Among the poorest and most marginalized communities, pneumonia, diarrhea, malaria, and AIDS (in some countries) remain the major causes of death in children under five. We know the effective preventive interventions—exclusive breastfeeding, basic hygiene including hand washing, vitamin A supplementation, and vaccinations.

And as the Lancet series on child survival shows, we have existing packages of proven interventions as well, interventions that could reduce child mortality by as much 63% if they were universally available.[1] But while we know what these life-saving interventions are—low-cost antibiotics for pneumonia, oral rehydration solution and zinc for diarrhea, and insecticide-treated mosquito nets and effective medications for malaria—millions of children, particularly from poor families in the developing world, do not receive them due to issues of availability, access or cost. Consequently, needless child mortality continues.

MCHIP is a technical leader in promoting community case management (CCM), a strategy for reaching underserved rural communities using community health workers (CHWs) to deliver treatment of sick children in the poorest and hardest to reach communities. With intractable problems like the public sector health worker shortage, MCHIP offers this alternative mode of health care delivery in the hopes of increasing coverage in settings where demand creation for public sector health facility services have reached their limit.

For example, we are working with partners to advocate policy change and create a favorable working environment for CHWs. To be effective, CHWs must be accepted and supported by professional health workers who provide supportive supervision and mentoring relationships. In addition, the health system has to support them with medicines and supplies, as well as financial or nonfinancial incentives. Through the global CCM taskforce (co-chaired by WHO, UNICEF and USAID), for which MCHIP is the secretariat, we have also developed CCM indicators and are finalizing the CCM toolkit (guidelines for training, planning, implementation and supervision) to harmonize and improve the quality of CCM implementation in countries that adopt the strategy.

MCHIP continues its support to programs to improve measurement and performance monitoring with a focus on equity. Through effective monitoring and documenting of beneficiaries of care provided, we will demonstrate that CCM is not only effective in delivering life-saving interventions, but that it saves lives of the poorest and most marginalized populations.

[1] Jones, G et al. The Lancet.