READ: ICCM+

This blog will introduce the iCCM strategy, as well as the new iCCM+ initiative: the aim to integrate SAM treatment into the iCCM approach.

iCCM stands for Integrated Community Case Management. It is an approach to realise higher coverage and quality care for sick children: community health workers (CHWs) are trained to diagnose and treat a number of common childhood illnesses, such as malaria, pneumonia and diarrhoea. Community health workers can perform these services during home visits in the communities where they work. This means that these children do not have to be taken to a health facility for diagnosis and even treatment. Particularly in communities where barriers to access a health facility are great, this approach provides an effective solution to receiving care, thereby increasing coverage.

Studies trialling the iCCM approach in countries such as Ghana, Zambia and a number of other countries have shown encouraging results. “These programmatic experiences suggests that the iCCM strategy can be effective in achieving high treatment coverage and delivering high-quality care for sick children in the community.” (WHO, 2016).

Now, attention is given to the possibility of expanding this approach: the ACF network supports the iCCM + SAM (iCCM+) approach, which integrates SAM treatment into iCCM. The aims of this new, integrated approach to iCCM and malnutrition are:

To increase the coverage of SAM treatment
To reduce opportunity costs to caregivers
To decrease the burden of care at the health facility
To decrease defaulting
To reinforce programming links between community health and SAM treatment

It is also an opportunity to strengthen the synergy between health and nutrition programming, by ensuring childhood diseases and acute malnutrition are addressed together to maximise impact on child survival. Furthermore, the approach seeks to strengthen health service delivery at the community level, by working with community health workers and integrating community health into a broader health system strengthening process.

To achieve this, the Action Against Hunger network proposes a thorough analysis of the iCCM pillars, and determining the appropriateness of this approach for specific contexts. Pilot studies for each context are recommended before scaling-up the approach more broadly within a country. With this strategy, Action Against Hunger is committed to reaching the goal of 60% coverage of care for SAM children by the end of 2020.

Some good news is that the realisation of this goal is underway, as the 2018 Global Performance Report has shown progress in this area. Four out of the six surveys indicated that CMAM programme coverage was greater than 50%. This is an improvement on reported coverage estimates in the 2017 Global Performance Report where, of the seven coverage estimates, only two districts reported coverage estimates over 50%.

The improved coverage estimates of 2018 indicate the success of the iCCM trials in Mali and the positive impact of transferring treatment of SAM from health centres to community health workers.

Existing ICCM+ research has found that:

We can increase treatment coverage maintaining a good quality of care
It is a cost-effective model
Community health workers can reach children earlier and prevent complications
The children are receiving more integrated management

But the research doesn’t end here. The current questions being asked are whether the iCCM approach can be implemented at scale, and which model of supervision is the best to assure the quality of SAM treatment.

Sources:
WHO, Integrated community case management of malaria, https://www.who.int/malaria/areas/community_case_management/overview/en/.