By Anna Bryant, MCSP
In 2009, global partners (USAID through the Maternal and Child Health Integrated Program [MCHIP] Kenya project, WHO and UNICEF) started supporting the Division of Family Health (DFH) in advocacy efforts to achieve MDGs 4 and 5 (to improve maternal health). As part of the technical support, MCHIP provided direct support to the Neonatal, Child, and Adolescent Unit (NCAU) within the DFH mainly to facilitate advocacy for iCCM policy change.
Cyprose Atieno lives in Otuoma Village of Nyaguda village. When her young daughter, Auma, is ill with fever or diarrhea she has to travel more than 7 km from the nearest health facility which is only open during the day. Many caregivers must travel long distances to health facilities to receive treatment for their children with illnesses like pneumonia, diarrhea and malaria. Additionally, in Kenya and many other countries with high mortality rates, facilities alone cannot provide access to treatment within the critical window of 24 hours after onset of symptoms.
Despite efforts to combat child mortality in Kenya, there is still much progress to be made to attain Millennium Development Goal (MDG) 4; to reduce the under-five mortality rate by two thirds between 1990 and 2015. By 2012, the under-five mortality rate in Kenya decreased to 73 per 1,000 live births — this was still remarkably high and well below the MDG 4 target of 33 per 1,000 live births by 2015 for Kenya. The Kenyan Ministries of Health recognized the urgent need to fill this gap in treatment for the leading causes of under-five mortality: pneumonia, malaria and diarrheal disease.
On Monday, February 23rd, iCCM (integrated Community Case Management) officially became part of an integrated package of interventions to combat childhood morbidity and mortality in Kenya. iCCM strategy was initiated by WHO and UNICEF in 2004 to provide timely access to diagnostics and treatment of pneumonia, malaria, diarrhea, neonatal diseases and malnutrition among children at the community level, especially in hard-to-reach areas. As part of the strategy, Community Health Workers (CHWs) are trained to identify and treat childhood illness. Elizabeth Olang’o, a Community Health Extension Worker in Nyaguda CU notes, “We’ve really achieved much in early detection of childhood illnesses. The CHWs are doing prompt testing, prompt treatment, and prompt referrals which used to not be there before.”
The official event of iCCM release in Nairobi, Kenya was officiated by the Cabinet Minister for Health. It was attended by high-level officials and minsters of health and county health management teams and county ministers. On display were the various iCCM policy materials, tools and job aids. The strategy was well-received by county ministers who were optimistic that the strategy would help reduce infant and child morbidity in remote rural areas.
At the community level, the introduction of iCCM in Kenya has been met with appreciation and enthusiasm. Cyprose Atieno, who received care for her child from CHW Millicent Nyawara, said, “My son is well now and I had no need to go far. I am very grateful to the CHV.”
Kenya’s success in implementing iCCM is a model for other countries looking to accelerate progress towards ending preventable child deaths. Community-level advances like these will help Kenya achieve MDG 4 and save thousands of lives in the future.
To provide local evidence to guide policy change, MCHIP/Maternal and Child Survival Program (MCSP) is implementing an iCCM feasibility study in Bondo district from December 2013 to June 2015. The objective of the study to test the feasibility of implementing iCCM using the current Kenya Community health platform. The midline assessment showed a more than 100% increase in care seeking and use of treatment for diarrhea, malaria pneumonia in the intervention area; acceptable competence levels for CHVs to manage iCCM conditions and community support for the intervention.
Learn more about Integrated Community Case Management (iCCM) in Bondo Sub County, Kenya via this video: