Community case managementRBM CMWG, 8-9th July 2009

Purpose

• What are the operational/implementation issues that need attention, if nation wide delivery of community case management is to be • feasible and • achievable?

• How can we address these issues?

Categorisation of the issues

• Health system• Health worker

• Community based• Health facility based

• Community• Policy• Private sector

Health systems

• Availability of malaria treatments; in the hands of CHWs – right treatment, right dosages, right time

• How does community-based case management fit/integrate into the “formal” health system?

• Use of regular supervision to sustain good practices and behaviour; models and funding

Health systems

• Record keeping and use of data for decision making; registers, data flow, feedback

• Resource mobilisation

• Using defined indicator/s to measure progress; reliably

Health worker – community-based

• Quality of services; assessing CHW performance and improving it, adherence to guidelines

• CHW motivational approaches; why volunteer? What is the right package, i.e. financial and non-financial?

Health worker – facility based

• Supervision of CHWs?• Perceptions of CCM? Extension of the health

system or “competition”?; resources to community not matched by resources to health facilities.

Community

• Treatment adherence; what is the status now and how can it be improved? Pre-packs, packaging

• Effective approaches for demand creation for treatment (and diagnosis); what is community mobilisation/ sensitisation? where is the evidence of what works?

Policy environment

• Rationale of community case management (malaria); (presumptive) treatment close to home? what about health facilities? Treatment and diagnosis=case management?

• Introduction of integrated community case management (malaria, pneumonia, diarrhoea); how will this affect current malaria case management approaches?

Private sector

• Is this a continuum of community case management? Acceptability-both sides

• How to engage? Policies, training, treatments, diagnosis, reporting, quality control

How can we address these issues?

• Distill the operational evidence (& experiences) to highlight • what works – best practices, implementation models• what has not worked and why

• Harness current funding opportunities to support feasible implementation models – link to operational research to inform future improvements

• Identify the gaps that have not be addressed and how to go about finding solutions

How can we address these issues?

Recommendations• CCM is a delivery approach that should

complement health facility delivery approach• Health facility delivery should be strengthened in

tandem with CCM; health facility delivery should be the ideal approach

• CCM is not a permanent delivery approach and there should be guidelines on “phasing in” and “phasing out” – changing role of CHWs?