Community case management RBM CMWG, 8-9 th July 2009.
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Transcript of Community case management RBM CMWG, 8-9 th July 2009.
Purpose
• What are the operational/implementation issues that need attention, if nation wide delivery of community case management is to be • feasible and • achievable?
• How can we address these issues?
Categorisation of the issues
• Health system• Health worker
• Community based• Health facility based
• Community• Policy• Private sector
Health systems
• Availability of malaria treatments; in the hands of CHWs – right treatment, right dosages, right time
• How does community-based case management fit/integrate into the “formal” health system?
• Use of regular supervision to sustain good practices and behaviour; models and funding
Health systems
• Record keeping and use of data for decision making; registers, data flow, feedback
• Resource mobilisation
• Using defined indicator/s to measure progress; reliably
Health worker – community-based
• Quality of services; assessing CHW performance and improving it, adherence to guidelines
• CHW motivational approaches; why volunteer? What is the right package, i.e. financial and non-financial?
Health worker – facility based
• Supervision of CHWs?• Perceptions of CCM? Extension of the health
system or “competition”?; resources to community not matched by resources to health facilities.
Community
• Treatment adherence; what is the status now and how can it be improved? Pre-packs, packaging
• Effective approaches for demand creation for treatment (and diagnosis); what is community mobilisation/ sensitisation? where is the evidence of what works?
Policy environment
• Rationale of community case management (malaria); (presumptive) treatment close to home? what about health facilities? Treatment and diagnosis=case management?
• Introduction of integrated community case management (malaria, pneumonia, diarrhoea); how will this affect current malaria case management approaches?
Private sector
• Is this a continuum of community case management? Acceptability-both sides
• How to engage? Policies, training, treatments, diagnosis, reporting, quality control
How can we address these issues?
• Distill the operational evidence (& experiences) to highlight • what works – best practices, implementation models• what has not worked and why
• Harness current funding opportunities to support feasible implementation models – link to operational research to inform future improvements
• Identify the gaps that have not be addressed and how to go about finding solutions
How can we address these issues?
Recommendations• CCM is a delivery approach that should
complement health facility delivery approach• Health facility delivery should be strengthened in
tandem with CCM; health facility delivery should be the ideal approach
• CCM is not a permanent delivery approach and there should be guidelines on “phasing in” and “phasing out” – changing role of CHWs?