Integrated Community Case Management of Childhood Malaria, Pneumonia and Diarrhoea

The document presents the implementation guidelines for integrated community case management (ICCM) for childhood malaria, pneumonia, and diarrhoea in Uganda. The guidelines are the result of collaboration between the Ugandan Ministry of Health (MOH), the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF). Policymakers, managers, districts, health workers, communities, and non-governmental organisations (NGOs) will use the strategies on how to best implement ICCM at all levels of the health services delivery chain. The ICCM strategies are part of the MOH’s efforts to make the Village Health Team (VHT) concept operational as well as to build on the experience of existing programmes such as Home-Based Management of Fever.

The primary strategy of ICCM is to use VHT to promote health and prevent deaths. VHT aims to train and support the work of five volunteer health workers in each village. ICCM adds a complimentary treatment component to the primarily preventative work of the VHTs. For example, promotion of hand washing reduces diarrhoea and pneumonia. Communication-related strategies that can result in a successful ICCM programme:

Nationally:

1. Mobilising communities to demand, support, and use the programme through advocacy and mobilisation of resources;
2. Sensitisation and orientation of districts and other stakeholders;
3. Capacity building for district training and supervision;
4. Monitoring, supervision, and evaluation;
5. Research to guide implementation of the strategy; and
6. Pre-packing and colour-coding the drugs for ICCM.

District level:

1. Sensitise and guide communities in selecting VHTs for ICCM;
2. Training VHT trainers and supervisors;
3. Training public and private health facilities to manage referred cases; and
4. Supervising and monitoring ICCM at lower levels.

Health facility level:

1. Supporting communities to select VHTs for ICCM;
2. Training, supervising, and replenishing medicines and supplies for VHTs;
3. Advocating for ICCM and maintaining good linkage with communities; and
4. Encouraging caregiver of newborns with danger signs to seek care from a health facility.

Community level:

1. Mobilising communities to participate in ICCM;
2. Selecting VHTs for ICCM; and
3. Motivating VHTs distributing medicines for ICCM.

VHT level:

1. Treating children and counselling mothers; and
2. Home visits for mother and newborns.

Activities include:

• Regular meetings of national ICCM advisory task force;
• Developing and disseminating advocacy materials for ICCM;
• Sensitisation visits to districts for health unit management committees and communities;
• Mobilising and counselling caregivers; and
• A training cascade process to prepare implementers at different levels to train others.

Some lessons learned from an ICCM pilot in Northern Uganda include the observation that tools should be used that motivate VHT members. Likewise, care should be taken to motivate community members to participate. VHT are capable of providing treatment when drugs are pre-packaged correctly.  VHTs should not be overload with the treatment of several diseases beyond their capacity.