A CHW in Tanzania draws a feverish baby’s blood for a malaria rapid diagnostic test. Photo by Zina Jarrah, courtesy of MSH.


iCCM was developed in large part to provide hard-to-reach communities with better access and availability to health services because barriers such as geography, language differences, and temporal events prevent them from visiting a health care facility. However, there must be a balance between implementing iCCM in extremely low-access
communities and in reaching the largest population in need. Referral systems are inherently tied with service delivery for those occasions where severely ill children need special services or treatment only provided at a health facility. Referral systems should ideally complement iCCM in the community, be supported by the health system, and be managed and implemented by community resources. They entail multiple actions by the community health worker, since verbal referral and/or referral slips do not do enough to ensure the child receives the treatment they need.


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