Abstract
BackgroundAcross the developing world, countries are increasingly adopting the integrated community case management of childhood illnesses (iCCM) strategy in efforts to reduce child mortality. This intervention’s effectiveness is dependent on community adoption and changes in care-seeking practices. We assessed the implementation process of a theory-driven community dialogue (CD) intervention specifically designed to strengthen the support and uptake of the newly introduced iCCM services and related behaviours in three African countries.MethodsA qualitative process evaluation methodology was chosen and used secondary project data and primary data collected in two districts of each of the three countries, in purposefully sampled communities. The final data set included 67 focus group discussions and 57 key informant interviews, totalling 642 respondents, including caregivers, CD facilitators community leaders, and trainers. Thematic analysis of the data followed the ‘Framework Approach’ utilising both a deduction and induction process.ResultsResults show that CDs contribute to triggering community uptake of and support for iCCM services through filling health information gaps and building cooperation within communities. We found it to be an effective approach for addressing social norms around child care practices. This approach was embraced by communities for its flexibility and value in planning individual and collective change.ConclusionsRegular CDs can contribute to the formation of new habits, particularly in relation to seeking timely care in case of child sickness. This study also confirms the value of process evaluation to unwrap the mechanisms of community mobilisation approaches in context and provides key insights for improving the CD approach.
Highlights
Across the developing world, countries are increasingly adopting the integrated community case management of childhood illnesses strategy in efforts to reduce child mortality
Low- and middle-income countries are increasingly adopting community-based strategies for delivery of basic health care, such as integrated community case management which aims to reduce mortality among children under 5 years. iCCM is a community-based child survival approach that provides life-saving treatment to sick children under five, for malaria, pneumonia, and/or diarrhoea, delivered by community members commonly known as community health workers (CHWs) as per the
Extent of implementation of the community dialogue (CD) The CD model recommends a minimum of one session every quarter per CHW catchment area over a year-long period, in order to cover the four proposed discussion topics
Summary
Countries are increasingly adopting the integrated community case management of childhood illnesses (iCCM) strategy in efforts to reduce child mortality This intervention’s effectiveness is dependent on community adoption and changes in care-seeking practices. Effectiveness trials and systematic reviews demonstrated the health impacts of interventions that supported community empowerment in low- and middle-income countries [8, 9], in particular through women’s groups [10, 11], village health committees [12], community led total sanitation [13], and other forms of community accountability [14, 15] These have drawn attention to the essential role played by communities in improving health practices and access to services [16]. Several reviews noted that the evidence is still scarce on what does or does not work, calling for more experimental designs [17], process evaluations [18] and qualitative research [19] to clarify how effectively community participation contributes to health outcomes
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