Community health worker-led treatment for uncomplicated wasting: insights from the RISE study and practice

ABSTRACT

South Sudan, Nigeria, Malawi, Kenya. What we know Delivery of treatment for uncomplicated wasting by community health workers (CHWs) is a simplified approach that can ensure continuity of detection and treatment, particularly in the context of the COVID-19 pandemic. What this article adds This article summarises operational insights developed by the RISE study consortium, a multi-partner, multi-country initiative to develop and test a simplified treatment protocol, tools and job aids for literate and low-literate CHWs to deliver treatment for uncomplicated wasting treatment services through the integrated community case management (iCCM) platform in several locations. The following operational aspects must be considered before embarking on this model context-specific underlying epidemiology (burden of malnutrition and seasonality), extent to which the model will remove top barriers to treatment in the context, existence of a community health system to embed the model within and the presence of a supply chain, supervision and financing. Once deemed appropriate, recommendations to improve implementation and uptake include the simplification of protocols to streamline CHW decision-making, the simplification and integration of CHW tools, the strengthening of referral mechanisms for complicated cases, the provision of motivations and incentives for CHWs, the tracking and addressing of defaulting, enhancing CHW training and supervision and engagement of communities. Full quantitative and qualitative results will be submitted for peer review publication in 2021. Further application of the considerations and recommendations listed here is needed to inform the operational feasibility, scalability and sustainability of the approach.