantly change despite the
increased program needs and overburdening in some
cases. It [funding] didn’t stop, which allowed the program
to continue, but it also did not increase given the
increased demand.” – partner NGO staff
Donor response

13. Conclusions

14. • iCCM model resilient during crisis
- Many indicators back to pre-crisis levels within 3-4 months
of onset
- CBDs and supervisors mobilized without formal process
• Implementing / donor agencies did not have
systematic strategy for onset of emergency or to
accommodate increased demand for CBD services
- Potential to mitigate morbidity / mortality burden if
emergency strategy in place
Conclusions

15. • Community health system has huge potential to
sustain coverage of care during crisis
- A strategy of equity – most vulnerable receive care
- Mobilization of displaced CHWs in IDP / refugee camps?
• iCCM not just as child survival strategy but
emergency preparedness investment
- Relevance to development settings may increase, e.g.
climate change
Conclusions – “Future of iCCM”

16. Thank you
Naoko Kozuki
naoko.kozuki@rescue.org
Katja Ericson
Bethany Marron
Yolanda Barbera-Lainez
Nate Miller
nmiller@unicef.org
Full report available, publication coming soon