| Study |
Input |
| Bhandari 2012a |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
All lay health workers (601 Anganwadi workers, 488 accredited social health activists) were provided an 8‐day training on IMNCI (including iCCM) following the MOHFW 2003 IMNCI training modules, included training on iCCM for diarrhoea, malaria (in high‐risk areas), pneumonia (ARI) and malnutrition – for children 0–59 months; treatment for newborn local infections; and referral of children 0–59 months with danger signs or severe illness to health facilities. Diarrhoea was diagnosed symptomatically and treated with ORT (ORS and zinc not specified); malaria was diagnosed presumptively based on fever and treated with antimalarials in high‐risk areas and for children with no other obvious cause of fever; pneumonia was diagnosed as the presence of fast breathing or chest‐indrawing (or both); it was unclear whether an RRT or watch with a second hand was used for the assessment of fast breathing; children diagnosed with pneumonia were treated with an antibiotic (type not specified); malnutrition (wasting and underweight) assessed per the 2003 MOHFW guidance referenced in the study; newborn local infection was assessed symptomatically and treated with antibiotics per the 2003 MOHFW guidance referenced in the study. Anganwadi and ASHAs served a population of 1.1 million, resulting in the following ratios of iCCM trained lay health worker per population: 1:1010 Anganwadi + ASHA per population; 1:1830 Anganwadi workers per population; 1:2254 ASHA per population; for a population of 1.1 million).
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children under‐5 years of age (iCCM/IMCI/IMNCI)
All 128 auxiliary midwives in intervention areas were provided an 8‐day IMNCI training, resulting in a 1:8593 ratio of IMNCI trained auxiliary nurse midwives per population. All 14 public sector physicians in intervention areas were provided 11‐day IMNCI training course for all 14 public sector physicians, resulting in a 1:74,571 ratio of IMNCI trained public sector physicians per population. 13 medically qualified private providers in intervention areas were provided a 6‐hour orientation on IMNCI. 614/973 (63%) non‐medically qualified providers in intervention areas were provided 6‐hour orientation (3 hours on 2 consecutive days) on IMNCI. Orientation (4 hours) for traditional birth attendants on newborn care, covering clean delivery, cord care and newborn care. 21 vacant supervisor positions were filled through temporary contractual hiring. Supervisors were trained on IMNCI and supervision skills.
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
Incentives for CHWs for home visits, women’s group meetings, sick child contacts: quote: "task based incentives were expanded to include IMNCI activities. CHWs routinely get incentives for promoting institutional births (100 rupees; £1.27; €1.52; $2.00) and immunisation (100 rupees). In the intervention clusters, they received additional incentives for doing postnatal home visits (75 rupees), treating sick newborns and children (35 rupees), and running women’s group meetings (35 rupees)." P. 2.
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
None. Quote: "...the IMNCI programme does not include an emphasis on improved referral care for sick newborns and children and does not have specific interventions to link communities with referral facilities. The effect of IMNCI might be even greater than seen in this study if the proportion of early home visits, essential new born care in health facilities, and access to quality referral care can be increased." P. 5.
Interventions to improve the supply of iCCM drugs and equipment
Providing iCCM providers with drugs and equipment at deployment and through the establishment of drug depots in villages. Training iCCM providers on the provision of prereferral medicines as part of the IMNCI training above.
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation, and research for iCCM
Interventions to improve managerial supervision of iCCM providers
Temporary contractual hiring to fill vacant supervisor positions (also under recruitment training and deployment above). Training supervisors of lay health workers (Anganwadi and accredited social health activist) on effective supervision. Implementing supervision of lay health workers (frequency, content and approach of supervision not reported).
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
8‐day IMNCI training for lay health workers (Anganwadi workers) to conduct home visits for counselling pregnant women and mothers on optimal newborn care practices, identify and treat illnesses among newborns, and refer sick newborns with danger signs or severe illness. The timing and frequency of the home visits was not stated but the authors provided references to the MOHFW training material. This training material indicated home visits were to be conducted on the day of birth (day 1), followed by visits on day 3 and day 7. Training lay health workers (accredited social health activists) in content and method of conducting women's group meetings. Conducting postnatal home visits by lay health workers (Anganwadi workers) and convening women's groups by lay health workers (accredited social health activists) based on the training above. Participation in the women's groups was reported as 45% in Bhandari 2012a/Mazumder.
|
| Boone 2016 |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
Training CHWs on iCCM – diarrhoea, malaria and pneumonia (moderate ARI) – for children 2–59 months and referral of children 2–59 months with severe illness to health facilities. Diarrhoea diagnosed symptomatically and treated with ORS and zinc; malaria diagnosed based on the presence of fever (i.e. no RDT) and treated with chloroquine for the first 12 months of the trial and then ACT thereafter. For pneumonia, no further definition was provided beyond "moderate acute respiratory infection;" it is unclear whether an RRT or watch with a second hand was used to diagnose; cotrimoxazole was used to treat. Training standards were developed in line with existing country protocols and WHO standards, and all training was delivered by qualified community IMCI trainers. 165 CHWs were trained with ≥ 1 CHW per village at a ratio of 1 CHW per 20–50 households.
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children under‐5 years of age (iCCM/IMCI/IMNCI)
10 trained community health nurses were hired to train and supervise CHWs and traditional birth attendants. The 10 trained community health nurses visited villages twice per month to offer mobile clinic services, which included vaccinations, supplementation, deparasitization and growth monitoring for children, as well as basic antenatal and postnatal consultations for pregnant women. Over 3 years, 22 mobile events were conducted in 121 locations, resulting in 7015 antenatal consultations, 1583 postnatal consultations, 3281 tetanus vaccinations, 19,668 children vaccinated, 36,553 child health checks and 3942 malnutrition cases managed.
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Implementation of iCCM per training above. The 165 CHWs provided at total of 40,796 child‐treatments over 3 years (or 82 child‐treatments per CHW per year). All services and treatments at the community level were provided free of charge at the point of delivery.
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
165 CHWs were trained on the identification and referral of young infants aged < 2 months and children with severe disease to health facilities as noted above under training and deployment. No other interventions reported (e.g. prereferral medicines).
Interventions to improve the supply of iCCM drugs and equipment
CHWs were supplied with iCCM drugs and equipment. The authors reported challenges with ensuring CHWs had a supply of iCCM drugs and equipment: quote: "We suggest that the distribution of medicines by community health workers might have been problematic because of inadequate protocols in communities, inadequate storage and care of drugs, or delays in referrals by community health workers in interventions villages, or a combination of these factors." No other interventions reported (e.g. prereferral medicines).
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation, and research for iCCM
Interventions to improve managerial supervision of iCCM providers
10 trained community health nurses were hired to train and supervise CHWs and traditional birth attendants. They visited villages twice per month to offer mobile clinic services, which included vaccinations, supplementation, deparasitization, and growth monitoring for children, as well as basic antenatal and postnatal consultations for pregnant women. Content and approach to supervision not reported.
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
128 community health clubs were organized and facilitated by 22 trained health promoters. They met approximately 3 times a month for the first 6 months and once a month, outside the rainy season, for the remainder of the trial (22 health club session in 128 locations in year 1 and 18 health club session in 111 locations in years 2 and 3). They used participatory methods to address a range of topics on maternal and child health, e.g. antenatal care, safe delivery, malaria and diarrhoea. Health club participation was 36% in year 1 and 38% in years 2 and 3. 128 traditional birth attendants (each village selected ≥ 1 female traditional birth attendant per 20–50 households) were trained to conduct home visits for counselling pregnant women and mothers on optimal care for newborn babies (this did not include treatment for sick newborns, only referral), and to promote healthy pregnancy and care for young infants, facility‐based delivery and the use of clean delivery kits for the first 10 days after birth. The traditional birth attendants registered and monitored pregnant women, facilitated access to antenatal care, attended home deliveries with clean delivery kits, promoted newborn hygiene and thermal practices in home births, and did postnatal visits for the first 10 days after birth.
Additional notes:
Quote: "The intervention did not include improvements to the standard health facilities, and these services were shared by people in both intervention and control clusters. Health facilities in the area were mostly so‐called type C (ie, basic rural) facilities with 1–4 members of staff, a consultation room, and a basic delivery suite. Only one regional hospital was available in the two districts. All rural facilities had very basic supplies, medicines, and vaccines, and only the hospital was suitably equipped to provide management of severe cases and emergency obstetric care. Facilities were not easily accessible for many villages." P. e330. Quote: "Pregnant women in the intervention group who were considered at high risk were encouraged to attend hospitals and were assisted with accommodation, transport, and modest food allowance." P. e330. Quote: "All services and treatments at the community level were provided free of charge at the point of delivery.” P. e330. Quote: "Villages in the control group received few or no community‐based services apart from annual vaccination campaigns. In some control villages, traditional birth attendants and community health workers had previously been trained, often many years before the trial, but they received no systematic training during the trial period, and did not have medicines or birthing kits to distribute. These villages did not receive any regular mobile clinic services, but pregnant women and children could travel to health clinics and hospitals with full access to available services." P. e331.
|
| Kalyango 2012a |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
Before randomization, all CHWs (609 in intervention arm and 667 control arm) received 3 days of training on single‐disease CCM for malaria for children 4–59 months following WHO guidance in 2009 (the trial was in 2009 and the WHO did not recommend using RDTs for diagnosis of malaria until 2010). CHWs were randomized to 3 strata in rural areas: clusters with populations of 190–320, 321–390 and ≥ 391. CHWs in urban areas were randomized to 2 strata: clusters with populations of 280–430 and ≥ 431. After randomization, CHWs in the intervention arm received an additional 3 days of training on iCCM – malaria and pneumonia (ARI) for children 4–59 months and referral of children 4–59 months with severe illness to health facilities. Pneumonia was diagnosed by the presence of cough or difficult breathing and fast breathing (≥ 50 breaths per minute for children aged 4 to 12 months and ≥ 40 breaths per minute for children 12–59 months), with fast breathing assessed using a watch with a second hand; treatment was amoxicillin. Fever was treated presumptively as malaria with artemether‐lumefantrine. Training of CHWs in control arm on CCM (malaria). Monthly refresher training (CCM for malaria in the control arm and iCCM for malaria in the intervention arm). CHWs in control arm were trained to assess children for febrile illness and to presumptively treat children with fever or with a history of fever in the last 24 hours with antimalarials and to refer children with danger signs or pneumonia symptoms, regardless of severity, to a nearby health facility (P. 3). CHWs in the control arm did not assess or classify pneumonia symptoms. Thermometers and RDTs were not used in either arm. Children with diarrhoea were not treated by the CHW in either arm (i.e. no CCM for diarrhoea).
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children under‐5 years of age (iCCM/IMCI/IMNCI)
District health teams were trained first on CCM for malaria and then on iCCM for malaria and pneumonia by Ministry of Health officials together with the study investigators. In both arms, health facility workers at public, non‐governmental organization and private health facilities received a 2‐day training in iCCM for malaria and pneumonia; they were oriented on the algorithms that were to be used by the CHWs, and were trained on investigating and documenting adverse events, and supervision and training of CHWs.
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
Children in both arms were classified as having severe illness and referred to the nearest health facility if any of the following danger signs were present: convulsions, repeated vomiting, lethargy/unconsciousness or failure to feed, chest indrawing, noisy breathing, dehydration or pallor. CHWs in both arms were required to follow up children they treated and refer those whose condition did not improve the nearest health facility. No other interventions reported (e.g. prereferral medicines).
Interventions to improve the supply of iCCM drugs and equipment
CHWs in the intervention arm were provided prepackaged dispersible artemether‐lumefantrine and amoxicillin tablets in age‐specific doses and wrist watches with second hands. CHWs in the control arm were provided with artemether‐lumefantrine only. Thermometers and RDTs were not provided to CHWs in either arm. The drugs were procured from manufacturers through local pharmaceutical distributors and distributed through the district system.
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation, and research for iCCM
Interventions to improve managerial supervision of iCCM providers
CHW supervisors (health workers at health facilities) were oriented on the algorithms CHWs were to use (iCCM for intervention and CCM for control) and they were trained on CHW supervision. CHWs in both arms received monthly supportive supervision from health workers based at the nearest health facility; content and approach to supervision not reported.
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
Additional notes
|
| Mubiru 2015 |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
In intervention districts, 5585 VHT members (2 per village) received a 5‐day training on iCCM – diarrhoea, malaria and pneumonia (ARI) – for children 0–59 months and referral of children 0–59 months with severe illness to health facilities. Diarrhoea was diagnosed symptomatically and treated with ORS and zinc; malaria was diagnosed with an RDT and treated with ACT; pneumonia was diagnosed as the presence of cough and fast breathing (assessed with RRT) and treated with amoxicillin. Training sessions demonstrating difficult topics such as fast breathing were held in clinical settings. The 5585 VHT members were selected for iCCM training because they ranked the highest per village on an assessment following their 6‐day training on the basic VHT package of prevention and promotion interventions (see below under communication and social mobilization). VHT members in comparison districts were not trained on iCCM. VHT members in some comparison districts had already received the 6‐day training on the basic VHT package.
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children under‐5 years of age (iCCM/IMCI/IMNCI)
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Implementation of iCCM per training above. VHT members trained on iCCM provided 519,785 iCCM treatments in 2011 (baseline) and 1,387,961 iCCM treatments in 2012 (endline). The number of iCCM treatments per VHT member per year in 2012 was 248 (or 22 per month).
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
Interventions to improve the supply of iCCM drugs and equipment
VHT members in intervention districts were provided with drugs, respiratory rate timers, job aids (algorithms for diagnosis and treatment) and registers for recording data. Supplies were purchased by UNICEF and distributed to each district by Malaria Consortium staff. CHWs were resupplied at health facilities during quarterly meetings. Broader interventions to improve the supply of iCCM drugs and equipment to VHT members were not reported.
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation, and research for iCCM
Among the data sources for the study were routine and contextual data. It was unclear to what extent the collection and use of data through the study served as an 'intervention.' VHT members reported on availability of commodities and treatments given on a monthly basis using standardized registers. Peer‐supervisors summarized VHT member data and sent it to the respective health facility affiliated with the parish. The reports were then sent to the district health management information systems focal person and Malaria Consortium. Facility treatment data were also collected from the health management information system in both the intervention and comparison districts. Data on health programmes taking place in the intervention and comparison districts during the study period were obtained from district officials in a standardized form. Relevant contextual factors, such as national stockouts of medicines, or disease outbreaks, were documented.
Interventions to improve managerial supervision of iCCM providers
Health facility workers were trained to supervise VHT members, summarize and report compiled data, and to inform patients of the availability of VHT members. VHT members were supervised by health facility and Malaria Consortium staff, as well as their peer supervisors in each designated parish. Supervision consisted of home visits conducted by health workers and quarterly meetings. Frequency of supervision provided through the intervention was not reported; however, the study monitored the percent of VHT members who received quarterly supervision. Content and approach to supervision not reported.
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
Radio spots announcing the importance of seeking care for the 3 conditions and availability of VHT members. Community leaders were trained to sensitize communities about the work of VHTs. 11,170 VHT members (including the 5585 VHT members trained on iCCM) in the intervention districts received a basic 6‐day VHT training package on promotion and prevention interventions, including hygiene, immunization, handwashing, optimal complementary feeding, insecticide‐treated nets and intermittent preventive treatment of malaria during pregnancy.
Additional notes
|
| Munos 2016 |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
Training of lay health workers (ASBC) on iCCM for diarrhoea, malaria, pneumonia (ARI) and malnutrition among children 2–59 months. Diarrhoea was diagnosed symptomatically and treated with ORS and zinc. Pneumonia was diagnosed as the presence of cough/difficulty breathing as assessed by an RRT and treated with antibiotics. Malaria was diagnosed with an RDT and treated with ACT. Acute malnutrition using a MUAC strip with referral as appropriate. Other community‐based activities included detection and referral of cases of acute malnutrition and promotion of healthy practices by ASBCs.
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children under‐5 years of age (iCCM/IMCI/IMNCI)
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
Identification and referral for danger signs per training on iCCM above. Other community‐based activities included detection and referral of cases of acute malnutrition. No other interventions reported (e.g. prereferral medicines).
Interventions to improve the supply of iCCM drugs and equipment
ASBCs providing iCCM services were responsible for visiting the local health facility to restock their drug kits; they then could sell these drugs to community members at a markup to provide a small financial "motivation" for their work. Broader interventions to improve the supply of iCCM drugs and equipment to ASBCs were not reported.
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation and research for iCCM
Interventions to improve managerial supervision of iCCM providers
iCCM‐trained nurses at the local health centres were responsible for supervising ASBCs in their catchment area; Nurses were to supervise ASBCs bimonthly (it is unclear whether the authors meant twice every month or once every 2 months) in the areas implementing iCCM for malaria and diarrhoea and monthly in the areas implementing iCCM for malaria, diarrhoea and pneumonia. Content and approach to supervision not reported.
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
Additional notes
The ASBCs were part of an existing cadre of volunteer lay health workers in Burkina Faso. They were selected by the community in which they worked (2 per village, 1 male and 1 female), were often illiterate and received little to no preservice training upon being selected as ASBCs. The number of ASBCs in a health facility catchment area in the programme districts ranged from 2 to 48. A parallel national effort to implement malaria CCM, funded by the Global Fund and managed by Plan Burkina, was not integrated with the intervention districts.
|
| White 2018 |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
Training of lay health workers – CHW on iCCM – diarrhoea, malaria, pneumonia (ARI) and malnutrition – and referral of children with severe illness to health facilities. The age of children targeted for iCCM was not stated in the study. Diarrhoea was assessed symptomatically and treated with ORS and zinc. Pneumonia was diagnosed by the presence of cough + fast or difficult breathing; it was unclear whether diagnosis was based on use of an RRT or watch with a second hand; amoxicillin was used for treatment. Fever treated presumptively (i.e. no RDT) as malaria with ACT in alignment with the WHO "no touch" protocol during the Ebola epidemic (RDTs were reinstated in the last month of the study and CHWs resumed using RDTs). Screening for malnutrition did not use a MUAC strip during implementation of the WHO "no touch" policy but was reinstated in the last month of the study; children classified as having acute malnutrition were referred to a health facility (during implementation of the "no touch" policy it was not clear what triggered referrals). Referral for illnesses and age groups outside of their scope of practice was also included. CHW trained to do active case‐finding in order to identify cases of illness in their community – as part of the active case‐finding approach, they were trained to conduct routine household visits, with the expectation that they would visit every household in their catchment area at least once per month. At endline, there were 229 CHW. Each CHW served approximately 161 people.
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children U5 (iCCM/IMCI/IMNCI)
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
Training on the identification and referral of children aged < 5 years with danger signs and age groups outside their scope of work. Danger signs necessitating referral were also reviewed and emphasized for each of these illnesses along with the principles of referral for illnesses and age groups outside of their scope of practice. No other interventions reported (e.g. prereferral medicines).
Interventions to improve the supply of iCCM drugs and equipment
Providing CHW with iCCM drugs and equipment. CHW were provided with age‐appropriate ACT, amoxicillin, paracetamol, zinc, oral rehydration salts, RDTs for malaria, MUAC straps, and thermometers. CHW were given paper household registration forms, forms to track routine household visits and materials needed to hand‐draw community maps. CHW were provided with sick child forms with diagnostic skip logic, referral forms and patient ledgers for tracking encounters. CHWL were responsible for ensuring CHW were restocked with iCCM drugs and equipment.
Interventions to improve health information systems and use of information communication technology for iCCM
CHW, CHWL and CHSS used a combination of paper and mobile health tools to assist in workflow, help guide clinical decision‐making, and collect programmatic data. Data were routed into a cloud‐hosed database application, from which a number of reports could be generated allowing for monthly monitoring of outputs and outcomes. For the mobile health component, all CHW, CHWL and CHSS were equipped with an Android mobile phone + a waterproof case, a USB battery pack and a solar panel. The primary application used was a version of Open Data Kit adapted for use in completely disconnected settings. Electronic forms allowed for more granular data to be captured and analyzed on iCCM treatment, routine household visits, supervision visits and supply restocking.
Interventions to improve monitoring, evaluation, and research for iCCM
During this time, CHW were also provided with visual job aids that enabled correct assessment, diagnosis and treatment of children aged < 5 years correctly. These job aids were designed in tandem with the iCCM sick child data collection forms and were highly visual and guided the CHW through a patient visit. CHW were also provided with a dose card job aid which allowed them to ensure correct medication and treatment was provided once they arrived at the correct diagnosis.
Interventions to improve managerial supervision of iCCM providers
Recruitment and training of 2 cadres of CHW supervisors, called CHWLs and CCS. CHWLs were recruited jointly with the county health team to provide weekly supervision of the CHW in their home community. Nurses, physician assistants, and midwives were recruited to serve as CCSs. The monthly cash incentive for the CHWLs was USD 220 and for the CCS was USD 313 for full‐time positions. The CCSs supervised the CHWLs and were responsible for overseeing the CHWs' clinical activities through monthly supervision in their home community. In addition, CCSs were attached to a primary health clinic to facilitate a stronger connection between community and the larger health system. While not formally a part of the supervision cascade within the programme, there was also a team made up of a mix of health professionals and non‐health professionals responsible for training support and quality assurance. At endline, there were 21 CHWLs and 11 CCSs working.
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
Training of CHW on community engagement, household registration, community mapping and how to conduct household visits, focusing on child health – with the expectation that they would visit every household in their catchment area at least once per month.
Additional notes
CHW were recruited from the communities in which they were assigned to serve. Only remote communities (those > 5 km from the nearest health facility) were targeted. Some CHW were assigned additional communities that were within a 30‐minute walk. Communities were involved in recruitment, recommending specific candidates for screening. Candidates were also able to self‐nominate. Candidates took a written literacy evaluation followed by a 1‐on‐1 interview for further assessment of internal motivation, communication skills and fit for the position. CHW training included community health and surveillance, child health, maternal and neonatal health, and adult health. CHW were trained on community engagement, household registration and community mapping. In the context of the ongoing Ebola epidemic, CHW were trained on appropriate Ebola infection prevention and control and surveillance. CHW were trained to conduct routine household visits, with the expectation that they would visit every household in their catchment area at least once per month. The authors noted that the Ebola epidemic had an effect on implementation of iCCM as well as other services. Regarding iCCM, the authors noted that CHW had to move to the WHO "no touch" policy. "The epidemic also precluded use of malaria rapid diagnostic tests because of Ebola contraction risks, limiting accurate report of malaria." (P. 1257). Other effects of the Ebola epidemic were described: " Standardized vaccination services were disrupted by stoppages during the Ebola virus disease epidemic and by mass campaigns after it, limiting estimation of the effect of CHW activities on vaccine uptake during the observation period." P. 1257.
|
| Yansaneh 2014 |
iCCM component: training and deployment
Interventions to recruit, train and retain lay health workers to provide iCCM
Training of lay health workers – CHVs – on iCCM for diarrhoea, malaria and pneumonia among children aged < 5 years and referral of children aged < 5 years with severe illness to health facilities. Diarrhoea was diagnosed symptomatically and treated with ORS and zinc. Malaria was diagnosed symptomatically (i.e. no RDT) and treated with artesunate‐amodiaquine combined therapy (ACT). Pneumonia was diagnosed by the presence of fast or difficult breathing in the chest as assessed using RRTs and treated with cotrimoxazole. Training on iCCM was for 1 week and based on simplified algorithms adapted from WHO/UNICEF guidance. 2129 iCCM providers (CHVs) were recruited and trained with a mean ratio of 2 iCCM providers per 100 children aged < 5 years (or per 100 households).
Interventions to recruit, train and retain other types of health workers to provide integrated case management services for children U5 (iCCM/IMCI/IMNCI)
Implementation of simplified IMCI‐adapted clinical guidelines for iCCM providers
Interventions for the payment of iCCM providers such as salary, fees for service, capitation
iCCM component: systems strengthening
Interventions to improve systems for referral of patients between community and facility levels
Interventions to improve the supply of iCCM drugs and equipment
UNICEF and civil society organizations provided CHVs with drug kits with simplified algorithms for ICCM and forms for recording number of visits, treatments and deaths. Broader interventions to improve the supply of iCCM drugs and equipment to CHVs were not reported.
Interventions to improve health information systems and use of information communication technology for iCCM
Interventions to improve monitoring, evaluation, and research for iCCM
CHVs used simplified algorithms and forms developed and previously tested in Sierra Leone for illiterate CHVs. Quote: "[The implementing civil society organizations] kept monthly reports on drug supply, CHV supervision and reports on treatment and referral of children U5." P. 1467.
Interventions to improve managerial supervision of iCCM providers
iCCM component: communication and community mobilization
Interventions to promote good practices for health and nutrition and generate demand for use of iCCM providers when children are ill
CHVs promoted good practices for health, nutrition and careseeking behaviour. CHV services and locations were announced in religious centres and during community functions.
Additional notes
CHVs were non‐paid volunteers, with limited or no literacy, and selected by their respective communities. Quote: "[The] intervention was implemented a few months after the launch of the Free Health Care Initiative in late 2010 to early 2011 in two districts of Sierra Leone … Before implementation, CHV services and locations were announced in religious centres and during community functions. Community members received free treatment from CHV homes or from local health posts where volunteers sometimes provided care." P. 1467.
|
