Abstract
Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.
Highlights
Dear Sir: Doherty and others suggest that our evaluation of the impact of the integrated Community Case Management of childhood illness in Malawi did not take into account spatial variations in exposure to iCCM within districts, thereby diluting the measured impact.[1]
An evaluation focused only on the effects of deploying community-based workers would miss the potential contribution of these broader health system interventions, as well as any negative side effects of the iCCM strategy such as the displacement of program effort from accessible areas to hard-to-reach areas” (HTRAs)
Doherty and others’ recommendations for alternative evaluation designs are flawed, and suggest an unfamiliarity with the realities of large-scale evaluations. Their suggestion to stratify the analysis by a measure of spatial exposure such as distance from a household to a health surveillance assistant (HSA) or to estimate a ratio of HSAs per population in a specified area ignores the fact that neither these data nor geospatial boundaries of district-defined HTRAs is available in Malawi
Summary
Dear Sir: Doherty and others suggest that our evaluation of the impact of the integrated Community Case Management of childhood illness (iCCM) in Malawi did not take into account spatial variations in exposure to iCCM within districts, thereby diluting the measured impact.[1]. The iCCM strategy as implemented by the Ministry of Health and partners in Malawi aimed to improve intervention coverage and reduce under-five mortality among all children. An evaluation focused only on the effects of deploying community-based workers would miss the potential contribution of these broader health system interventions, as well as any negative side effects of the iCCM strategy such as the displacement of program effort from accessible areas to HTRAs. The appropriate unit of analysis for the evaluation is the district, with all under-five children included in the analysis.
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