Ending Preventable Child Deaths with Integrated Community Case Management: Stronger Pharmaceutical Systems for Healthier Communities

Ending Preventable Child Deaths with Integrated Community Case Management: Stronger Pharmaceutical Systems for Healthier Communities

{Photo credit: Brooke Huskey/MSH}Photo credit: Brooke Huskey/MSH

Many child deaths in developing countries are preventable: Children die from treatable conditions, such as pneumonia, diarrhea, and malaria, because families in rural, hard-to-reach, or conflict-ridden areas can’t access or afford the treatments. The Sustainable Development Goals (SDGs), launched in September 2015, set ambitious targets of ending preventable child deaths by 2030 and reducing mortality among children under age five to at least 25 per 1,000 live births.

Integrated community case management (iCCM) has been recognized as a key strategy for increasing access to essential treatments and meeting the objectives for children under five laid out in the SDGs. Integrated community case management entails training volunteer community health workers to serve as the first point of contact for medical treatment in remote areas, enabling them to recognize and treat common childhood illnesses. To be effective, community health workers must operate within a broader pharmaceutical system in which the needs for quality medicines and other health commodities are assured.

That’s where the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, led by Management Sciences for Health (MSH), comes in: supporting community health workers using integrated community case management to save children’s lives by helping governments strengthen five elements of the pharmaceutical system.

1) Governance

One of the most important parts of supporting community health workers is ensuring that they have access to the health commodities they need to do their jobs. This begins with improved governance of the pharmaceutical system, which includes:

  • Developing robust policy documents, such as essential medicines lists and standard treatment guidelines, which guide a pharmaceutical system’s procurement needs and the use of health commodities.
  • Establishing or improving medicines registration processes, which help ensure quality, efficacy, and safety of medicines.
  • Streamlining quantification procedures, which help governments take stock of their supply and estimate needs.

For example, in Democratic Republic of the Congo, SIAPS Program helped the Ministry of Health revise its Essential Medicine List to include all commodities necessary for community use—a particularly important step for ensuring that women and children in the country have access to lifesaving medicines they need.   

2) Information management

Proper management of information on pharmaceutical use and supplies is another important factor in supporting community health workers. Governments must be able to accurately track the availability and consumption of pharmaceutical commodities to prevent stock-outs and ensure access to medicines at all levels of the system, from central medical stores down to the community level. Information management can be improved through the development of logistics management information systems and dashboards, such as the SIAPS-developed OSPSANTE in Mali, that can track stocks levels and consumption at all levels—including the community level—and capture data in easily digestible forms that can be used for decision making.

3) Service delivery and 4) human resources

Many community health workers do not have formal medical education, and therefore require training and supervision to perform their jobs correctly. Strengthening systems for performance monitoring of workers and supervisors and continuous refresher trainings of community health workers and meetings with supervisors, who are usually facility-based, lay the foundations for the successful delivery of medicines and services by community health workers. Performance improvement and capacity building are particularly important to ensure that medicines are dispensed properly, and that patients’ adverse reactions from medicine use are tracked and reported. Appropriate dispensing of medicines by community  and facility health workers also plays an important role in preventing the spread of antimicrobial resistance, which is caused in part by the improper use or overuse of antimicrobial medicines.

Additional resources, like job aids and posters, provide instruction on key health system areas, such as the rational use of medicines, supply chain procedures, and waste management. 

5) Financing

Resource mobilization is a key component for scaling up integrated community case management.  While The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) permits the inclusion of integrated community case management platform costs in grants for malaria work for example, but the cost of non-malaria commodities have to be financed with alternative funds.  Countries therefore need to estimate the cost of their integrated community case management programs and address any funding gaps to mobilize resources effectively.   

SIAPS has worked with several governments to establish and finance successful integrated community case management programs staffed by knowledgeable community health workers. At the global level, SIAPS has been a key player in supporting countries to include integrated community case management in Global Fund grants though its contributions to the Integrated Community Case Management Financing Task Team. SIAPS has also supported resource mobilization and planning at the country level in Burundi, helping the Ministry of Health to conduct a costing exercise to determine the funding necessary for integrated community case management activities.

Stronger pharmaceutical systems, healthier communities

For integrated community case management programs to be successful, countries must support community health workers and their supervisors by strengthening the governance, information management, service delivery and human resources, and financing of their pharmaceutical systems. Improved dashboards and information systems, job aids, trainings and performance monitoring, empower country-led efforts to give community health workers  and their supervisors the tools and information they need to end preventable child deaths and ensure healthier communities.

Elyse Franko-Filipasic contributed to this content.