The publication of Community Case Management Essentials is exceptionally well-timed. It comes at a moment of increasing need for community-based treatment of child illness. The global community and the governments of most developing countries have committed themselves to achieving the Millennium Development Goal of reducing infant and child mortality by two-thirds from 1990 levels. Most countries, however, are not on track to reach that goal… and analyses done in a number of those countries indicate that scaling up high impact interventions— especially treatment of pneumonia, diarrhea and malaria, newborn care, and nutrition—is critical to reach it. Community Case Management (CCM) is an important approach to increase coverage of these interventions, and also to increase the equity in child health services that is another major objective of child survival programs.
The timing is also good because there is now a solid body of evidence and experience that governments and their development partners can draw upon to develop successful CCM programs. A number of countries—Nepal, Pakistan, Honduras, Senegal, and others—now have well-established national CCM programs whose experience and approaches are reflected in this publication. Many international and national non-governmental organizations have worked with local and national governments to implement CCM as an element of their health programs, especially in underserved populations. All these experiences, along with the scientific studies that led to them, have produced the evidence and guidance that is provided here.
We know with certainty, for example, that well-trained, supervised and supported community health workers (CHWs)—literate or even illiterate—can successfully diagnose child pneumonia, malaria, or diarrhea and provide effective treatment. We know from several countries’ at-scale experience that this approach actually increases the total numbers of children receiving appropriate treatment when they need it, rather than just changing the place where they get treatment. Operations research in Nepal has clearly demonstrated that allowing trained CHWs to provide treatment is far more successful in increasing appropriate care than just allowing them to refer cases. Studies of quality of care provided by well-trained CHWs implementing CCM indicate that this quality can equal or even exceed the quality of care often documented in public health facilities. The presence of trained health workers in communities themselves can increase not just the availability of services, but the knowledge and willingness of families to seek appropriate care.
For these reasons, more and more governments and development partners are recognizing the contribution that CCM can make to accelerating progress in child survival. Over forty countries have initiated some CCM activities; most, however, are not yet at scale. As these activities expand, and as more countries contemplate and initiate CCM, the experience, tools, and guidance contained in this publication can be of substantial value. It will be especially important for program managers, technical officers and consultants, as well as for those who wish to gain greater understanding of community-based public health programs. It is part of the continuing efforts of our community to apply the results of research and program experience in improving the survival, health and well-being of children, families, and communities around the world.
Alfred V. Bartlett, III, M.D., F.A.A.P.
Senior Advisor for Child Survival, USAID, Bureau for Global Health
Click here to read Community Case Management Essentials.