Guest posting by Jhpego‘s John Munthali, Malaria Program Officer on the Support for Service Delivery Integration-Services (SSDI-Services) Project, a reproductive, maternal and child health project in Malawi.
Case Management with the appropriate antimalarial drug for children below five years of age in Malawi children within 24 hours has not changed much since the Roll Back Malaria Partnership was launched in 2000. RBM set a target of 80% for the year 2010. In 2000 only 10% received the approved drug of that time within 24 hours. Various national surveys including Demographic Health Survey (DHS), and Malaria Indicator Survey MIS) showed an increase to 23% by 2004, but this has not changed perceptibly in the intervening years with only 24% of these children getting the correct medicine on time in 2012.
Integrated community case management (iCCM) was envisioned as an approach to address these coverage/access challenges. The implementation platform is a sector-wide approach focusing on implementation of the national Essential Health Package (EHP) targeting 13 priority health interventions: Approaches emphasized promotion of equity by scaling up access to underserved populations through Community Mobilization (CM), iCCM, Community Based Maternal and Newborn Care (CBMNC) and Scaling Up Nutrition (SUN).
No missed opportunity is aimed for by promotion of integration of EHP services at all levels and by promotion of continuum of care from household to hospital. Jhpiego through USAID’s Support for Service Delivery Integration (SSDI) project supports iCCM. iCCM services delivered by Health Surveillance Assistants (HSAs) at village clinics to treat sick children with pneumonia, diarrhea and malaria including malnutrition screening, use malaria Rapid Diagnostic Tests (mRDTs) and use of rectal artesunate for pre-referral treatment of severe malaria is in the pipeline.
So far 96 trainers refreshed in iCCM. In turn these have trained 722 HSAs on iCCM in all 15 SSDI project districts. The project has also supported ongoing iCCM activities through supervision and mentoring. Equipment for iCCM has been distributed to HSAs. Now there are 1846 HSAs providing iCCM in the 15 districts. They can test and treat for malaria, check for palmar pallor for anemia, and count respirations per minute for acute respiratory infections among other skills.so far HSAs have treated 530 000 cases of malaria in the SSDI supported districts.
Challenges include work overload for HSAs, especially when involved in facility work as well. Transport problems affect some HSAs that reside outside the catchment area. Delays in procurement of the necessary equipment negatively affected the roll out of certain services. Inadequate supervision of services, especially at community level is common. There are weak referral linkages and follow up mechanisms between communities and health facilities. Finally there are drug stock-outs in some village clinics.
Therefore need exists to strengthen integration of service delivery at village clinics and health facilities through better supervision of HSAs. Strengthening of referral linkages and follow-up is also required. Community sensitization will continue to stress the importance of early care seeking and compliance with treatment regimens.