In 2012, the Government of Canada awarded a grant to the WHO Global Malaria Programme to support the scale-up of integrated community case management (iCCM) of pneumonia, diarrhoea and malaria among children under 5 in sub-Saharan Africa. Through the Rapid Access Expansion Programme (RAcE), WHO awarded implementation funding to nongovernmental organizations, selected through a competitive process.
The Programme took place in 5 malaria-endemic countries, with the support of selected partners:
- Democratic Republic of the Congo (International Rescue Committee)
- Malawi (Save the Children)
- Mozambique (Save the Children)
- Niger (World Vision)
- Nigeria (Malaria Consortium and Society for Family Health)
Programme objectives
The Programme’s first objective was to contribute to the reduction of child mortality due to malaria, pneumonia and diarrhoea by increasing access to diagnostics, treatment and referral services for these diseases. The aim, initially focused on the Millennium Development Goals (now Sustainable Development Goals), was to accelerate progress towards the post-2015 health and development agenda.
The Programme’s second objective was to generate evidence to inform WHO policy recommendations and programmatic guidance on iCCM. As part of final reporting and sustainability activities, partners are reviewing lessons learned and sharing experiences to identify best practices for the scale-up of iCCM programmes across sub-Saharan Africa. The Programme served as a foundation for a comprehensive policy review on case management in the five target countries, and a review of WHO policy guidance on the subject. The RAcE team in each programme country created a roadmap to sustain the achievements.
Programme results
RAcE partnerships, initiated and facilitated by WHO, had the following results:
- RAcE partners have given logistical, technical and financial support to implementing countries for iCCM scale-up. As a result, nearly 1.5 million children under 5 were diagnosed and treated for more than 8.2 million episodes of malaria, pneumonia and diarrhoea in RAcE-supported sites between 2013 and 2017. Each country also has updated their national policies to facilitate iCCM scale-up.
- RAcE partners generated solid evidence on iCCM programme implementation through research on supervision, motivation of community health workers, quality of care, supply chain management, and the use of innovative tools such as mobile phone applications.
- RAcE partners worked with implementing countries to strengthen in-country systems for monitoring and evaluating iCCM. ICF International supported monitoring and evaluation efforts in all RAcE programme areas.
- WHO, RAcE partners and ICF International facilitated ownership and sustainability plans to hand over the programme to implementing countries and minimize the risk that iCCM services would be interrupted when project funding ended.
The RAcE team has trained 8420 community health workers to deliver iCCM services in the 5 countries where the Programme was implemented. Ministries of health now have evidence-based policy solutions, operational guidance for iCCM scale-up, as well as better systems for measuring the performance of their iCCM programmes, and plans are underway in programme countries to scale up iCCM beyond initial districts and provinces.
Governance and project oversight
The RAcE Programme was governed by an international steering group, which provided general oversight to the WHO Global Malaria Programme to help improve the relevance, impact and sustainability of the Programme. A project review panel reviewed grant applications from nongovernmental organizations and made recommendations to WHO for initial selection of implementing partners and renewal of funding.