Performance of Ethiopia's Health System in Delivering Integrated Community-Based Case Management

Background. Analyzing complex health programs by their components and subcomponents serves design; documentation; evaluation; research; and gap identification and prioritization. In 2012; we developed a rapid methodology to characterize integrated community case management (iCCM) programs by assessing benchmarks for eight health system components in three program phases. Objective. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced; and to compare the benchmarks across the geographical region. Methods. Six national iCCM experts scored each of 70 benchmarks (no; partial; or yes) and then were facilitated to reach consensus. Results. Overall; iCCM benchmark achievement in Ethiopia was high (87.3); highest for pre-introduction (93.0); followed by introduction (87.9) and scale-up (78.1) phases. Achievement bysystem component was highest for coordination and policy (94.2) and lowest for costing and finance (70.3). Six regional countries' benchmark assessments; including two from Ethiopia 14 months apart; were highly correlated with program duration at scale (correlation coefficient: +0.88). Conclusion. Ethiopia has a mature; broad-based iCCM program. Despite limitations; the method described here rapidly; systematically; and validly characterized a complex program and highlighted areas for attention through government or partners

Utilization of Integrated Community Case Management Services in Three Regions in Ethiopia after Two Years of Implementation

Background: The integrated community case management (iCCM) strategy has brought fully integrated treatment for sick children to the community in Ethiopia since 2010. Objectives: To describe patterns of use of iCCM services in 31 woredas (districts) in three regions of Ethiopia. Methods: We analyzed all 60;452 encounters (58;341 [98.2] for children 2-59 months of age and 2079 [1.8] for children2 months of age) recorded in iCCM registration books from December 24; 2012 to January 15; 2013 in 622 randomly sampled health posts. Results: Children 2-23 months constituted more than half (58.9) of the total children treated; and about half of the registered infants 2 months (1000/2079 [48.1]) were not sick since some Health Extension Workers (HEWs) were recording well-infant visits. On average; sick children had 1.3 symptoms; more among children 2-59 months than among young infants (1.4 vs. 1.04; respectively). The main classifications for children 2-59 months were diarrhea with some or no dehydration (29.8); pneumonia (20.7); severe uncomplicated malnutrition (18.5); malaria (11.2); and other severe diseases (4.0). More than half the sick children 2 months (52.7) had very severe disease. Treatment rates (per 1000 children per year) were low for all classifications: 11.9 for malaria (in malarious kebeles only); 20.3 for malnutrition; 21.2 for pneumonia; and 29.2 for diarrhea with wide regional variations; except for pneumonia. Nearly two-thirds of health posts (64) treated 5 cases/month; but one treated 40. Health Extension Workers saw 60 more sick children 2-59 months in the third quarter of 2012 than in the third quarter of 2011. Conclusion: The use of iCCM services is low and increasing slowly; and the few busy health posts deserve further study. Recording healthy young infants in sick registers complicates tracking this vulnerable group