Community Case Management of Childhood Illness State of the Art

1. Community Case Management of Childhood IllnessState of the Art WHO/AFRO

2. Outline of the Presentation • Magnitude of Child Mortality in the African Region • Child Survival: A Strategy for the African Region • Childhood pneumonia • Barriers to implementation • Capacity building for CHWs • Way Forward • Conclusions

3. Magnitude of Child Mortality in the African Region • It is estimated that 12,000 children die every day in sub-Saharan Africa • Every minute 8 children die from easily preventable or treatable conditions, 2 of them are newborns • This is compared to 1 jumbo jet full of children crashing every hour

4. The Regional Child Survival Strategy • Priority Interventions • Newborn care • Infant and young child feeding including micronutrient supplementation • Prevention and prompt treatment of malaria • Immunization • Management of common childhood illnesses and treatment and care of HIV exposed or infected child • PMTCT of HIV

5. Coverage of key Child Survival interventions, AFRO, 2005 Int’l Targets (2010) Current coverage 73 65 43 39 37 35 30 4

6. Total number of U5 pneumonia Deaths, AFRO, 2004 (x000) Source: UNICEF/WHO, Pneumonia: The forgotten killer of children

7. Percentage of children U5 with Susp. Pneumonia taken to appropriate H. Provider, African Region 0-32% 33-49% 50%+ No data or not AFRO 1996-2003 2000-2006 Source: UNICEF/WHO, Pneumonia: The forgotten killer of children, 2006, SOWC 2008

8. Percentage of children U5 with Susp. Pneumonia receiving antibiotics, African Region 0-32% 33-49% 50%+ No data or not AFRO 2000-2006 Information on this indicator is still very scanty despite DHS being conducted in several countries each year Source: UNICEF/WHO, Pneumonia: The forgotten killer of children, 2006, SOWC 2008

9. WHO/UNICEF Joint Statement “CHWs can be trained to assess sick children for signs of pneumonia; select appropriate treatments; administer the proper doses of antibiotics; counsel parents on how to follow the recommended treatment regimen; follow-up sick children; and refer them to a health facility in case of complications. There is strong scientific and program evidence to support the effectiveness of this approach.” WHO/UNICEF Joint Statement, “Management of Pneumonia in Community Settings,” May 2004

10. Policy and Implementation Status of CCM for Pneumonia, 2007 African Region Permissive & Implemented Permissive & not Implemented Not permissive & Implemented Not permissive No data or not AFRO Source:Lancet, Vol 371, Nr 9620 Countdown to 2015, Bul WHO, May 2008, David R Marsh et al.

11. Status of Adoption of Low Osmolarity ORS and Zinc Policy, 2007 African Region No data or not AFRO Adopted Partial Not adopted Countdown Working Group on Health Policy and Health Systems

12. Few countries have adopted so far a complete set of policies, 2007 Midwives authorized to deliver life-saving interventions Policy indicators for service delivery Integrated Management of Childhood Illness adapted to cover first week of life 1-2 policies adopted No policy adopted 3 policies adopted All 4 policies adopted Data not complete 14 31 2 3 18 Community health workers authorized to identify and manage pneumonia Based on 50 countries assessed globally for the countdown process Promotion of low Osmolarity ORS and zinc for management of diarrhoea Countdown Working Group on Health Policy and Health Systems

13. Barriers to implementation Professional interests e.g. Community-based workers to manage cases of pneumonia Task delegation and task shifting to lower cadres often resisted by higher cadres. Dialogue between professional associations and programme planners Product availability e.g. Management of diarrhoea The availability of a suitable zinc supplement on the international market is a barrier to implementation. Manufacturers to produce the zinc supplement Stewardship for health weak Other Health system barriers Human Resources Financing of health services

14. Caring for Newborns and Children in the Community : The potential • Improvements in home care couldprevent more than one-third of childhood deaths • Improved breastfeeding and complementary feeding • Treatment of childhood pneumonia • Wider use of ORT and zinc • Wider use of insecticide-treated bednets and other materials (Jones et al., The Lancet, 2003)‏

15. Caring for Newborns and Children in the communityThe actors • Policy-makers to authorize and support the use of antibiotics at community level • Community Health Workers to support families in caring for their young children. Need to be trained, supervised and motivated • Community members to be involved and supportive

16. Promotion of key family practices Care-giving skills and support for child development Newborn care at home Infant and young child feeding Family response to child’s illness Prevention of illness Caring for Newborns and Children in the CommunityThe intervention Main topic areas Community-level integrated case management of childhood illness • Referral of children with danger signs • Treatment in the community • Diarrhoea • Fever (malaria)‏ • Pneumonia (treatment or referral)‏ • Newborn illness • Feeding problems/malnutrition • Mobilization of communities • Problem-solving • Creating demand for services and a safe environment

17. To expand the coverage of household and community interventions that will reduce child mortality and promote the healthy growth and development of young children Aim of the materials for CHW training • To providetraining materials and job aids forcommunity health workers working with families

18. Packages of Community-based interventions for newborns • For all mothers and newborns: • Routine postnatal care(EBF, Tem, cord&sk, care seek)day 1,2-3, 5-7 • For special groups: • LBW infants - additional care(+exp milk, refer) • Sick infants - management of illness where access is very low (ass dang sign refer sever cases) Meeting 30 June 4 July on harmonization of available tools)

19. Way forward • Support for policy change through global, regional and national advocacy • Disseminate more widely existing evidence and successful experiences on treatment of pneumonia at community level. Show impact on mortality • Intensify efforts to facilitate dialogue between professional associations and programme planners • Incorporate community management of pneumonia where community malaria management is implemented and well supported (Clinical overlap of pneumonia and malaria) • Promote integrated approach to child health at community level • Technical assistance for programming, M&E, Tools and Finance

20. Governance Supportive policies and functioning health systems are essential for maternal, newborn and child survival New Evidence and Information Policy Environment Coverage Outcomes Service Delivery Financing Health Workforce Adapted from Everybody's Business: Strengthening health systems to improve health outcomes: WHO Framework for action, 2007

21. Conclusion • Community Case Management of Childhood Illness: A Hope for children living in limited resource settings • Adoption of clear policies on interventions and delivery mechanisms: a key building block of well functioning health systems • Inadequate health financing, human resources and lack of policy measures pose a serious threat to rapid scaling-up of effective child health interventions • Child Survival MDG can be achieved; it will require rapid scale-up to high and sustained coverage (HF and community action are complementary)