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| Child health: delivering improvements through community-based care | Child health: delivering improvements through community-based care |
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| Almost 75% of all child deaths are attributable to just six conditions: neonatal causes, pneumonia, diarrhoea, malaria, measles and HIV/Aids. But these conditions are all preventable and/or manageable with adequate treatment. With that in mind, is the biggest factor causing death of children a lack of access to healthcare services? | Almost 75% of all child deaths are attributable to just six conditions: neonatal causes, pneumonia, diarrhoea, malaria, measles and HIV/Aids. But these conditions are all preventable and/or manageable with adequate treatment. With that in mind, is the biggest factor causing death of children a lack of access to healthcare services? |
| Many who work in global health think so and have sought to bring down the barriers to access. Some have suggested embedding healthcare services within communities themselves – rather than investing solely in regional facilities – is the best way to ensure quality services reach remote and underserved groups. | Many who work in global health think so and have sought to bring down the barriers to access. Some have suggested embedding healthcare services within communities themselves – rather than investing solely in regional facilities – is the best way to ensure quality services reach remote and underserved groups. |
| Integrated community case management (ICCM), is a strategy that aims to extend services beyond health facilities, by identifying and training community health workers who can deliver quality care closer to home. This proximity enables treatment to be provided within a crucial 24-hour window and is already proving invaluable to communities . A 2007 World Health Organisation report on the home management of malaria in four African countries found that in Ghana 92% of carers of sick children sought treatment from community-based agents – most within 24 hours of the onset of fever. | Integrated community case management (ICCM), is a strategy that aims to extend services beyond health facilities, by identifying and training community health workers who can deliver quality care closer to home. This proximity enables treatment to be provided within a crucial 24-hour window and is already proving invaluable to communities . A 2007 World Health Organisation report on the home management of malaria in four African countries found that in Ghana 92% of carers of sick children sought treatment from community-based agents – most within 24 hours of the onset of fever. |
| Despite the signs of success, ICCM is not without its risks and challenges. First there is the challenge of designing a programme that reflects the cultural and social context of each community. Then there is a logistics and information challenge, developing a supply chain that ensures the flow of medicines and equipment is adequate and uninterrupted. To bring the nuts and bolts of the approach to life, well-trained and supervised community health workers have to be identified, recruited, motivated and retained. | Despite the signs of success, ICCM is not without its risks and challenges. First there is the challenge of designing a programme that reflects the cultural and social context of each community. Then there is a logistics and information challenge, developing a supply chain that ensures the flow of medicines and equipment is adequate and uninterrupted. To bring the nuts and bolts of the approach to life, well-trained and supervised community health workers have to be identified, recruited, motivated and retained. |
| So is ICCM worth the investment? How can its unique features be specifically geared towards reducing child mortality? What can be learned from existing programmes about how to take scale up these initiatives and integrate them into existing healthcare systems? | So is ICCM worth the investment? How can its unique features be specifically geared towards reducing child mortality? What can be learned from existing programmes about how to take scale up these initiatives and integrate them into existing healthcare systems? |
| Finally, just how sustainable is an approach that relies on volunteer health workers? | Finally, just how sustainable is an approach that relies on volunteer health workers? |
| Join our expert panel on Thursday, 12 September from 1-3pm BST to share your experiences and knowledge of community-based child healthcare services. | Join our expert panel on Thursday, 12 September from 1-3pm BST to share your experiences and knowledge of community-based child healthcare services. |
| The live chat is not video or audio-enabled but will take place in the comments section (below). If you are unable to get online on Thursday, email your views to globaldevpros@theguardian.com or follow our tweets using the hashtag #globaldevlive | The live chat is not video or audio-enabled but will take place in the comments section (below). If you are unable to get online on Thursday, email your views to globaldevpros@theguardian.com or follow our tweets using the hashtag #globaldevlive |
| Panel | Panel |
| Emanuele Capobianco, chief of health and nutrition, Unicef Mozambique, Maputo, Mozambique. @ecapobianco Emanuele trained as a doctor and specialised in public health in low-income countries at the Johns Hopkins School of Public Health. He has worked with Unicef, the World Bank and the World Health Organisation in Africa, South Asia and in the Middle East. | Emanuele Capobianco, chief of health and nutrition, Unicef Mozambique, Maputo, Mozambique. @ecapobianco Emanuele trained as a doctor and specialised in public health in low-income countries at the Johns Hopkins School of Public Health. He has worked with Unicef, the World Bank and the World Health Organisation in Africa, South Asia and in the Middle East. |
| Helen Counihan, public health specialist, Malaria Consortium, London, UK. @fightingmalaria Helen specialises in community health service delivery, diagnostics and operational research. For the past four years she worked as the regional coordinator of an integrated community case management programme implemented in four African countries. | Helen Counihan, public health specialist, Malaria Consortium, London, UK. @fightingmalaria Helen specialises in community health service delivery, diagnostics and operational research. For the past four years she worked as the regional coordinator of an integrated community case management programme implemented in four African countries. |
| Margaret Njenga, national health coordinator, World Vision Nairobi, Kenya. @MaggieLelo Margaret is a doctor with expertise in public health and extensive experience working with poor communities in marginalised areas of Kenya. She influences national policy in maternal and child health as a member of the national child health inter-coordinating committee. | Margaret Njenga, national health coordinator, World Vision Nairobi, Kenya. @MaggieLelo Margaret is a doctor with expertise in public health and extensive experience working with poor communities in marginalised areas of Kenya. She influences national policy in maternal and child health as a member of the national child health inter-coordinating committee. |
| Ciro Franco, global technical lead on maternal, newborn, and child health, Management Sciences for Health (MSH), Arlington, USA. @MSHHealthImpact Ciro is a physician with 20 years of experience in providing technical assistance to child survival programs in sub-Saharan Africa, including through USAid's basic support for institutionalising child survival and accelerating the reduction of malaria morbidity and mortality programmes. | Ciro Franco, global technical lead on maternal, newborn, and child health, Management Sciences for Health (MSH), Arlington, USA. @MSHHealthImpact Ciro is a physician with 20 years of experience in providing technical assistance to child survival programs in sub-Saharan Africa, including through USAid's basic support for institutionalising child survival and accelerating the reduction of malaria morbidity and mortality programmes. |
| David Mukanga, programme officer, Bill and Melinda Gates Foundation, Seattle, US. David Mukanga is a Gates global health fellow and program officer. At the foundation, David works within the pneumonia programme strategy team. David has been involved in a range of studies mainly in the areas of immunisation, childhood malaria and pneumonia, and health systems. | David Mukanga, programme officer, Bill and Melinda Gates Foundation, Seattle, US. David Mukanga is a Gates global health fellow and program officer. At the foundation, David works within the pneumonia programme strategy team. David has been involved in a range of studies mainly in the areas of immunisation, childhood malaria and pneumonia, and health systems. |
| Atilio Rivera-Vasquez, public health advisor, International Medical Corps UK, Washington DC, USA. @IntMedCorps_UK Atilio focuses on maternal and child health, supporting the development of health programme design, planning, implementation and monitoring. Prior to this he was International Medical Corps medical director in Afghanistan. | Atilio Rivera-Vasquez, public health advisor, International Medical Corps UK, Washington DC, USA. @IntMedCorps_UK Atilio focuses on maternal and child health, supporting the development of health programme design, planning, implementation and monitoring. Prior to this he was International Medical Corps medical director in Afghanistan. |
| Franco Pagnoni, medical officer, Global Malaria Programme, World Health Organisation, Geneva, Switzerland. @WHO Franco specialises in tropical and community medicine in developing countries. He has worked for over 20 years in Africa as head of several public health projects. He joined the WHO Global Malaria Programme in June 2012 to work on integrated community case management of malaria, pneumonia and diarrhea. | Franco Pagnoni, medical officer, Global Malaria Programme, World Health Organisation, Geneva, Switzerland. @WHO Franco specialises in tropical and community medicine in developing countries. He has worked for over 20 years in Africa as head of several public health projects. He joined the WHO Global Malaria Programme in June 2012 to work on integrated community case management of malaria, pneumonia and diarrhea. |
| Tamara Bugembe, paediatric registrar and founder of African Child Health, Liverpool, UK. @tbugembe Tamara Bugembe is a paediatric registrar who recently worked as a paediatrician in a district general hospital in Cameroon. She is interested in connecting clinical paediatricians to research happening in Africa through collating publications on her blog African Child Health. | Tamara Bugembe, paediatric registrar and founder of African Child Health, Liverpool, UK. @tbugembe Tamara Bugembe is a paediatric registrar who recently worked as a paediatrician in a district general hospital in Cameroon. She is interested in connecting clinical paediatricians to research happening in Africa through collating publications on her blog African Child Health. |
| Seyi Soremekun, epidemiologist and technical advisor for the InScale Project, London School of Hygiene and Tropical Medicine, London, UK. @SeyiSoremekun Seyi is currently responsible for evaluating and providing technical input for two large ICCM-based trials in Mozambique and Uganda. The trials aim to use innovative methods to improve the motivation and retention of community health workers. | Seyi Soremekun, epidemiologist and technical advisor for the InScale Project, London School of Hygiene and Tropical Medicine, London, UK. @SeyiSoremekun Seyi is currently responsible for evaluating and providing technical input for two large ICCM-based trials in Mozambique and Uganda. The trials aim to use innovative methods to improve the motivation and retention of community health workers. |
| Christopher Hedrick, coordinator, Stomping out malaria in Africa, Peace Corps, Dakar, Senegal. @hedrickchris Chris leads the Peace Corps malaria prevention initiative in 23 African countries and serves as Peace Corps director in Senegal. Stomping out malaria in Africa engages more than 3,000 American Peace Corps volunteers in malaria prevention and treatment seeking efforts. | Christopher Hedrick, coordinator, Stomping out malaria in Africa, Peace Corps, Dakar, Senegal. @hedrickchris Chris leads the Peace Corps malaria prevention initiative in 23 African countries and serves as Peace Corps director in Senegal. Stomping out malaria in Africa engages more than 3,000 American Peace Corps volunteers in malaria prevention and treatment seeking efforts. |