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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