This document summarizes the use of CCM benchmarks, frameworks, and indicators as a tool for documenting country CCM programs. It provides background on the development of the CCM concept and framework, which was created through an inter-agency working group to take a systems strengthening approach. The framework includes 8 components for assessment. The document then discusses the application of the framework in Senegal, finding that the country has over 1,600 functional health huts providing CCM services across regions. It analyzes Senegal's CCM program under each of the 8 components, identifying successes and challenges. The goal is to inform CCM policy/programming and share lessons with other countries.

1. CCM Benchmarks,framework and indicatorsas a tool for documentingcountry programs Baltimore, May 12th2011 1 Serge Raharison, MD, MSc Child Health Technical officer

2. Content CCM benchmarks,framework and indicators Application of the framework in Senegal Key findings and implications for the CCM national program in Senegal 2

3. The ccm benchmark matrix Part 1 3

4. The origin of the Concept Shared understanding of evidence supporting CCM Different stages of country implementation Diversity of country programs and NGO experiences “Unsuccessful pilots have lacked key components of a comprehensive health system.” 4

5. The origin of the Concept Inter-Agency working group, including WHO, UNICEF, USAID and International NGOs Technical Working Group at the Global level Systems strengthening approach to CCM 5

6. Eight components 6 Expansion and Scale-Up Pilot and Early Implementation Advocacy and Planning Coordination and Policy Setting Financing Human Resources Supply Chain Management Service Delivery and Referral Communication and Social Mobilization Supervision and Performance Quality Assurance M&E and Health Information Systems …indicators…

7. The ccm documentation Part 2 7

8. Rationale Assist countries in surpassing their previous targets to impact mortality, malaria, pneumonia and diarrheal disease: Inform CCM-related policy and programmatic decision-making in the countries assessed Share with other countries about how to accelerate progress towards their CCM targets

10. Inform the design of programs and program monitoring during the anticipated expansion of iCCM.

11. Specific Objectives:

12. Document successes and promising strategies that have supported CCM programming success

13. Document existing bottlenecks in program implementation and approaches to overcome them

15. …an adapted framework The framework Service Delivery and Referral STRATEGIC ELEMENT 2: Services and Information from CHWs available to the Communities STRATEGIC ELEMENT 1: Link between the Health System and the Communities Human resources Supervision and Performance Quality Assurance M &E and Health Information Systems STRATEGIC ELEMENT 3: Behavior Change Communication and Social Mobilization INSTITUTIONAL PLATFORM : Policy and Institutional Support Coordination and Policy Setting Supply Chain Management Financing

16. Key findings in senegal Part 3 12

17. CCM Senegal: Historical overview POLICY Decree 92-118: official status to health committees Adoption of ACT for the national Protocol Approbation of the use of Cotrim at health huts ORS treatment provided at health huts Zinc pilot USAID community bilateral DIARRHEA Chloroquinetreatment provided at health huts ACT at health huts USAID community bilateral Pilot RDT and ACT PECADOM Introduction of RDT USAID community bilateral MALARIA PNEUMONIA Research on Cotrimoxazoe at health hut level Second extension USAID community bilateral First extension of Cotrim at health hut 1990 2003 2010 2006 2007 2008 2005 2009 2004

18. Current program status # health huts offering CCM Beginning of 2010: More than 1,600 functional health huts 13/14 regions 58 of the 69 health districts 14

19. 1. Coordination and Policy Setting 15

20. 1. Coordination and Policy Setting 16

21. 2. Costing and Financing 17

22. 2. Costing and Financing 18

23. 3. Human Resources 19

24. 3. Human Resources 20

25. 4. Supply chain management 21

26. 4. Supply chain management 22

27. 5. Service Delivery and Referral 23

28. 5. Service Delivery and Referral 24

29. 6. Communication and Social Mobilization 25

30. 6. Communication and Social Mobilization 26

31. 7. Supervision & Performance Quality Assurance 27

32. 7. Supervision & Performance Quality Assurance 28

33. 8. M&E and Health Information Systems 29

34. 8. M&E and Health Information Systems 30

35. Questions What information do we get from the tables? How can we use this information? What isn’t captured? 31