The integrated Community Case Management Symposium (iCCM) in Accra, Ghana this week provides an ideal opportunity to examine the practical issues of getting the commodities to manage cases of malaria, pneumonia and diarrhoea at the community level. http://iccmsymposium.org/
Ordinarily one would expect the medicines needed for iCCM would be obtained through a country’s normal essential drug management system. ACTs, ORS, amoxicillin, etc., should be available through the regular primary health system of a country to all front line health facilities. It is from this frontline facility that community health workers (CHWs) delivering iCCM would normally receive training and stocks/supplies.
The reality is that many front line facilities experience frequent stock-outs. They cannot meet the demands for their own clinic services, let alone provide supplies for community volunteers. Whether it is an issue of financial resources or political will, lack of essential medicines makes it difficult to guarantee child survival more than 25 years after UNICEF, WHO, USAID and other partners launched various initiatives to save children’s lives.
Currently countries are placing hopes in international financial programs such as the Global Fund to solve their commodity needs and scale up to prevent child deaths. http://www.theglobalfund.org/en/ In particular opportunities to develop a basic iCCM infrastructure and obtain appropriate malaria commodities are potentially available through Global Fund malaria grants. Child health program managers must work with national malaria control program staff to access this resource.
The Global Fund’s new funding mechanism is based on the national malaria strategic plan. If that plan does not address iCCM, it is unlikely countries can use their ‘envelop’ of funds for that purpose. Regardless, the Global Fund support will provide only malaria commodities. Where can counties get ORS, zinc and amoxicillin, especially if they do not have well-funded national medical stores/essential drugs program.
The RNMCH* Trust Fund with support from Norwegian and British aid agencies is being established and may help provide these pneumonia and diarrhoea commodities in stocks large enough to scale up iCCM. USAID child health projects also include diarrhoea and zinc. The long term sustainability of iCCM based on donor assistance is questionable. We are far from eliminating malaria, and there is no serious discussion of eradicating diarrhoeal diseases and pneumonia.
A pilot project to improve access to quality child illness case management that is being designed in Bauchi State, Nigeria demonstrates the challenges of coordinating commodities. Some were available through a World Bank Malaria Booster Program under a malaria plus package concept. USAID was providing ORS and zinc to child health projects. The US President’s Malaria Initiative could provide ACTs and RDTs, but the local governments and medicine shops involved in the project would have to buy amoxicillin through their normal wholesale channels. Getting the right mix of medicines at the right time in the right amounts to the right places is not easy.
Collaboration among different disease and health programs is always a challenge, but in the short term, program managers in both malaria control and child health need to work together to tap all available resources for iCCM. In the long run donors need to address health system strengthening so countries can manage their own essential drug programs successfully.
*Reproductive, Neonatal, Maternal and Child Health