Current scientific evidence for integrated community case management (iCCM) in Africa: Findings from the iCCM Evidence Symposium

In March 2014, over 400 individuals from 35 countries in sub-Saharan Africa and 59 international partner organizations gathered in Accra, Ghana for an integrated Community Case Management (iCCM) Evidence Review Symposium. The objective was 2-fold: first, to review the current state of the art of iCCM implementation and second, to assist African countries to integrate lessons learned and best practices presented during the symposium into their programmes. Based on the findings from the symposium this supplement includes a comprehensive set of articles that provide the latest evidence for improving iCCM programs and ways to better monitor and evaluate such programs.

S ince early 2000 the use of integrated community case management (iCCM) strategy to deliver pneumonia, malaria and diarrhea treatments to children under 5 has dramatically increased. In 2005 there were only 10 countries in sub-Saharan Africa with policies supporting implementation of iCCM of which 7 included pneumonia treatment [1]. This increased to 28 countries by 2013 that now support implementation of iCCM and this includes pneumonia treatment [2].
iCCM, in the hands of well trained, supplied and supervised community health workers can reduce child mortality [3,4]. Recognizing this, in 2012 the World Health Organization and UNICEF released a Joint Statement for iCCM as an equity-focused strategy to improve access to case management, emphasizing important standard practices that should be part of any such programming in countries [5]. However, iCCM implementation has faced challenges considering the poor health care infrastructure in the countries in which this strategy has been introduced.
Since the joint statement was released an increasing amount of evidence has been generated on the strengths and limita-Current scientific evidence for integrated community case management (iCCM) in Africa: Findings from the iCCM Evidence Symposium Theresa Diaz 1 , Samira Aboubaker 2 , Mark Young 1 In March 2014, over 400 individuals from 35 countries in sub-Saharan Africa and 59 international partner organizations gathered in Accra, Ghana for an integrated Community Case Management (iCCM) Evidence Review Symposium. The objective was 2-fold: first, to review the current state of the art of iCCM implementation and second, to assist African countries to integrate lessons learned and best practices presented during the symposium into their programmes. Based on the findings from the symposium this supplement includes a comprehensive set of articles that provide the latest evidence for improving iCCM programs and ways to better monitor and evaluate such programs.
tions of iCCM, as well as the outcome and impact of iCCM within a variety of different country contexts [6]. A number of key impact and outcome studies were finalized in 2013. New and innovative methods for reporting and supervision have been tested. A comprehensive assessment of cost drivers and cost-effectiveness of this approach is ongoing. Finally, given the acceptance of iCCM as a delivery strategy to reach particularly those with limited access to health services, there has been much interest to add other interventions to the package such as maternal and newborn but these additions are only currently being tested in a few countries.
Between 3 and 5 March 2014, over 400 individuals from 35 countries in sub-Saharan Africa and 59 international partner organizations gathered in Accra, Ghana for an iCCM Evidence Review Symposium. The objective of the symposium was 2-fold: first, to review the current state of the art of iCCM implementation by bringing together researchers, donors, governments, implementers and partners to examine the current iCCM implementation landscape and status of evidence in key programme areas, in order to summarize lessons learned and best practices, and identify priorities and gaps in knowledge for improving maternal-newborn and child health. Second, to assist African countries to integrate lessons learned and best practices presented during the evidence symposium into their programmes and identify key actions to include in their national plans.
We conceptualized a theory of change model as to what factors may increase utilization of quality iCCM services (Figure 1). We assumed that this increase in utilization would translate into increased coverage and thus ultimately contribute to decreased child hood mortality.
The symposium and articles in this supplement were organized in thematic areas based on this model. Presentations were given in each thematic area and tools to support implementation were shared with participants for each of these areas as well as in three additional topic areas (private sector, innovations and newborn interventions). In addition lessons learned were documented in each area. This supplement includes articles, based in part on these experiences and lessons learned. The thematic and additional areas, their relationship to the model, and their associated articles are shown in Box 1.  In addition to the articles covering the key thematic areas of the symposium we also have three additional articles. Awor et al describe how the private sector can contribute to iCCM. Aboubaker et al also present the role of Community Health Workers in newborn survival. Based on a systematic process to prioritize research areas, known as CHNRI (Child Health and Nutrition Research Initiative) Wazny et al report on priority iCCM research areas that are still needed. Finally, using the evidence available, Young et al suggest a way forward to improve and sustain iCCM where it is needed. This comprehensive set of articles provides the latest evidence for improving iCCM programs and ways to better monitor and evaluate such programs.