This document summarizes research on using community health workers to treat malnutrition in Mali. A study compared treatment of severe acute malnutrition (SAM) by community health workers versus at health facilities. The study found community health workers increased coverage of SAM treatment from 41.5% to 86.7%, reduced abandonment rates, and increased cure rates. Community health workers also properly assessed children for clinical signs. The intervention was more cost-effective, costing $259 per recovered child versus $501 at facilities. Challenges included the number of community health workers and their salaries. The organization plans to scale up the model and conduct pilots in other areas.

1. TRANFORMING THE WAY
OF TREATING
MALNUTRITION WITH
COMMUNITY HEALTH
WORKERS
Core group. Global Health Practitioner Conference
September 2017. Baltimore

2. 1.iCCM ( Integrated Case Community Management) and CHW
( Community Health workers) in Mali
2.Research study in Mali
3.Operational challenges
4.Looking forward
2
INDEX

3. • 2010. Mali has developed, the Primary Health Care in the
community
 “ Soins Essentielles dans la Communaute”
• 2011 Training module for Community Health Workers
 “ Guide de formateur pour les ASC au Mali”
 “Manual de formation pour les ASC au Mali”
• April 2011, 1,651 CHWs have been trained in the full package of
iCCM and deployed
• 2015 review of the policy
 “ Guide de misse en ouvre de SEC”
 “Guide de formateur pour les ASC au Mali”
1. ICCM ( INTEGRATED CASE COMMUNITY
MANAGEMENT) AND CHW ( COMMUNITY HEALTH
WORKERS IN MALI

4. DESCRIPTION OF ICCM HUMAN RESOURCES
Profil of CHW Profil of CV
Being of Malian nationality Knowing how to speak, read and write in
local or other language is desirable
Be at least 18 years of age Be chosen by the population, available and
engaged
Have at least a certificate / attestation
of caregiver or matron
Being of the area, experienced man/woman
Have a perfect command of a local
language
Be credible (honest, respectful, sociable,
tolerant)
Be available, active and stable in the
intervention area
Do not combine the functions of several
development programs
Accept and work in rural areas Volunteer and accept volunteer work
Experience in social mobilization is
desirable
Having an assured source of income
Have experience in social mobilization
(former relays, organizers, leaders etc.)

5. 2. RESEARCH STUDY IN MALI EFFECTIVENESS OF
SAM TREATMENT DELIVERED BY COMMUNITY
HEALTH WORKERS
• Kita district, Situated in the Kayes
Region ( south)
• Approximate population 550,763 with
131,152 children aged 0-59 months
• Nutritional situation, serious :
prevalence of global acute malnutrition
( GAM) 14%. SMART 2014
• Coverage of severe acute malnutrition
treatment (SAM) 24.9%. SQUEAC
2013
• Identified barriers geographical and
financial access to health facilities

6. Comparing the
effectiveness of
SAM treatment
delivered by
CHW with
treatment
delivered at
health facilities
Comparing
early
admissions of
SAM children
Comparing
coverage
Quality of
care of
CHW
Cost-
effectivenes
s analyse
PILOT STUDY QUESTION RESEARCH
June 2014- December 2016

7. Longitudinal prospective
clinical cohort study
Control group
SAM children treated
at the health facilities
Intervention group
SAM children treated at
the health facilities and
CHW
• 4 health facilities
• 16 CHW
• 3 health health
facilities
• 19 CHW
METHODOLOGY

8. 1. Coverage of SAM treatment was more of the double in the
intervention group: 86.7% versus 41.5% in the control group
2. Effectiveness of the intervention: CHW reduced the risk of
abandoning the program and increase cured rates
3. The majority of SAM-affected children were correctly assessed
for the presence of major clinical signs (cough, diarrhea, fever
and vomiting) and similarly most children were correctly
assessed for presence of danger signs (e.g. lack of appetite)
EVIDENCE PHASE 1

9. EVIDENCE PHASE 1
Intervention Control
nº % nº %
Total 617 212
Cured 581 94,17 187 88,2
Defaulters 28 4,5 23 10,85
Death 5 0,49 2 0,94
Non reponse 3 0,49 0 0
43.9 43.8
86.7
41.3
0
10
20
30
40
50
60
70
80
90
100
Intervention Control
Coverage assesment
Base line End line
Alvarez Moran JL, et al. The efectivennes of treatment for severe
acute malnutrition delivered by Community Health Workkers ,
compared to a traditional facility based model. Submitted
February 2017 to BMC Health Services Research

10. EVIDENCE PHASE 1
« Avant qu’il (ASC) n’arrive je dépensais mille cinq cent
francs (1500 FCFA) en essence pour aller à kobIri. Nous
ne payons pas pour le plumpy, mais effectuons des
dépenses en carburant. Je déboursais mille cinq cent
chaque fois pour aller chercher la dotation de mon
enfant à kobiri cela m’a vraiment coûté. »
(Bénéficiaire, zone d’intervention)
Alvarez Moran JL, et al. Quality of care for treatment of
uncomplicated severe acute malnutrition delivered by community
health workers in a rural area of Mali. Maternal and child Nutrition
2017.
http://onlinelibrary.wiley.com/doi/10.1111/mcn.12449/abstract;jsessionid=
A8A61DEB4089C11F0217CA8C036B9506.f02t01
• 97.6 % of children correctly assessed
for major clinical signs
• 95.2%, were checked for the
presence of danger signs
• 96.8% mid-upper arm circumference
correctly assessed
• 78.4% correctly assessed for
oedemas

11. EVIDENCE PHASE 1
Mali
intervention control
Total cost (USD) $150,523.00 $93,614.00
Number of children in program 617 212
Recovery Rate 94.17% 88.21%
Number of children recovered 581 187
Cost per child treated (USD) $244.00 $442.00
Cost per child recovered (USD) $259.00 $501.00
Rogers E, et al. Cost-Effectiveness of the Treatment of Uncomplicated Severe Acute Malnutrition by Community Health Workers Compared to
Treatment Provided at an Outpatient Facility. Submitted April 2017 to Public Health Nutrition

12. 3. CHALLENGES OF THE INTERVENTION
Number of CHW
Salary of CHW
Model of supervision
Training module

13. 4. WAY FORWARD
Developed an Action Against
Hunger Strategy
Performance at scale
Pilot study in others areas

14. ACTION AGAINST HUNGER STRATEGY
• The objective is to have an
international strategy to be able
to include de management of
severe acute malnutrition with
CHW in our intervention
• Actually in discussion the
document in the International
Technical Meeting in Madrid

15. PERFORMANCE AT SCALE. MALI PHASE 2
OBJECTIVE . Increase the
coverage of SAM treatment
with the scaling up of the
treatment with CHW
• Model 1. Kita. 47 Health
facilities and 80 CHW
• Model 2. Kayes. 49
health facilities and 45
CHW
• Model 3. Bafoulabe 19
Health facilities and 39
CHWPhase 1 Phase 2
1 district 3 districts
7 health facilities 115 health facilities
19 CHW 164 CHW

16. PILOT STUDY IN OTHER AREAS
KENIA ( 2017-2019)
• Fund by Children’s Investment Funds Foundation
• October 2017- January 2019
• Action Against Hunger, UNICEF and Save the Children
• “Improving Coverage and Treatment Outcomes of Acute
Malnutrition in Children under Five Years through integrated
Community Case Management (iCCM)”
NIGER AND MAURITANIA ( 2017-2018)
• Fund by OFDA /USAID
• October 2017- January 2019
• “Increased coverage of management of severe acute malnutrition
through the support of community health workers in Mauritania
and Niger”

17. A WORLD WITHOUT HUNGER
“…in the case of child health, 97% of
research grants support the
development of new technologies, but
only 3% investigate ways of achieving
full use of existing technologies, even
though this approach has the potential
to save three more lives than the
development of new technologies”
Saul S Morres et al "Effective international action against
undernutrition: why has it proven so difficult and what can be done to
accelerate progress?" Volume 371, No. 9612, p608–621, 16 February
2008 . Lancet

18. Insert your website address
Pilar Charle Cuellar
pcharle@accioncontraelhambre.or
g
00 34 91 184 0845