PSI’s experience in Community Case

Management programsMegan Wilson, Child Survival Program Manager

CoreGroup Spring Meeting, April 2010

PSI’s work

• To improve health of low-income population through behavior change communication and increased access to health-related products;

• Traditional delivery models are:

(i) social marketing

(ii) franchised clinic and

(iii) free distribution campaign; • Recently, focus on accelerating Child Survival by

integrating life-saving interventions through community case management of common childhood illnesses.

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PSI’s Role in Preventing Child Deaths

• 3rd cause (8%): Malaria prevention / treatment

• 2nd cause (17%): Diarrhea prevention / treatment

• 1st cause (19%): Pneumonia treatment

• Promotion of household water treatment and hand washing

• Early treatment of diarrhea at home / community

Diarrhea prevention & treatment

• Improved nutrition of infants through Sprinkles promotion

• Treatment of pneumonia at the community level through antibiotics

Pneumonia Management & Nutrition

Communications + Product = Healthy Behavior

So what does PSI do around CCM?

• Training and equiping Community Health workers in rural area to assess fever, cough with fast-breathing and diarrhea in children and determine treatment or whether a referral to a health facility is needed;

• Regular supervision in partnership with local health authorities and partners

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Experience in Myanmar

« Village-based Community Health Workers » from the Sun Primary Health network identify, assess and refer cases of pneumonia to Sun Quality Health franchised clinic network where pre-packaged ATB treatment is provided.

MadagascarChildren under five with: • non-severe pneumonia• diarrheal diseases and• non-severe malaria:

in rural settings are managed by Community Health Workers using respectively pre-packaged treatment.

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Uganda• Public « Village Health Teams » will receive training

and supervision to identify and refer sick child to private health providers

• These private health providers are part of PSI’s franchised clinic network ProFam. The patient will be referred and receive adequate treatment developed by PSI.

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CIDA CCM Program

• To learn how best to scale-up delivery of ACTs, antibiotics and ORS/ZN to ensure maximum impact on overall child mortality,

• Hope to avert 27,800 deaths overall• Through Integrated management of childhood illnesses by

« Health Security Agents » in Malawi and Community Health Volunteers in DRC,

• And Home Management of Malaria in under five by « Community Volunteers » in Mali and « Community Relay Agents » in Cameroun

Cameroun

• Target Group: 2.1 M• What: Scale-up delivery of

ACTs, Pilot delivery of antibiotics and ORS/ZN

• How: Community Outreach Agents 

• Goal: Avert an estimated 4,114 deaths

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Democratic Republic of Congo

• Target Group: 1.5 million people • What: To learn how best to scale-up

delivery of ACTs, antibiotics and ORS/ZN to ensure maximum impact on overall child mortality,

• How: Through Integrated management of childhood illnesses by Community Health Volunteers,

• Goal: Avert an estimated 5,361 deaths

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Malawi

• Target Group: 1.7 million people in 5 districts in Malawi• What: To learn how best to scale-up delivery of ACTs,

antibiotics and ORS/ZN to ensure maximum impact on overall child mortality,

• How: Through Integrated management of childhood illnesses by « Health Security Agents »

• Goal: Avert an estimated 3,927 deaths

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District Population

Hospitals H/ Centres

HSAs Villages households

Machinga 488996 1 21 370 897 115136Zomba Rural

583167 5 28 640 1539 142394

Thyolo 514138 3 39 580 456 142039Mwanza 94476 1 4 269 156 47433Neno 108897 1 9      Total 1789674 11 101 1859 3048 447002

Mali

• Target Group: Over a population 2.22 M in Segou

• What: Scale-up delivery of Home Management of Malaria (HMM)

• How: Delivering 1,655,000 ACTs by « Community Volunteers »

• Goal: Avert an estimated 14,392 deaths

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Progress to date• Reduction in:

1. Severe dehydration

2. Severe malaria cases,

3. Reduction in transfusions

have been reported by health facilities staff in settings PSI’ CCM interventions are implemented

• On going health impact research will tell us much more over the couple of years

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Challenges and Lessons learned• On-going communications about CHW services

needed with target groups• Drug Stock-out could be avoided by ensuring health

center staff which are responsible for CHW supervision and replenishment are supportive,

• CHW Training & Refreshers needs to be rigourous so that case management algorithm can be done correctly,

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Challenges and Lessons learned continued• Monitoring & evaluation is essential for

programmatic improvements • Partnership is critical and roles need to be clearly

defined throughout the management system• CHW need to be empowered to highlight when they

more commodities, support and training• Communication channels/ means need to be

established and maintained

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