Where to from here? Policy and financing of integrated community case management (iCCM) of childhood illness in sub-Saharan Africa.

Integrated community case management of childhood illness (iCCM) is a strategy to equip, train, support and supervise community health workers (CHWs) to assess children and deliver curative interventions in communities [1]. In particular, iCCM includes the delivery of amoxicillin (with use of respiratory timers) for pneumonia, oral rehydration salts and zinc for diarrhoea, and rapid diagnostic tests and artemisinin–based combination therapy for malaria. iCCM may also include screening, referral and treatment for malnutrition, and of newborns with illness. A “community health worker” (CHW) in this context is a health worker that provides health care in the community, with some training in the interventions they deliver (and who may or may not receive monetary payment), but who does not have a formal health professional or paraprofessional certificate or tertiary education degree. In sub–Saharan Africa, recent years have seen increasing recognition of iCCM as a core strategy to deliver care to children, particularly those with poor access to health facilities, and reduce child mortality, in the context of the drive to achieve the Millennium Development Goals. Twenty–eight countries in sub–Saharan Africa are now the site of delivery of community case management for each of pneumonia, diarrhoea and malaria, albeit at widely differing levels of coverage between countries [2]. Despite this progress, there are significant remaining obstacles to realizing the potential of iCCM to provide effective coverage of interventions for childhood illness at scale and quality. Here we review current trends in policy and financing of iCCM in sub–Saharan Africa to highlight two key issues: sustainable financing of iCCM, particularly from domestic sources, and the integration of iCCM in national health systems. We conclude by providing suggestions for how to move forward on these linked challenges.