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C-IMCI Element Two: Frequently Asked Questions:

What are the underlying assumptions for Element 2?

  • Many children continue to receive treatment outside of health facilities, even though facilities may offer those services sought by the community

Where is Element 2 crucial?

  • Long distances and/or difficult terrain separate people from health facilities, especially during the rainy season
  • Traditional healers and private providers are the major sources of care
  • There is concern about unsafe treatment practices in the community setting

How does Element 2 differ from other community programs?

  • Focus can be on formal and non-formal private providers and/or CHWs
  • Training courses for community-based workers are integrated rather than disease specific
  • IMCI concepts and tools are adapted for use in the home and community (ex. treatment of all conditions a child has, algorithms for making decisions)

What is Community Case Management?
In high-mortality communities with poor access to health facilities, having the ability to treat children in the community makes the difference between life and death. Community case management (CCM) is a delivery strategy to increase the access to, and thus the use of, several life-saving interventions at the community level. Specifically, it places treatment in the hands of trained, supervised, and supplied providers (CHWs, MOH extension workers, private providers, etc.). Depending on the disease prevalence in the community and the capacity of the community providers, the intervention package could include malaria, pneumonia, diarrhea, malnutrition and/or newborn care. A CCM program involves linkages with a health facility for referral, on-going training, and supervisory support; a drug stock or depot located within the community; and social and behavioral change interventions focused on improving prevention, recognition of danger signs, and care-seeking practices. Additionally, an effective approach needs to be part of a larger package that includes improving quality of care at facilities, strengthening of drug logistics and distribution systems, and consideration of referral mechanisms and involvement of other providers such as private providers, ambulatory drug vendors and traditional healers.

Impact of under-five mortality: Need for CCM

Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet 2005;365(9465):1147-52.

CCM for diarrhea

Joint Statement on Clinical Management of Acute Diarrhoea, WHO/UNICEF 2004. Also available in French.

CCM for malaria

Winch P, Gilroy K, Wolfheim C, Starbuck ES, Young M, Walker L, Black R. Intervention models for the management of children with signs of pneumonia or malaria by Community Health Workers. Health Policy and Planning Jul 2005;20(4):199-212.

Kidane G, Morrow RH. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 2000;356(9229):550-5.

CCM for pneumonia

Joint Statement on the Management of Pneumonia in Community Settings, WHO/UNICEF, 2004. Also available in French.

Winch P, Gilroy K, Wolfheim C, Starbuck ES, Young M, Walker L, Black R. Intervention models for the management of children with signs of pneumonia or malaria by Community Health Workers. Health Policy and Planning 2005;20(4):199-212.

CCM for neonatal sepsis

Bang AT, Bang RA, Stoll BJ, Baitule SB, Reddy HM, Deshmukh MD. Is home-based diagnosis and treatment of neonatal sepsis feasible and effective? Seven years of intervention in the Gadchiroli field trial (1996 to 2003). Journal of Perinatology 2005;25 Suppl 1:S62-71.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354(9194):1955-61.

How has CCM been implemented?

What types of materials are available to support programmers?

   
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