WHO’s Rapid Access Expansion (RAcE) programme, which has been supporting ministries of health in sub-Saharan Africa to scale up a package of health interventions for child survival, held its first international Best Practices and Policy Meeting from 9–13 February 2015 in Lilongwe, Malawi.
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Prisca Laimani, the mother of a baby girl with a fever and a cough, holds the medicines her child needs after a visit to the Matapila village clinic in Ntcheu District, Malawi. The community health worker there has been supported by the RAcE 2015 project to provide iCCM services.
WHO / Amos Gumulira
The RAcE programme aims to tackle pneumonia, diarrhoea, malaria and malnutrition – the leading killers of children under age 5 in sub-Saharan Africa – with a proven and cost-effective solution: a community health worker stationed in each village, trained and equipped to appropriately diagnose, treat and refer the children who suffer from these illnesses. This approach, known as the integrated community case management of childhood diseases, or iCCM, has been shown to save lives and is gaining traction across sub-Saharan Africa. In 2012, Canada awarded WHO’s Global Malaria Programme a 5-year grant to roll out iCCM in the Democratic Republic of the Congo, Malawi, Mozambique, Niger and Nigeria.
Seventy-two participants from RAcE Programme teams in the 5 implementing countries, comprised of international nongovernmental organizations, WHO staff at all levels of the Organization, and government officials, came to Lilongwe to share successes and lessons learned in managing the rollout of this child survival programme, and to identify solutions for sustainability.
RAcE programme covers more than half a million children
RAcE country teams in each country reported concrete results. A total of 648 126 cases of malaria, 403 213 cases of pneumonia, and 255 473 cases of diarrhoea were treated across all implementation sites since the start of the project. The total population covered by the project gradually increased to 657 249 children aged 2 to 59 months by December 2014, indicating that significant progress has been made towards the project goal to cover 1.4 million children by the end of 2017.
"Funds made available for the RAcE project have already allowed more than half a million children living in remote areas of sub-Saharan Africa to access life-saving health services."
- Ms Maria C Ramirez Serrano, Policy analyst at the Canadian Department of Foreign Affairs, Trade and Development
Said Ms Maria C Ramirez Serrano, Policy analyst at the Canadian Department of Foreign Affairs, Trade and Development: “The Canadian Government is delighted to learn that the funds it has made available for the RAcE project have already allowed more than half a million children living in remote areas of sub-Saharan Africa to access life-saving health services. The RAcE programme has been helping to meet the promises of Canada’s Muskoka initiative, by saving lives, securing futures, and building more equitable societies”.
Dr Franco Pagnoni, team leader of the RAcE project based at WHO’s Global Malaria Programme, stated: “Much of the increase in intervention coverage could not have happened without the leadership and vision of the ministries of health, who effected a series of significant iCCM-friendly policy changes, after continual interactions with, and support from, experts from implementing nongovernmental organizations and technical staff at all levels of the World Health Organization ”.
A ‘learning’ approach for better results
In the spirit of the reflective and adaptive nature of the project, participants visited villages in Malawi where iCCM services are provided, so they can witness first-hand the opportunities and operational challenges involved in iCCM programme roll out. The next day, at the plenary sessions, they had thoughtful discussions about country-specific problems and possible solutions.
Dr Abosede Remilekun Adeniran, Director of the Child Health Department of Family Health at the Federal Ministry of Health in Abuja, Nigeria, exclaimed: “We are learning a lot. Much of what we are seeing in Malawi can be adapted to the Nigerian iCCM experience. Examples include the strong community mobilization component and the mhealth application which is a telephone application that facilitates the health worker’s adherence to protocol and reporting to central authorities, which can help improve quality of care, data quality, and health information systems”.
Mr Davies Kapota, the focal point in Lilongwe for the Integrated Management of Childhood Illness at the Ministry of Health, explained that strengthened community mobilization may help to retain and increase the motivation of community health workers: “One of the important challenges in Malawi is that the community health workers often do not have proper housing, and therefore cannot reside in their catchment areas. So the communities in Malawi have been sensitized to this problem; and they have been moulding bricks and building houses for the health workers. When communities actively support community health workers in this manner, we find they tend to remain in their catchment area”.
The project has also been examining the modalities and impact of supervision. Said Tiyese Chimuna, Child Health and Nutrition Advisor at Save the Children Malawi, “The project is helping us to gather valuable lessons on supervision and its critical importance to all aspects of implementation: quality of service, health worker motivation, systematic reporting, data quality, and even commodity availability”.
Information and evidence for sustainability
The sustainability of funding and programmes was an important topic of discussion at the meeting. WHO will support RAcE country teams develop strategies to hand over the programme to the ministries of health.
Dr Mahamadou Idrissa Maïga, Secrétaire Général of the Ministry of Health in Niger, highlighted the urgency of having well-planned sustainability strategies: “We have made progress in the fight against these preventable and treatable diseases that account for more than half of the 3.2 million annual child deaths in the region. It would be scandalous to stop these programmes when the funding ends. RAcE programme countries will work with their partners to secure the momentum and continue saving children’s lives”.
"RAcE programme countries will work with their partners to secure the momentum and continue saving children’s lives."
- Dr Mahamadou Idrissa Maïga, Secrétaire Général of the Ministry of Health in Niger
Follow-up actions to the meeting included accelerating efforts to reach RAcE coverage targets, intensifying advocacy efforts for policy change and increased funding, ensuring iCCM appears in national health strategies and budgets, and sharing operational lessons learned, evidence of impact, and working tools across all project sites.
This RAcE Best Practices and Policy meeting can be seen as an important first step in an information gathering and learning process, aimed at supporting and catalysing the scale-up of iCCM in these 5 project countries and across sub-Saharan Africa.