Abstract
We conducted a prospective evaluation of the “Rapid Scale-Up” (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.
Highlights
Because districts had few data on integrated community case management (iCCM) available at district level, we conducted an assessment of the implementation of iCCM and quality of care provided by ASBCs in the program districts in February–May 2013.12 The methods used were based on an earlier study in Ethiopia,[23] except that we provided ASBCs with a fully stocked drug kit to use during observations of sick child consultations, and we conducted in-depth interviews and focus groups with ASBCs and their supervisors as well as community members
ASBCs providing iCCM services who had all essential drugs in stock on the day of the visit
The evaluation still measured this indicator and observed a large decrease, but we put little weight on that decrease because of the concerns regarding the validity of the indicator. In addition to this indicator, we reported on careseeking for children with symptoms of pneumonia, which has fewer validity concerns
Summary
From 2008 to 2010, the Catalytic Initiative funded “proof of concept” evaluations in three countries (Burkina Faso, Malawi, and Mozambique; Mozambique was later dropped due to implementation challenges and Ethiopia was added instead) to show that proven interventions could be scaled up rapidly to reduce maternal, newborn, and child mortality. The Ministry of Health (MoH), together with a UN agency, planned and implemented a “Rapid Scale-Up” (RSU) of high-impact interventions that was evaluated prospectively by Johns Hopkins University together with incountry research partners. Burkina Faso, which is ranked 181st of 187 countries on the Human Development Index,[6] has declining but still high levels of mortality. The under-five mortality rate decreased from 186 per 1,000 live births in 2000 to 114 per 1,000 in 20107; the maternal mortality ratio has fallen from 580 per 100,000 live births to 400 per 100,000 in 2013.8 The major causes of under-five deaths in Burkina in 2010 were infectious
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