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Abstract
Integrated community case management (ICCM) is a program that allowed Health Extension Workers (HEWs) treat the three most common childhood illnesses: pneumonia, diarrhea and malaria through delivering a closer and accessible care. In Ethiopia, this proven strategy was being implemented in selected districts of the regions but there were no sufficient evidences to decision-makers for improvement interventions. Cross-sectional study was conducted by including all functional health posts and HEWs from four randomly selected districts. Pre-tested structured questionnaires and observation checklist were used to collect data. Data was entered into Epi data version.3.1 and transported to SPSS v.21.0 for analysis. Bivariate and multiple binary logistic regression analysis were used to identify the determinants. 60 (60.6%) of the Health post were in good implementation category. 24 (15.3%) had only one HEW each, 26.8% had recommended three HEWs and 16 (16.2%) had no. HEWs mentored quarterly had three times better implementation (AOR) 3.14, 95% CI [1.65-6.52]). The services were less likely implemented in kebelles lacking any CHAs (AOR 0.47, 95% CI [0.19-0.83]). Health posts which were serving community for greater than eight hours per day had five times better implementation (AOR 5.33, 95% CI [2.58-9.33]). The study revealed that there is still a long way to go for better implementation of the program. Improving the program implementation needs a coordinated effort of all stakeholders at different levels. Nationally, preparing a system-wide approach towards resolving multifaceted challenges facing the programs will help attain the sectorial mission of reducing child mortality. Key words: Integrated community case management, health extension workers, community health agents.  
Highlights
Integrated Community Case Management (ICCM) is a community care strategy which seeks to extend case management of childhood illness beyond health facilities to the community level so that more children have access to lifesaving treatments (Unicef, 2012)
A total of 157 health extension workers deployed in 99 health posts from four districts were included in the study
More than 83% of HEWs reside in their respective villages. 44.6% stated that the initiation of the ICCM had increased their acceptance from the community (Table 1)
Summary
Integrated Community Case Management (ICCM) is a community care strategy which seeks to extend case management of childhood illness beyond health facilities to the community level so that more children have access to lifesaving treatments (Unicef, 2012). The ICCM package can differ based on national contexts, but most commonly includes diarrhea, pneumonia and malaria diagnosis and treatment For these reasons, various NGOs like UNICEF, WHO, USAID and other partners are funding and technically supporting the ICCM strategy to train, supply and supervise front-line workers to treat children for diarrhea, pneumonia and malaria, using Oral Rehydration Salt (ORS) and zinc, oral antibiotics, and artemisin based combination therapy (ACT), respectively. Various NGOs like UNICEF, WHO, USAID and other partners are funding and technically supporting the ICCM strategy to train, supply and supervise front-line workers to treat children for diarrhea, pneumonia and malaria, using Oral Rehydration Salt (ORS) and zinc, oral antibiotics, and artemisin based combination therapy (ACT), respectively Their target is mainly toward low income and malariaaffected countries (Unicef Ethiopia, 2011)
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