National Scale-Up of Integrated Community Case Management in Rural Ethiopia: Implementation and Early Lessons Learned

ABSTRACT

Background. Although under-five mortality in Ethiopia has decreased 67in the past two decades; many children still die from preventable or treatable conditions; mainly pneumonia; newborn problems; diarrhea; malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care; but access to and use of treatment remains inadequate. Community health workers appropriately trained; supervised; and supplied with essential equipment and medicines; can deliver case management or referral to most sick children. In 2010; Ethiopia added pneumonia to diarrhea; malaria and severe acute malnutrition; targeted for treatment in the integrated community case management (iCCM) strategy. Purpose. This article describes the national scale-up of iCCM implementation and early lessons learned. Methods. We reviewed data related to iCCM program inputs and processes from reports; minutes; and related documents from January 2010 through July 2013. We describe introduction and scale-up through eight health system components. Results.The government and partners trained and supplied 27;116 of the total 32;000 Health Extension Workers and mentored 80 of them to deliver iCCM services to over one million children. The government led a strong iCCM partnership that attracted development partners inimplementation; monitoring; evaluation; and research. Service utilization and weak supply chain remain major challenges. Conclusion:Strong MOH leadership; policy support; and national partnerships helped successful national iCCM scale-up and should help settle remaining challenges