Stakeholders' perceptions of integrated community case management by community health workers: a post-intervention qualitative study.

Denise L Buchner,Celestine Barigye,Alberto Nettel-Aguirre,Jerome Kabakyenga,Jennifer L Brenner,Samuel Maling,Kyomuhangi Teddy,Nalini Singhal,Suryaprakash Sambhara

doi:10.1371/journal.pone.0098610

Abstract

BackgroundIntegrated community case management (iCCM) involves delivery of simple medicines to children with pneumonia, diarrhea and/or malaria by community health workers (CHWs). Between 2010 and 2012, an iCCM intervention trial was implemented by Healthy Child Uganda. This study used qualitative tools to assess whether project stakeholders perceived that iCCM improved access to care for children under five years of age.MethodsThe intervention involved training and equipping 196 CHWs in 98 study villages in one sub-county in Uganda in iCCM. During the eight-month intervention, CHWs assessed sick children, provided antimalarials (coartem) for fever, antibiotics (amoxicillin) for cough and fast breathing, oral rehydration salts/zinc for diarrhea, and referred very sick children to health facilities. In order to examine community perceptions and acceptability of iCCM, post-intervention focus groups and key respondent interviews involving caregivers, health workers, CHWs and local leaders were carried out by experienced facilitators using semi-structured interview guides. Data were analyzed using thematic analysis techniques.ResultsRespondents reported increased access to health care for children as a result of iCCM. Access was reportedly closer to home, available more hours in a day, and the availability of CHWs was perceived as more reliable. CHW care was reported to be trustworthy and caring. Families reported saving money especially due to reduced transportation costs, and less time away from home. Respondents also perceived better health outcomes. Linkages between health facilities and communities were reportedly improved by the iCCM intervention due to the presence of trained CHWs in the community.ConclusionsiCCM delivered by CHWs may improve access to health care and is acceptable to families. Policymakers should continue to seek opportunities to implement and support iCCM, particularly in remote communities where there are health worker shortages.

Highlights

Many children still die from preventable and treatable infections, including malaria, pneumonia, and diarrhea
Since 2004, when UNICEF and the World Health Organization issued a joint statement on Integrated community case management (iCCM)[5], iCCM programs have demonstrated success in treating childhood illnesses including fever/malaria [6], pneumonia [7], and diarrhea [8]. iCCM has been proposed over the past decade as a child health strategy to reduce under-five mortality and as means of improving progress toward Millennium Development Goal 4 (MDG) [9]
Access to iCCM community health workers (CHWs) was reported to be more reliable than services offered at formal health facilities; iCCM CHWs were almost always available, unlike health centres, which might be closed, without staff, or have medicine stock-outs

Summary

Introduction

Many children still die from preventable and treatable infections, including malaria, pneumonia, and diarrhea. There is growing recognition that in low-resource settings with shortages of trained health care staff, communitybased health programs can reduce mortality and morbidity of young children, and support health service delivery [1,2,3]. Integrated Community case management (iCCM) involves using lay individuals trained as community health workers (CHWs) to provide curative treatment within their communities. Since 2004, when UNICEF and the World Health Organization issued a joint statement on iCCM[5], iCCM programs have demonstrated success in treating childhood illnesses including fever/malaria [6], pneumonia [7], and diarrhea [8]. Integrated community case management (iCCM) involves delivery of simple medicines to children with pneumonia, diarrhea and/or malaria by community health workers (CHWs). This study used qualitative tools to assess whether project stakeholders perceived that iCCM improved access to care for children under five years of age

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