Access Symposium,

June 2 – 3; 2011-Dar es Salaam

IMPROVING ACCESS TO TREATMENT

THROUGH ICCM - The Malawi Experience

Why Integrated Community Case

Management (ICCM)

6/8/2011 2

• Policy aims at bringing child care services closer to the

home through Health Surveillance Assistants by ensuring;

• Prompt child recognition for danger signs

• Prompt health care seeking from community

• Proper assessment of the child

• Correct classification

• Proper use of ORS, zinc, antibiotics, antimalarials

• Counseling for adherence to treatment

• Referral of severely ill children

HEALTH SURVEILLANCE ASSISTANTS

(HSAs)

6/8/2011 IMCI Unit MoH 3

Community based Health care workers deployed at community

level as frontline workers to perform 5 key functions

Community Disease Surveillance feedback meetings

Conducts outreach clinics and home visits

Village clinics

Community Public facility inspection

Salaried by MoH ($100/Month)

Report to DHMT - DEHO – IMCI Coordinator

1 HSA is responsible for 1000 population

No of HTR is 4000, trained HSAs for vge clinics 3446 and

functional vge clinics 2181

Integrated Community Case

Management (ICCM)

HSAs trained to manage sick

children aged 2-59 months with

simplified WHO IMCI algorithm

Assess symptoms

Classify illness

Treat or refer (severe cases)

Pneumonia antibiotics

Fever / malaria antimalarials

Diarrhea ORS and zinc

Danger signs/severe illness refer

ELEMENTS

Train HSAs in ICCM

Procure drug boxes; ORT equipment, bicycles

Provide support for DEC’s and TWG’s meetings

Support for orientation of Health Centre In-Charges

Support orientation of village health clinic committees

Support HSA quarterly review meetings

Support Mentorship program

Support training of senior HSA’s as VC supervisors

Strengthen drug management system

Strengthen M&E system

Essential Elements for effective ICCM

implementation

6/8/2011 5

IMCI Unit MoH

Partners Contribution

Name of partners Type of support

SAVE THE CHILDREN Supports all elements including

ICCM medicines procurement

PSI Supports all elements including

ICCM medicines procurement

UNICEF Supports all elements and

committed to beef up availability

WHO Supports all elements minus

medicines

USAID - BASICS Supports all elements including

ICCM medicines procurement from

PMI

UTILIZATION

317878

74415

205197

16346

2303 2139 11822

0

50000

100000

150000

200000

250000

300000

350000

Fever Diarrhoea fast breathing Red eye Malnutrition Anaemia Other

Cases seen in village clinics (July 2010 - March 2011)

Series1

7% 6%

4%

35%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Fever Diarrhoea fast breathing Red eye

Referral rates(July 2010- March 2011)

Series1

USE OF ACTs and RDTs ICCM in Malawi use ACTs 1X6 and 2x6 for children aged

between 2 to 59 months for the treatment of malaria

In 2009, a policy was made to start use of RDTs in Malawi i.e at health facility level

3 million combined tests of bioline and paracheck have been procured

Trainings to health workers on how to use RDTs will take place when funds are approved by the Ministry of Health

ICCM MEDICINES UTILIZED Jan 2010-Mar 2011

PRODUCT NAME QUANTITY USED

ACT 1x6

1,156,140

ACT 2x6 2,210,760

COTRIMOXAZOLE 480MG 1, 074,400 TABLETS

PARACETAMOL 500MG 842,000 TABLETS

ZINC SULPHATE 20MG 10,068,780 TABLETS

ORS 91,328 SACHETS

REPORTING AND SC4ICCM HSAs use LMIS 01G forms to report on medicinal use, losses,

adjustments,orders,receipts and balances on hand

Village clinic register books are used to collect all the information about the sick child

Form 1A is used to report on all cases seen per month by HSAs and quantities of medicines used

Consolidated monthly reporting form is filled at facility level. This form include cases seen and treated/referred and quantities of medicines used by all HSAs under each H/Facility

The information is added to Supply Chain for the facility and send to DHO for resupply

SUPERVISION

Integrated supervisions are done quarterly by the DHMT

Monthly supervisions are done by Senior HSAs

During supervisions,HSAs are assessed in the following;

Assessment of the sick child and diagnosis, filling of village

clinic register books, dosages of medicines,counselling and

advise on when to come back

Checking availability of ICCM medicines i.e ACTs 1x6, 2x6

cotrimoxazole,ORS and zinc,paracetamol and Eye ointments

Challenges Infrequent monitoring by DHMTs

Delayed reporting of monthly reports

Inadequate H/C staff orientation on mentorship to strengthen

ICCM implementation

Inadequate ACTs in village clinics

Deployment of HSAs in their catchment areas

THANK YOU