IFGH 2012: Community-Driven Scale-Up of Community Case Management

Authors:Luz R., Weiss J., Tamming R.

Author Affiliations: Concern Worldwide Rwanda, US and Ireland respectively

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Poster

Issues:

Concern Worldwide was the lead partner in the Kabeho Mwana Expanded Impact Child Survival Project (2006- 2011) dedicated to the scale-up of integrated community case management (CCM) for diarrhea, malaria, and pneumonia in Rwanda in accordance with the priorities and policies of the Ministry of Health (MOH). CCM involves using community health workers (CHWs) to bring basic treatment services to the community to reduce barriers associated with attending a health facility. The goal of the five year project was to reduce child mortality among 318,090 children under five in an area representing approximately 19% of the country.

Description:

A preceding small scale project was scaled up to build the capacity of 6,168 CHWs to provide CCM; and establishing and strengthening CCM service delivery systems in 88 health facilities. The approach to CCM scale-up emphasized on-the-ground capacity building, mainly of CHWs and supervisors, both through formal trainings and continuous presence at the facility and community level to provide on-going support to put the knowledge received into practice.

Results:

The project resulted in high levels of CHW utilization for community treatment in the target districts. The percent of children with respiratory symptoms who were taken to an appropriate health provider increased from 13% to 63%, and the percent of children with a febrile episode who were treated with an effective anti-malarial drug within 24 hours increased from 20% to 43%.

Lessons learned:

Over the five years of the project, the project played a pivotal role in the scale-up of CCM in Rwanda building on the network of CHWs. The successes of the EIP demonstrates the vital importance of synergistic technical assistance and guidance from both the central and field levels, and that building from the ground-up is essential and complementary in scaling up key sustainable interventions such as CCM.