Table 2.

Meeting the challenges of scaling up iCCM in Malawi

Program component	What has been shown to work
National orientation and capacity building	Clear leadership of the MOH and an understanding of partners about their roles and responsibilities
	Demonstration course for district and national managers to create awareness among relevant stakeholders
	National planning and adaptation workshop to reach consensus moving forward
	Minimal adaptation to the generic WHO/UNICEF guidelines
	Orientation of DHMTs, mapping of hard-to-reach areas, and joint planning
	Engagement of the national IMCI technical working group in the process
	Proper coordination of available support and collaboration of partners to roll out activities in assigned districts
Community ownership and participation	Community dialogue before introduction of the services
	Formation of village health committees under each functional VHC
	Engagement of community leaders to manage the VHC
Skills building	Devolution of HSAs training to district level
	Leadership of district IMCI coordinators and engagement of DHMT members
	Appropriate case load in district hospitals for inpatient and outpatient clinical practice during training
Supervision	Assignment of specified responsibilities to various cadres of staff (senior HSA, environmental officer, and community nurse)
	Training supervisors in iCCM and supervisory skills
	Development of integrated checklists incorporating key elements of the sick child recording form
	Creation of a mentorship program for periodic skills reinforcement of trained HSAs
Medicines and supplies	Provision of medicines to HSAs during their monthly visits to the designated health center
	Supervisors carrying medicines and supplies to alleviate stock outs
	Guidance on quantification of medicines to DHMTs
	Rollout of standard operating procedures for logistics management information systems to strengthen use and management of medicines and other supplies
Referral	Designation of health centers where HSA should refer
	Use of referral note and feedback on the same
	Engagement of VHC in finding solutions to facilitate referral, such as bicycles or ox cart as transport, and escorts at night
Monitoring	Recruitment of a national monitoring and evaluation officer in the IMCI unit
	Development of the iCCM register based on the sick child recording form
	Quality of care assessment of HSAs performance
	District-based village clinic review meetings to strengthen implementation
Motivation	Recognition of HSAs as formal members of the health work force
	Provision of adequate housing to HSAs in hard-to-reach areas through village health committees
Innovations	Provision of mobile phones to HSAs to facilitate contact and SMS-based reporting and ordering of medicines and supplies